Obstetrics and Gynaecology Communications
Three-pronged Strategy to Prevent MTCT of HIV
Introduction
HIV Screening in a Rural Antenatal Clinic
Introduction
The acquired immunodeficiency syndrome (AIDS) epidemic has proved to be a major stumbling block in achieving health improvements in many regions. In the developing world, it is estimated that 2.5 million HIV-infected women give birth each year1 with the risk of maternal-child transmission of the infection a real concern. The aims of the current study were:
Vaginal Infections - A Pathological Appraisal
Summary
Cytology plays a major role in screening for vaginal infections.
In addition to the Papanicolaou (Pap) stain, Gram's stain, periodic acid-Schiff (PAS) stain, acid-fast bacilli (AFB) stain, and fungus stain are helpful in identifying the aetiologic agent.
When the patient does not respond to standard treatment, unusual causes of vaginitis should be considered.
Prevention of Maternal-Child HIV Transmission
Summary
- Acquired immune deficiency syndrome (AIDS) has already doubled infant mortality in countries worst affected and is a growing problem in India and south-east Asia.
- Human immunodeficiency virus type 1 (HIV-1) the aetiological agent of AIDS can be vertically transmitted during pregnancy, childbirth, or breastfeeding.
- Key preventive strategies include family planning services for HIV-infected women as well as reducing transmission risk factors such as maternal vitamin A deficiency.
Bacterial Vaginosis
Summary
- Bacterial vaginosis (BV) is characterised by anaerobic bacterial overgrowth of the vaginal flora, but the exact aetiology and pathogenesis remain unclear.
- BV is associated with complications during pregnancy including chorioamnionitis, premature rupture of the membranes (PROM), and preterm labour and delivery, as well as with post-hysterectomy vaginal cuff cellulitis.
- Oral metronidazole remains the treatment of choice, although recurrences and relapses of infection are common.
Editor's Comment
HIV/AIDS and the Asian Woman
Introduction
AIDS is a dreaded disease because it is a life-long infection for which there is curently no cure or vaccine. The virus which causes AIDS can be spread by asymptomatic 'carriers', of which there are an estimated 50-100 for every known AIDS patient. Thus, this 'hidden epidemic' puts considerable stress on the economic and social fabric of any country affected.
This two-part article focuses on HIV/AIDS from the perspective of the Asian woman: part I covers the epidemiological and social issues, and part II the obstetric and gynaecological issues.
TOC - Volume 2, Issue 5
Editorial
HIV/AIDS and the Asian woman
Dr Manju Purohit
Feature Articles
Bacterial vaginosis
Dadhawal V
Prevention of maternal-child HIV transmission
Patel AK
Vaginal infections a pathological appraisal
Kumar KR
Clinical Communiques
HIV screening in a rural antenatal clinic
Doshi S
Three-pronged strategy to prevent MTCT of HIV
Damania KR, Merchant RH, Karkare J
Images in Obs&Gyn
Chlamydia trachomatis infection
Dr Susan Bagshaw
Managing Menopause
Recurrent UTIs and oestrogen replacement
Sinha R
Pause for Pregnancy
The Endometriosis Association - India Network
If you would like to help women with endometriosis, please contact the Endometriosis Association with your ideas, questions, or purely for support. Doctors, women's health groups, women with endometriosis, and any other interested party are very welcome to contact the Endometriosis Association for free brochures in Hindi to distribute to health centres, hospitals, and pharmacies, or for their own use. The representatives are:
India
Dr Siya S. Sharma
Assistant Professor and Consultant Obstetrician and Gynaecologist
Sita Bari, Near Airport
Endosonography in Obstetrics and Gynaecology
It may be time to consider routine use of endovaginal ultrasonography, as this diagnostic tool picks up many abnormalities the bimanual exam misses. In her study of 633 premenopausal women, Dr M. Lynee Reuss of Bellvue Women's Hospital in Niskayuna, New York, reported that bimanual exams missed 36% of fibroids and 70% of abnormalities in the corresponding adnexa that were later detected by ultrasound.1 Ultrasound was also useful in distinguishing uterine from adnexal masses, she noted.
Acute Respiratory Failure in Pregnancy
Key Points
- Acute respiratory failure (ARF) is an important cause of maternal and foetal morbidity and mortality.
- Knowledge of normal maternal-foetal physiology and determinants of foetal oxygen delivery (i.e. uterine blood flow, placental transfer, foetal circulation) can help sustain normal foetal development, usually without compromising maternal care.
- Treatment of ARF in pregnancy is largely supportive, including mechanical ventilation, haemodynamic support, nutrition, and prophylaxis against thromboembolism.
Constipation and Vomiting in Pregnancy
Introduction
Constipation is a normal physiological change occurring in pregnancy, presumably as a result of altered progesterone and oestrogen levels which decrease intestinal transit. Nausea and vomiting are prominent symptoms in patients with disordered gastrointestinal motility.
Patients and Procedures
Postpartum Pulmonary Embolism
Department of Cardiology, I.G. Medical College, Shimla, India
Summary
- Women have a higher risk of pulmonary embolism (PE) in comparison to men.
- Thrombolytic therapy is more effective than heparin in producing rapid lysis of emboli, but is less cost-effective.
- Heparin is more effective as a preventive measure against recurrent PE than as a treatment for an acute event.
- Echocardiography is a useful technique for identifying right ventricular overload following PE.
Editor's Comment
Contraceptive Knowledge and Use: A Survey of New Delhi Women
Suneeta Mittal (Professor)
P. N. Anandalakshmy (Additional Professor)
M. Lakhatia (Research Officer)
Department of Obstetrics and Gynaecology*, Department of Statistics and Demography**, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Summary
- Two thousand women of reproductive age were interviewed regarding their contraceptive behaviour.
- Of the married women participating in the survey, very few used any form of contraception for the first 2 years of marriage, or immediately postpartum.
Surgery for Recurrent Cervical Carcinoma
Andreas J. Papadopoulos (Subspecialty Fellow)
Omer Devaja (Subspecialty Fellow)
Rahul Nath (Research Registrar)
George D. Wilbanks (Visiting Professor)
K. Shanti Raju (Consultant and Director of Department)
Department of Gynaecological Oncology, Guy's and St Thomas' Hospital NHS Trust, London, England
Summary
- Recurrent disease occurs in approximately 35% of cervical cancer cases.
- Evaluation of the patient includes assessing the extent of disease and performance status for surgery.
Should Ultrasound Scanning in Pregnancy be Performed by Indication Only?
Key Points
- There is little scientific support for routine foetal anomaly scanning using ultrasound.
- Detection of foetal abnormalities during the second trimester depends in part on the sonographer having sufficient time (and skill) to examine the foetus in detail.
- Compared with routine scanning, there are several advantages to select screening of women identified by other prenatal tests as having risk factors for foetal abnormalities.
- Serious consideration should now be given to a selective screening policy.