Current Women's Health Reviews

ISSN: 1573-4048

Current Women’s Health Reviews
Volume 3, Number 1, February 2007

Contents


Editorial Pp. 1


Anti-Shock Garments for Obstetric Hemorrhage Pp. 3-11
Suellen Miller, Aderinola Ojengbede, Janet Turan, Oladosu Ojengbede, Elizabeth Butrick and Paul Hensleigh
[Abstract] [Full text article]


Maternal Stress / Distress and Low Birth Weight, Preterm Birth and Intrauterine Growth Restriction - A Review Pp. 13-29
Patricia H.C. Rondó
[Abstract] [Full text article]


Insight of Women’s Sexual Function and Intimate Relationships After Termination of Pregnancy: A Review on Recent Findings and Future Perspectives Pp. 31-41
Francesco Bianchi-Demicheli and Stephanie Ortigue
[Abstract] [Full text article]


Attitudes of Infertile Couples to a Multiple Birth: A Review of the Literature and Results from a Survey Pp. 43-48
Christine Glazebrook, Charlotte Sheard, Laura Winstanley, Sara Cox and George Ndukwe
[Abstract] [Full text article]


Ovarian Hyperstimulation Syndrome: The Best Approaches for Prevention and Treatment: A Mini-Review Pp. 49-54
Massimo Manno, Francesco Tomei, Alessandro Fasciani and Mauro Costa
[Abstract] [Full text article]


Pelvic Floor Muscle Training During Pregnancy and After Delivery Pp. 55-62
Siv Mørkved
[Abstract] [Full text article]


Ovarian Ageing and Fertility - Review Pp. 63-67
Abha Maheshwari and Siladitya Bhattacharya
[Abstract] [Full text article]


The Dynamics of the Hypothalamic-Pituitary-Ovarian Axis, Reproductive Performance and Sexuality Following Bariatric Surgery Pp. 69-76
Zaher Merhi and Lubna Pal
[Abstract] [Full text article]


Local Physiological Regulation and Modern Treatments in Gynaecology Pp. 77-78
Niels Einer-Jensen, Ronald H.F. Hunter and Ettore Cicinelli
[Abstract] [Full text article]




Abstracts

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EDITORIAL

Involvement of Women in their Care and the Search for Research Ideas

All those inspiring to provide a better health to women should aim at the different options open to obtain better outcomes and also to counter health inequities.

To achieve this aim, innovative approaches based on the culture and conditions of the target population are needed. Biological science should be closely linked to social science in the search of plausible interventions to improve health in the myriad of situations of the world. Also, the knowledge of the local situation is mandatory to orient the focus of research and interventions.

Two articles of this issue highlight that it is not only the biological outcome but also the satisfactory care that needs to be considered regarding issues related to women health. We need to address women expectations about care and also share with them, the limitations of the diagnostic and prognostic tools used in care as well as the concept of diversity on responses to interventions and their potential side effects.

A review by Manno et al. clearly shows the problem of ovarian hyperstimulation as a consequence of fertility treatments.

Another review by Miller et al. addresses an innovative approach to treat maternal haemorrhage, a pneumatic garment that can be used at every level of care. Maternal haemorrhage particularly postpartum, is a major contributor of maternal death. We are eager to see the results of trials testing such approach that could imply a significant contribution on the decrease of global maternal mortality.


José M. Belizán
(Editor-in-Chief)
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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Anti-Shock Garments for Obstetric Hemorrhage
Suellen Miller, Aderinola Ojengbede, Janet Turan, Oladosu Ojengbede, Elizabeth Butrick and Paul Hensleigh

[Full text article]

Annually, over 500,000 women die from complications of pregnancy and childbirth; the majority die from hemorrhage and shock. Obstetrical hemorrhage of all etiologies, such as uterine atony, ruptured uterus, and ruptured ectopic, can cause massive blood loss resulting in severe shock. Unless women can access fluid replacement, blood transfusions, and, often, surgery, the shock leads to organ failure and death. Therefore, the majority of maternal hemorrhage deaths occur in developing countries. The non-pneumatic anti-shock garment (NASG) is a light-weight, reusable, neoprene and Velcro compression device that can be rapidly applied to a hemorrhaging woman to shunt blood from the lower extremities to the core organs, heart, lung and brain, and to decrease blood loss. We review literature on the history, mechanisms of action, and use of Anti-Shock Garments (ASGs) in emergency medicine, focusing on the use of inflatable or Pneumatic ASGs (PASGs) for obstetrical, gynecological, and urological hemorrhage. We describe similarities and differences between the PASG and the newer NASG. We then review recent studies on the NASG for obstetrical hemorrhage in Pakistan, Nigeria, and Egypt, and conclude with recommendations for the types of research necessary to bring the NASG into wider use.


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Maternal Stress / Distress and Low Birth Weight, Preterm Birth and Intrauterine Growth Restriction - A Review
Patricia H.C. Rondó

[Full text article]

In this article a PubMed (www.ncbi.nlm.nih.gov/entrez), ISI Web of Science (www.isinet.com/isi) and Lilacs (www.bireme.br) literature review was carried out from 1986 to 2005, to search for publications which assessed the associations between maternal stress/distress and low birth weight (LBW), preterm birth and intrauterine growth restriction (IUGR). The studies investigated have yielded different results. The reasons are probably related to the terminology of stress and distress (not yet standardized); utilization of different instruments and populations to evaluate these psychological disorders; the fact that a considerable percentage of the studies did not use adequate sample sizes, and that some of them were retrospective in design. The impact of stress/distress on preterm birth and LBW seems to be more important than its impact on IUGR. According to the majority of the studies assessed in this review, women exposed to acute stress in early pregnancy and to distress (anxiety, depression, etc) in late pregnancy are at significantly increased risk of shortened gestation. In conclusion, interventions to prevent stress/distress have to start before conception. Appropriate programmes should be carried out to address the origins and effects of stress/distress to pregnant women, to implement relevant preventive interventions.


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Insight of Women’s Sexual Function and Intimate Relationships After Termination of Pregnancy: A Review on Recent Findings and Future Perspectives
Francesco Bianchi-Demicheli and Stephanie Ortigue

[Full text article]

Introduction: Controversy exists over psychological risks associated with termination of pregnancy (TOP). Although some studies recently shed some lights on the consequences of TOP on women’s emotions and mental health, the positive and negative psychological and psychiatric impacts of TOP on sexual psychodynamic and intimate relationships have been poorly investigated.

Objective: The objective of this article is to review the studies focusing on women's sexual function and intimate relationships after TOP.

Methods: A systematic search of the literature was performed. Studies had to have a quantitative or qualitative evaluation of sexuality after TOP.

Results: Fourteen studies were included. Sexual dysfunctions were reported in up to 30% after TOP. Women undergoing a TOP had significantly more conflicts in their partnerships. This was similar in all studies. Separation occurred in about one quarter of all couples. Nevertheless, long-term effects of TOP on sexual function were less frequent than short-term impacts.

Discussion: Some studies show an increase in sexual dysfunction after TOP. Nevertheless, follow-up studies show that persisting negative impacts of TOP on sexual function and intimate relationships are rare. In about half of the couples separated after a TOP, TOP seemed not to have directly led to the separation. Rather, psychological factors, together with intimate relationship problems might have played a role in failed contraception. Sexual response is psychosomatic and so often difficult to understand. A detailed exam is thus needed before and after TOP in order to establish the importance of either its organic or psychological factors.


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Attitudes of Infertile Couples to a Multiple Birth: A Review of the Literature and Results from a Survey
Christine Glazebrook, Charlotte Sheard, Laura Winstanley, Sara Cox and George Ndukwe

[Full text article]

Background: Although multiple births are associated with poorer clinical and psychological outcomes, there is a perception that couples choose multiple embryo transfer because they would prefer a multiple IVF birth.

Objective: To review literature concerning the attitudes of infertile couples to a multiple birth and to explore factors influencing couples’ decisions about embryo transfer.

Methods: Thirteen research articles were identified in the medical literature that examined women’s choices concerning multiple IVF pregnancies. A cross-sectional survey was conducted at one centre for the treatment of infertility in the East Midlands, UK. Sixty-eight couples undergoing in-vitro fertilisation (IVF) with at least two embryos available for transfer were recruited to the study. Outcome measures were couples’ ratings of factors influencing the number of embryos transferred.

Results: Eight of the 13 studies found couples favouring a multiple birth to be in the majority. Most studies, however, had required hypothetical or retrospective judgments. In the present survey no patient had chosen single embryo transfer (SET), 56 (76%) had had 2 embryos transferred and 16 (24%) had 3 embryos transferred. Patients strongly perceived that SET would reduce the chances of having a child. Only 13 women (19.1%) considered that a desire for twins had influenced their decision. Of more importance was the desire to increase the chance of pregnancy (92.7%), the medical advice received (91%) and a desire to avoid further treatment (57.3%). The majority of couples found the decision regarding embryo transfer easy but a third would have liked more information. Participants with children were less likely to report a desire for twins (p<0.06) but other demographic factors had no influence.

Conclusions: Although the literature has suggested that infertile couples have strongly positive attitudes to multiple pregnancies, most patients are not seeking a twin birth when they choose multiple embryo transfer and physicians have an important role to play in helping patients make informed decisions.


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Ovarian Hyperstimulation Syndrome: The Best Approaches for Prevention and Treatment: A Mini-Review
Massimo Manno, Francesco Tomei, Alessandro Fasciani and Mauro Costa

[Full text article]

Ovarian hyperstimulation syndrome (OHSS) is the most serious iatrogenic disorder resulting from ovarian stimulation during assisted reproductive techniques (ARTs). It can result in renal failure, thromboembolic phenomena, adult respiratory distress syndrome and, occasionally, death. Almost all previous preventive strategies resulted ineffective.

Vascular Endothelial Growth Factor (VEGF) plays a pivotal role in the pathophysiology of this syndrome so VEGF antagonism has been suggested for OHSS prevention. Since VEGF is also a physiological regulator of folliculogenesis, progesterone secretion and endometrial angiogenesis, its complete inactivation by monoclonal antibodies could produce potential undesirable effects. Administration of Human Chorionic Gonadotropin (HCG) stimulation of VEGF production is fatal for the developing of OHSS; the use of GnRH agonist instead of HCG for ovulation triggering, is a promising strategy. Recently dopamine D2 agonists have been shown to counteract VEGF induced vascular permeability. The lack of toxic or teratogenic effects could make cabergoline an effective and safe aetiological approach for OHSS prevention/treatment. A recent meta-analysis has indicated that the administration of metformin significantly prevents OHSS development in polycystic ovary syndrome, an high risk group.

In the light of these new studies we believe that recent guidelines on OHSS prevention need a substantial revision.


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Pelvic Floor Muscle Training During Pregnancy and After Delivery
Siv Mørkved

[Full text article]

Objective: Female urinary incontinence is often considered a problem that occurs primarily during pregnancy and after childbirth. The aim of this article is to review the literature addressing pelvic floor muscle training in the prevention and treatment of urinary incontinence during pregnancy and after delivery.

Method: Only full publications of prospective controlled studies were included. Urinary incontinence was the primary outcome variable and pelvic floor muscle training was the main intervention.

Results: Four randomised controlled trials (RCTs) assessing the effect of pelvic floor muscle training during pregnancy were found. Ten articles were identified addressing the effect of pelvic floor muscle training postpartum; seven of these presented RCTs, two presented matched controlled studies and a controlled study. Three were follow-up studies. The interventions included pelvic floor muscle training, however, various training protocols were used. All studies, except for two, reported statistically and clinically significant effects of the interventions, with a significant reduction in symptoms or frequency of urinary incontinence after the intervention period. No adverse effects of the interventions were reported.

Conclusions: This review suggests that women should be encouraged to perform pelvic floor muscle training during pregnancy and postpartum to prevent and/or treat urinary incontinence.


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Ovarian Ageing and Fertility - Review
Abha Maheshwari and Siladitya Bhattacharya

[Full text article]

Declining fertility in women occurs as a result of ovarian ageing - a process associated with a reduction in the number and quality of oocytes. Knowledge of ovarian age is important at a time when many women tend to delay pregnancy and childbirth. As the natural history of ovarian ageing is unknown, it is difficult to predict, prevent or treat this phenomenon. The evaluation of ovarian reserve has been largely restricted to women undergoing assisted reproduction. Hence, the predictive value of some of the commonly used tests, in a general population of women is unknown. In this review we discuss the natural history and the potential causes of ovarian ageing. We also assess available methods of prediction and treatment of this condition including the use of techniques such as in vitro maturation and oocyte cryopreservation.


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The Dynamics of the Hypothalamic-Pituitary-Ovarian Axis, Reproductive Performance and Sexuality Following Bariatric Surgery
Zaher Merhi and Lubna Pal

[Full text article]

Obesity has reached epidemic proportions globally. Multi-system and morbid ramifications of obesity are recognized in both sexes that are at least partly reversible following significant and sustained weight reduction. Bariatric surgery is a relatively recent intervention in the therapeutic armamentarium for the management of morbid obesity and utilization of bariatric surgery as an option for weight loss is escalating.

We provide an overview of the effects of morbid obesity on the hypothalamic-pituitary-ovarian (HPO) axis, reproductive and sexual performance. This review focuses on the alterations in reproductive physiology, with specific regard to the alterations in fertility status, efficacy of oral contraception and sexuality following bariatric surgery. Our perusal of the published literature reveals that although non-surgical weight loss in morbidly obese improves fertility, data on reproductive performance after weight loss by bariatric surgery is sparse and somewhat controversial. In the current setting of an increasing utilization of this therapeutic modality in the reproductive age population, this underscores a need for better appreciation of the alterations in physiology following bariatric surgery by well-designed trials. The suboptimal efficacy of oral contraceptives after weight loss by bariatric surgery needs to be further evaluated and in the interim, when prescribing OCP’s to patients anticipating undergoing bariatric procedures, counseling should include a discussion on potential contraceptive failure after surgery. Although an improvement in sexual performance and satisfaction may follow dramatic weight reductions, the possibility of a detrimental influence specifically after bariatric surgery remains to be determined by future trials.


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Local Physiological Regulation and Modern Treatments in Gynaecology
Niels Einer-Jensen, Ronald H.F. Hunter and Ettore Cicinelli

[Full text article]

A local hormone environment based on local transfer of hormones between adjacent blood vessels is important for the normal function of the genital system. The hormones from a large follicle or a corpus luteum are transferred locally from ovarian venous blood to the ovarian arterial blood, thus the ipsilateral organs (ovary, Fallopian tube, and uterine corner) receive blood with an increased hormonal content compared to that on the contralateral side. Likewise, messenger substances from the uterus and Fallopian tube will reach the ovary through local transfer. A similar system exists with transfer from vagina to uterus and urethra. The system of local transfer can be utilized for local treatments targeted towards the urethra or uterus through drug deposits into the vagina. A small vaginal oestrogen dose will, for example, prevent post-menopausal degenerative changes in the urethra without inducing systemic effects.