Perspectives of intrauterine artificial insemination applicability in gilts / Perspectivas de aplicabilidade da inseminação artificial intrauterina em leitoas

ABSTRACT: The application of the intrauterine artificial insemination (IUAI) technique allows optimization of a swine production system due to the reductions in volume and number of sperm cells in the insemination dose, and by reducing the time taken to perform the insemination. However, IUAI is not recommended for gilts due to the difficulty of intrauterine cannula passage through the cervix. This difficulty is associated mainly with the fact that the reproductive tract is smaller in gilts than in pluriparous females. However, few studies have evaluated the application of IUAI in gilts. In these studies, there are variations in approach concerning the definition of the success rate for cannula passage through the cervix, the type of cannula and the body characteristics of the gilts used, making it difficult to extrapolate the recommendation for the use of IUAI in gilts. Considering the evidence that such characteristics influence or even determine the success of the application of IUAI, there is a necessity for an understanding of the influence of these factors in the improvement and later application of the technique. Gilts represent about 15-20% of the breeding group, and the use of IUAI could optimize the processes of insemination on farms. The approach used in this review highlights the aspects that could aid in structuring further studies for improving IUAI in gilts, allowing its use on commercial farms.

RESUMO: A aplicação da técnica de inseminação artificial intrauterina (IAU) permitiu uma otimização do sistema de produção de suínos por possibilitar a redução do volume e número de células espermáticas na dose inseminante e, também, por diminuir o tempo de execução da inseminação. Porém, a IAU não tem sido recomendada para leitoas devido à dificuldade de passagem do cateter intrauterino através da cérvix. Essa dificuldade é associada principalmente ao menor tamanho do trato reprodutivo de leitoas se comparado ao das fêmeas pluríparas. Entretanto, ainda são poucos os estudos que avaliaram a aplicação de IAU em leitoas. Nesses estudos, existem variações quanto à definição da taxa de sucesso na inserção do cateter através da cérvix, ao tipo de cateter e, também, quanto às características corporais das matrizes utilizadas, dificultando extrapolações de recomendação do uso da IAU em leitoas. Considerando os indícios de que tais características podem influenciar ou, até mesmo, determinar o sucesso de aplicação da técnica, ainda há necessidade de compreender a influência desses fatores para que a técnica possa ser aprimorada e posteriormente aplicada. Leitoas representam cerca de 15 a 20% do grupo de cobertura e viabilizar a IAU nessa categoria pode otimizar os processos de inseminação nas granjas. A abordagem realizada nessa revisão traz aspectos que podem auxiliar na estruturação de futuros estudos para aprimorar a IAU em leitoas e permitir seu emprego em granjas comerciais.

A comparative study of perinatal outcome in primary caesarean in multiparous women to that in nulliparous women

Background: To compare indication, incidence, complication, fetal and maternal morbidity and mortality in primary caesarean section in multiparous women and nulliparous women. Objective of this study was to compare perinatal outcome of caesarean section in multiparous women to that in nulliparous women.Methods: It is a prospective observational study conducted in a tertiary care centre during April 2017 to April 2018. All patients who delivered vaginally and abdominally were noted during study period. All patients undergoing primary caesarean section were noted. Their indication, incidence and complication throughout stay were noted. Statistics were calculated separately for multiparous women and primiparous women. Statistical analysis was done using chi square test.Results: Total 150 primary caesarean section in primiparous women and 100 primary caesarean section in multiparous women were done.  Fetal distress and meconium stained amniotic fluid forms the most common indication in study. Birth weight of babies was more in multiparous women. Need of blood and blood products was more in multiparous women compared to nulliparous women. Complications like postpartum fever and wound gape was more in multiparous women.Conclusions: In the study population significant difference was seen between the indication and complication between multiparous and nulliparous women.

Comparison of pelvic floor dysfunction in primiparous and nulliparous women and its relation to pelvic floor muscle strength

Background: The pelvic floor muscles (PFM) play an important role in supporting the pelvic and abdominal organs and controlling urinary and fecal continence, in addition to their role in the sexual function. The objective of this study was to compare pelvic floor muscle strength in primiparous 6 months after delivery and nulliparous women, to evaluate pelvic floor dysfunction (PFD) in these women and to find the association of PFD with pelvic floor muscle strength (PFMS).Methods: A total of 100 women were recruited in the cross-sectional study which included 28 nulliparous and 72 primiparous women 6 months after delivery. The assessment included general physical examination (GPE), POP-Q and assessment of pelvic floor muscle strength by modified oxford score and perineometer.Results: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Mean of the duration of contraction was significantly higher in nulliparous group as compared to primipara i.e., 28.61 seconds and 23.9 seconds in nulliparous and primiparous group respectively (p=0.005). Mean of the number of contractions performed in one minute was significantly higher in nulliparous group as compared to primipara i.e., 31.04 and 19.97 in nulliparous and primiparous group respectively (p<0.0001). None of the nulliparous women had any PFD symptoms, while 4.17% of the primiparous patients had PFD in the form of bladder symptoms and 1.39% of them had PFD in the form bowel symptoms. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery. It was 39.78±13.33 cmH20 in vaginal delivery, 51.42±12.88 cmH2O in Caesarean section and 31.67±14.36 cmH2O in instrumental delivery (p-0.039).Conclusions: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery.

Early Predictors of Preeclampsia: A Prospective Screening Study

Introduction: Hypertensive disorders of pregnancy comprisea spectrum of diseases that include chronic hypertension,gestational hypertension, preeclampsia, eclampsia andHELLP syndrome- are uniquely challenging as its pathologyand management simultaneously affects both the mother andbaby. Preeclampsia (PE) is an important cause of maternaland perinatal morbidity and mortality and is a most fearedcomplication of pregnancy. In India the incidence of PE isreported to be 2%-8%.Material and methods: In this study 200 pregnant womenwere enrolled from March 2018 – November 2019 for a periodof 21 months in Lalla Ded hospital department of Obstetricsand Gynaecology Government Medical College Srinagar.Inclusion criteria, first trimester of pregnancy (8 – 12 weeks),singleton gestation, pregnancies with aneuploidies ruled out.A detailed history taking and examination was done. Historyregarding their age, parity, smoking and past medical historyof hypertension was taken and their mean arterial pressure(MAP) was taken.Results: In our study out of 200 patients enrolled in firsttrimester 14 developed Pre Eclampsia (PE) in third trimester.Out of which majority were in the age group of 15-20 years(10%) and > 35 years (9%), 12.7%were nulliparous, 15.5% hada MAP of more than 89 mmHg, 11.5% of them were smokersmajority, 10% of them had past history of hypertension and30.7% of them had BMI of more than 30 kg/ m2.Conclusion: It can be concluded from the study that these riskfactors can be used as a screening method for preeclampsiaprediction and its early diagnosis, thus allowing time forintervention and thereby decreasing maternal mortality andmorbidity

Endometrial stromal nodule: a rare case report

Endometrial stromal nodules (ESN) are benign tumours of mesenchymal origin with features reminiscent of proliferative phase endometrial stroma. Diagnosis of ESNs can be established only by light microscopy and no preoperative diagnostic methods are available. Although ESNs are benign and rare, distinguishing it from other types of invasive stromal tumours is of utmost importance since prognosis and management change considerably with the diagnosis. This was a rare case report of endometrial stromal nodule in a nulliparous woman, 30 years old who presented with complaint of menorrhagia and primary infertility and had a preoperative diagnosis of large leiomyoma with cystic degeneration. She underwent a fertility preserving conservative surgery i.e. myomectomy via abdominal route, histopathology reports of which revealed endometrial stromal nodule that changed the final diagnosis and follow up regime of the patient.

Comparative study of induced and spontaneous labour in nulliparous women using modified WHO partograph

Background: Induced or spontaneous labour has implication on the eventual mode of delivery and neonatal outcome. The aim of study is to compare mean duration of labour andmaterno-foetal outcome of induced versus spontaneous labour among nulliparous women using modified WHO partograph.Methods: The study was conducted in nulliparous women coming at term in active phase of labour (with cervical dilatation at least 4 cm) either spontaneous or induced, both labouring women were monitored using modified WHO partograph. Outcomes measures include requirement of augmentation of labour with oxytocin, mean duration of labour, eventual mode of delivery and the materno foetal outcome.Results: A total 100 women were compared in each group. There was no difference in mean age group, BMI, gestational age. More women had spontaneous vaginal delivery among those with spontaneous labour (76% versus 58%) (p=0.033). The mean duration of second stage of labour was significantly more in induced labour (16.25 minutes) than in spontaneous labour (14.60 minutes) (p=0.0212). The mean Apgar scores were comparable in two groups. Induced labour is comparable to spontaneous labour regarding fetomaternal outcomes but with increased rate of caesarean deliveries.Conclusions: Study concluded from our study that in spontaneous group mean duration of labour was less than induced group and most of the patient delivered vaginally. In induced group rate of caesarean was higher and requirement of oxytocin for labour augmentation was also more than spontaneous group. Maternal complications were also found more in induced group than spontaneous group whereas neonatal outcome was similar in both the groups. We observed in our study that induced labour can be a safe procedure among nulliparous women if labour is partographically monitored by WHO modified partograph.

Antenatal determinants of maternal weight gain during pregnancy in nulliparous women of urban and suburban parts of Maharashtra

Background: Weight gain in pregnancy remains a matter of great concern for women and health care providers. Adherence to a balanced diet throughout pregnancy, influences maternal body weight as well as short- and long-term health of mother and child. Objective of this study was to study antenatal maternal and social factors affecting maternal weight gain among Nulliparous women.Methods: study was carried out in antenatal clinics of tertiary care hospital and a suburban health center with sample size 197 and 97 respectively. Maternal weight was measured at the first antenatal clinic visit and at delivery. Statistical analysis was done with SPSS version 20. Statistical tests used were mean, percentages and chi square.Results: The antenatal determinants of maternal weight gain were: being underweight at the booking visit, maternal complications during pregnancy, passive cigarette smoking during third trimester, low educational level and low per capita income, controlling for the effect of gestational age.Conclusions: maternal educational level, per capital income, passive smoking, caloric and protein deficiency, early pregnancy body mass index determines the weight gain during pregnancy.

Prevalencia y factores de riesgo de Incontinencia Urinaria de esfuerzo en mujeres deportistas nulíparas / Stress urinary incontinenece: Prevalance and risk factors in sportive women

Resumen El objetivo de este estudio fue descubrir la prevalencia de la incontinencia urinaria de esfuerzo (IUE) en las mujeres nulíparas deportistas y qué factores de riesgo se asocian a la misma. Se hizo una búsqueda minuciosa en bases de datos utilizando palabras claves en español, inglés y portugués. Se incluyeron solamente artículos con esta población, publicados del 2000 a 2015, y con metodologías de cohortes, casos y controles, de prevalencia, revisiones bibliográficas, y ensayos clínicos aleatorios. La muestra de estudios comprendió 20 artículos, la mayoría en el idioma inglés. Se encontró que la prevalencia de IUE encontrada fue muy variada, ya que se presentaron casos en los que solo el 9% de mujeres evaluadas la padecían, mientras que, en otros, la totalidad de la población la presentaba. No obstante, las investigaciones con una prevalencia alta concordaron en que las poblaciones estudiadas practicaban deportes de alto impacto y eran de países nórdicos. En cuanto a los factores de riesgo (FR) personales, se destacaron el estreñimiento, la lumbalgia, la inhabilidad de detener el flujo urinario y el asma considerados también factores predictores. Por su parte, los deportes con mayor predisposición a padecer IUE fueron los considerados de alto impacto, así como aquellos que involucraban atajar un objeto. Otros factores que mostraron resultados importantes fueron: la cantidad de años de practicar el deporte, el nivel y el volumen semanal de entrenamiento. Se concluye que a pesar de que aún no existe suficiente evidencia científica que explique la relación de la IUE en mujeres nulíparas deportistas, esta investigación demuestra que el deporte juega un papel importante en el desencadenamiento de este padecimiento.

Abstract The purpose of this study was to discover the prevalence of Stress Urinary Incontinence (SUI) in nulliparous female athletes and the associated risk factors. A thorough search was conducted in databases using keywords in Spanish, English, and Portuguese. Only articles with the following characteristics were included: those containing the described population, published from 2000 to 2015, and using methodologies such as cohort studies, case-control studies, prevalence studies, systematic reviews, and randomized trials. The sample included 20 studies, mainly in English. It was found that the prevalence of SUI varied widely, ranging from 9% in some cases to the total amount of participants evaluated in others. Despite of this, the investigations that showed the highest prevalence of SUI were found in sports involving high impact activities and were originally from Nordic countries. Regarding personal risk factors, constipation, low back pain, inability to interrupt the urine flow, and asthma were also considered predictive factors. In addition, sports with a higher risk of SUI were those that involved high impact and catching objects. Other factors that showed important results were: years of practice and level and volume of training per week. It is concluded that, although there is still not enough scientific evidence to explain the relationship between SUI and nulliparous female athletes, this research shows that the type of sport plays an important role in the presence of SUI.

Resumo O objetivo deste estudo foi investigar a prevalência de incontinência urinária de esforço (IUE) em mulheres nulíparas e quais fatores de risco estão associados a ela. Uma busca minuciosa nas bases de dados foi realizada usando palavras-chave em espanhol, inglês e português. Foram incluídos apenas artigos publicados de 2000 a 2015, e com metodologias de estudos quantitativos (estudos transversais, coorte, caso-controle), revisões de literatura e ensaios clínicos randomizados. A amostra incluiu 20 artigos, a maioria no idioma inglês. Verificou-se que a prevalência de IUE encontrada foi muito variada, pois houve casos em que apenas 9% das mulheres avaliadas apresentaram, enquanto que, em outros, se manifestou em toda a população. No entanto, nas pesquisas que encontraram uma alta prevalência da IUE as populações estudadas praticavam esportes de alto impacto e eram de países nórdicos. Em relação aos fatores de risco pessoal (FR), constipação, dor lombar, incapacidade de interromper o fluxo urinário e asma também foram considerados fatores preditivos. Por outro lado, os esportes com maior predisposição para suas praticantes sofrerem IUE foram os de alto impacto e que precisem pegar um objeto. Outros fatores que mostraram resultados importantes foram: o número de anos de prática do esporte, o nível e o volume semanal de treinamento. Conclui-se que, embora não haja evidências científicas suficientes para explicar a relação da IUE em mulheres atletas nulíparas, esta pesquisa mostra que o esporte desempenha um papel importante no desencadeamento dessa condição.

Long term follow-up study for abdominal sacrocolpopexy/sacrohysteropexy

Background: Pelvic organ prolapse is common in women and 7-9% undergo surgical repair. Abdominal sacrocolpopexy and sacrohysteropexy is the most durable operation for vault prolapse and Nulliparous prolapse respectively. The objectives of this study were to describe Anatomic and symptomatic outcomes up to 5 years after abdominal sacrocolpopexy or sacrohysteropexy.Methods: This study was conducted in ASCOMS hospital for a cohort of patients who underwent abdominal sacrocolpopexy (ASC) or sacrohysteropexy (ASH) in 2 years (2013-2015) and follow up done for a period of 5 years from 2015-2019. These patients were evaluated for subjective and objective outcomes following ASC and ASH. women completed questionnaires and were examined in gynaecology clinic. Prospective follow up study using standarised examination with pelvic organ prolapse quantification system (POP-Q) and questionnairesResults: In the present study, there was low incidence of intraoperative and postoperative complications as well as long term complications were significantly low. The anatomical cure rate and patient satisfaction rate was both 100%.Conclusions: Abdominal sacrocolpopexy for vault prolapse and sacrohysteropexy for Nulliparous prolapse is safe and effective method and is considered gold standard for treatment of Apical compartment prolapse.

Effects of aromatherapy with Rosa damascena on nulliparous women's pain and anxiety of labor during first stage of labor / 中西医结合学报

<p><b>BACKGROUND</b>Reducing labor pain and anxiety is one of the most important goals of maternity care.</p><p><b>OBJECTIVE</b>This study aimed to assess the effects of aromatherapy with Rosa damascena on pain and anxiety in the first stage of labor among nulliparous women.</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>This was a randomized clinical trial of 110 nulliparous women. The eligible participants were randomly assigned to two groups of aromatherapy and control in an Iranian maternity hospital. The participants received 0.08 mL of Rosa damascena essence in the aromatherapy group and 0.08 mL of normal saline in the control group, every 30 min. Pain was measured 3 times, once each at three stages of cervical dilation (4-5, 6-7, and 8-10 cm). Anxiety was measured twice, once each at two stages of cervical dilation (4-7 and 8-10 cm). The tools for data collection were the Spielberger anxiety questionnaire, numerical pain rating scale, demographic and obstetric questionnaire, and an observational checklist. Data analyses included the t-test, Mann-Whitney U test and Chi-square test.</p><p><b>MAIN OUTCOME MEASURES</b>Severity of labor pain and severity of anxiety were used as primary outcome measures. Labor and delivery characteristics (including number of contractions, duration of contractions in second stage, Bishop score, augmentation by oxytocin, Apgar score, and mode of delivery), demographic characteristics, and fertility information were used as secondary outcome measures.</p><p><b>RESULTS</b>Pain severity in the group receiving aromatherapy with R. damascena was significantly lower than in the control group after treatment at each pain assessment (cervical dilation of 4-5, 6-7, and 8-10 cm; P < 0.05). Anxiety levels were also significantly lower in the treatment group than in the control group after treatment at each time of measurement (cervical dilation of 4-7 and 8-10 cm; P < 0.05).</p><p><b>CONCLUSION</b>Aromatherapy with R. damascena reduced the severity of pain and anxiety in the first stage of labor. Aromatherapy with R. damascena is a convenient and effective method for pain and anxiety reduction during the first stage of labor.</p><p><b>TRIAL REGISTRATION</b>Iranian Registry of Clinical Trial: IRCT201306258801N3.</p>

Performance reprodutiva de leitoas submetidas à inseminação artificial pós-cervical / Reproductive performance of gilts submitted to post-cervical artificial insemination

O objetivo deste trabalho foi avaliar o desempenho reprodutivo de nulíparas submetidas à inseminação artificial pós-cervical (IAPC) comparada à inseminação artificial tradicional (IAT). Foram avaliados ocorrência de sangramento, ocorrência de refluxo, dificuldade no transpasse da cérvix e total de células refluídas até 30 minutos após inseminação. Fêmeas submetidas à IAPC (n=279) foram inseminadas com doses de 1,5 x 109 diluídas em 45mL, e fêmeas submetidas à IAT (n=273) inseminadas com doses de 2,5 x 109 em 80mL. O transpasse da cérvix foi possível em 91,04% (254/279) das leitoas. A dificuldade no transpasse foi de 41,58% (116/279), não comprometendo o desempenho reprodutivo (P>0,05). Presença de sangramento não afetou a taxa de parto nem o número de leitões nascidos para ambos os tratamentos (P>0,05). O percentual de espermatozoides presentes no refluxo foi maior na IAT, não sendo observada diferença no tamanho de leitegada de acordo com o percentual de espermatozoides no refluxo (P>0,05) e no número de leitões nascidos totais (11,63 e 11,81) entre os tratamentos IAT e IAPC, respectivamente. Pode-se realizar IAPC em leitoas sem causar redução no desempenho, utilizando-se doses com 1,5 x 109 células espermáticas.(AU)

The objective of this study was to evaluate the reproductive performance of gilts subjected to post-cervical artificial insemination (PCAI) compared to traditional artificial insemination (TAI). We also evaluated the degree of difficulty in bypassing the cervix, time required to perform the insemination, presence of bleeding after insemination, semen backflow, as well as the volume and the total reflow cells 30 minutes after insemination. Gilts submitted to PCAI (n = 279) were inseminated with 45 mL doses of 1.5 x 109 sperm cells and the ones submitted to TAI (n = 273) were inseminated with 80 mL doses with 2.5 x 109 cells. The bypassing of the cervix was possible in 91.04% (254/279) of gilts. The difficulty bypassing the cervix in at least one of the gilt's PCAI procedures happened with 41.58% (116/279) of the females, but it did not affect reproductive performance (P>0.05). The presence of bleeding after insemination did not affect the farrowing rate and total number of piglets born for both treatments (P>0.05). The average time needed to carry out the PCAI was 1.47 minutes and the TAI was 4.04 minutes. The percentage of sperm present in the reflux was higher in TAI than the PCAI, but no correlation was found between litter size and the percentage of sperm in reflux (P>0.05) and the total number of piglets born (11.63 and 11.81) between TAI and PCAI treatments, respectively. Thus, it is possible to perform the post-cervical artificial insemination in gilts without causing a reduction in reproductive performance, using doses with a concentration of 1.5 x 109 sperm cells.(AU)

Outcome of breech deliveries in nulliparous women

Background: Compared to cephalic presentation with respect to fetal morbidity and mortality, breech delivery management was a high risk. Aim: To evaluate the outcome of breech deliveries in nulliparous women. Materials and methods: This was a retrospective study conducted from October 2012 till September 2015 .The study was conducted at Government hospital Nizabmabad and CKM hospital, Warangal. The selection criteria were gestational age ≥ 32 weeks which was validated by ultrasound examination performed before 20 weeks gestation when calculated from last menstrual period, a singleton with breech presentation and normal fetal heart beats in nulliparous women. Adequate pelvis, frank or complete breech, estimated weight of foetus lesser than 3500 grams, no other obstetric complication were the inclusion criteria. Results: During these 3 years survey, 12000 deliveries were done. Out of which, 3000 were nulliparous, and there were 400 cases of breech presentation, and there was an incidence of 3.33%. A total of 250 women met the inclusion criteria and had undergone delivery by VBD or by Caesarean section. There were 120 caesarean deliveries, of which 56 (46.66%) were elective and 64 (53.33%) were emergencies. The main indication for emergency CS was acute foetal distress accounting to 42 (65.63%) cases. The main indication for elective CS was foetal birth weight ≥3500 grams accounting to 25 (44.64%) cases. Out of 130, 15 (11.54%) neonates had poor APGAR score (<7) at the 5th minute of birth. In elective caesarean section, none had poor APGAR score at 5th minute. In emergency, caesarean section, 6 (9.38%) had a poor APGAR score at the 5th minute. Out of the 6 cases, the indication for the emergency caesarean section was acute foetal distress, 2 in 35 years old patients carrying foetus of 3300 grams and 3200 grams, others had cord prolapsed. In APGAR score between Allanki Suneetha Devi, Jalem Anuradha. Outcome of breech deliveries in nulliparous women. IAIM, 2017; 4(7): 33-38. Page 34 the group of elective and emergency caesarean section, there was a statistically significant difference in the mean 5th minute. Conclusion: It can be concluded from this study that in cases of inadequate pelvis, foetal weight ≥3500 grams or ≤1800 grams, footling breech presentation, post term pregnancies, vaginal breech delivery is unsafe.

Participation in Prenatal Education, Knowledge and Attitude related to Delivery, Postpartum Care, Newborn Care in Nulliparous Women

PURPOSE: This study was done to identify content of prenatal education and to examine differences in prenatal education, knowledge, and attitude of nulliparous South Korean women. METHODS: A cross-sectional survey design was used with 134 conveniently recruited nulliparous women. Data were collected through self-report questionnaires. RESULTS: Average number of institutional prenatal education programs was 5.96 at clinics, 4.31 at health care centers, and 0.49 at hospitals. Women participated in an average 5.78 out of the 35 prenatal education contents: 15 types of prenatal and delivery, 10 postpartum self-care, and 10 parenting. Score for knowledge was 7.57out of 10. Women who participated in prenatal education (n=72) reported significantly higher scores in knowledge (t=2.71, p=.008) than women who did not participate (n=62). The average score for attitude was 7.22 out of 10. Nulliparous women over 36 weeks of gestational age had significantly higher scores for attitude (t=2.38, p=.019) than women under 36 weeks. There were significant positive correlations between newborn care knowledge and postpartum care self-efficacy (r=.26, p=.026), and newborn care knowledge and parenting confidence (r=.25, p=.034). CONCLUSION: Results indicate that policy is needed to increase participation in prenatal education and to establish strategies for health care centers and hospitals to provide prenatal education.

Longitud de vagina, hiato genital y cuerpo perineal en mujeres nulíparas

Objetivo: Estimar la longitud promedio de vagina, del hiato genital y cuerpo perineal en mujeres nulíparas. Diseño: Estudio descriptivo transversal con muestreo por conveniencia. Institución: Departamento de Ginecología y Obstetricia, Hospital Nacional Cayetano Heredia, Lima, Perú. Participantes: Mujeres nulíparas. Métodos: En 85 mujeres nulíparas atendidas en el Hospital entre enero y marzo 2014, en edad fértil, que habían iniciado relaciones coitales vaginales y que requerían evaluación ginecológica, se realizó medición del peso y talla. En posición de litotomía, se midió con un hisopo milimetrado la longitud total de la vagina, hiato genital y el cuerpo perineal. Las mediciones fueron realizadas por un solo examinador. La participación fue completamente voluntaria y con firma de consentimiento informado. Principales medidas de resultados: Longitud total de la vagina, hiato genital y el cuerpo perineal. Resultados: La media de la longitud total de vagina fue 8,1 ± 1,4 cm (DE), del hiato genital 2,2 ± 0,5 cm (DE) y del cuerpo perineal 2,3 ± 0,5 cm (DE). Conclusiones: Las medidas estimadas no difieren con resultados de estudios internacionales. Se requiere estudiar una mayor muestra de pacientes de las diferentes regiones para tener un estimado más representativo de estas medidas en pacientes nulíparas del Perú.

Objectives: To determine vaginal, genital hiatus and perineal body length in nulliparous women. Design: Cross-sectional descriptive study with convenience sample. Setting: Department of Obstetrics and Gynecology, Hospital Nacional Cayetano Heredia, Lima, Peru. Participants: Nulliparous women. Methods: From January through March 2014 in 85 nulliparous women in childbearing age who had coital sex and required gynecological evaluation, weight and height were obtained and length of vagina, genital hiatus and perineal body were measured with a graph swab in lithotomy position. Measurements were obtained by one single examiner. Participation was voluntary with signed informed consent. Main outcome measures: Length of vagina, genital hiatus and perineal body. Results: Average length of patients vagina was 8.1 ± 1.4 cm (SD), genital hiatus 2.2 ± 0.5 cm (SD), and perineal body 2.3 ± 0.5 cm (SD). Conclusions: Measures obtained did not differ from international studies. A broad population study is suggested to better estimate these measures in nulliparous Peruvian women.

Meta-analysis of the relationship between the breast cancer and abortions among nulliparous women / 局解手术学杂志

Objective To evaluate the relationship between the risk of breast cancer and abortions among nulliparous women. Methods Searched the data of Cochrane Library and PubMed before June 2014 to identify potentially studies which involved the relationship between the risk of breast cancer and abortions among nulliparous women. Data was extracted by two independent authors from each study. STATA software was used for statistical analysis. Calculated the pooled RR and 95% CI as the assessment of the link between abortions and breast cancer in fixed effects models. Results 13 studies were included. The study showed the RR and 95%CI of the relationship between the risk of breast cancer and abortions was 0. 98[0. 89,1. 08],P>0. 05 in nulliparous women, and the number of abortions was not associated with the risk of breast cancer. The RR and 95%CI of the relationship between the risk of breast cancer and induced abortions or spontaneous abor-tions were 0. 96[0. 88,1. 04],1. 01[0. 88,1. 14], respectively. Conclusion There is no correlation between breast cancer and abortions a-mong the nulliparous women, and the risk of breast cancer would not increas as the number of abortions increase.

Bilateral phyllodes tumor of the breast in a young nulliparous woman.

Cystosarcoma phyllodes is a rare breast tumor with incidence of 1% of all the mammary tumors. Bilateral occurrence is very rare. Median age of presentation is 40-50 years. We present a case of 24 years old nulliparous female with phyllodes tumour developing in both the breasts one after another with a gap of five years. Patient underwent simple mastectomy on both sides. Histopathology report confirmed benign variety of cystosarcoma phyllodes on both sides.

Maternal Anthropometric Characteristics and Fetal Birth Weight as Predictors of Cesarean Delivery in Nulliparous Women, with Singletons Pregnancies in Cephalic Presentation: A Cross Sectional Study.

Background: Globally, the rate of cesarean delivery is increasing rapidly over the past years. Aim: The study was conducted to investigate the incidence and the predictors for cesarean delivery in nulliparous women at Khartoum Hospital, Sudan. Methods: A prospective cross-sectional hospital-based study was conducted where all parturient nulliparous women delivered in the period between February to April 2012 were included. Socio-demographic characteristics were gathered through structured questionnaires. Maternal anthropometric measures, birth weight, gender and mode of delivery were recorded and compared between those who delivered vaginally and by emergency cesarean delivery. Results: A total of 533 parturient women were enrolled, of these, 147(27.6%) were emergency cesarean delivery. The cesarean delivery rate in nulliparous increased significantly with increased maternal, age ˃ 30 years (OR=2.4, 95% CI= 1.1─5.2, P= 0.032), decreased maternal height < 150 cm (OR=2.4, 95% CI=1.4─4.1, P=0.002), and in increase BMI ≥ 30 Kg/m 2 (OR=2.2, 95% CI=1.1─4. 9, P=0.046) and increase in birth weight > 3750g (OR=2.7, 95% CI=1.1─6.4, P=0.026). There was no association between cesarean delivery rate, mid-upper arm circumference and fetal gender. Conclusion: There was a high incidence of cesarean delivery among nulliparous women especially among elder, obese women, short statue women and with a fetal birth weight > 3750g.

Comparison of pelvic floor muscle strength evaluations in nulliparous and primiparous women: a prospective study

OBJECTIVE: This study aimed to compare the pelvic floor muscle strength of nulliparous and primiparous women. METHODS: A total of 100 women were prospectively distributed into two groups: Group 1 (G1) (n = 50) included healthy nulliparous women, and Group 2 (G2) (n = 50) included healthy primiparous women. Pelvic floor muscle strength was subjectively evaluated using transvaginal digital palpation. Pelvic floor muscle strength was objectively assessed using a portable perineometer. All of the parameters were evaluated simultaneously in G1 and were evaluated in G2 during the 20th and 36th weeks of pregnancy and 45 days after delivery. RESULTS: In G2, 14 women were excluded because they left the study before the follow-up evaluation. The median age was 23 years in G1 and 22 years in G2; there was no significant difference between the groups. The average body mass index was 21.7 kg/m² in G1 and 25.0 kg/m² in G2; there was a significant difference between the groups (p = 0.0004). In G2, transvaginal digital palpation evaluation showed significant impairments of pelvic floor muscle strength at the 36th week of pregnancy (p = 0.0006) and 45 days after vaginal delivery (p = 0.0001) compared to G1. Objective evaluations of pelvic floor muscle strength in G2 revealed a significant decrease 45 days after vaginal delivery compared to nulliparous patients. CONCLUSION: Pregnancy and vaginal delivery may cause weakness of the pelvic floor muscles.

Anatomical Evaluation of Shofukukyuketsu by 3D Image Analysis / 日本東洋医学雑誌

Lower abdominal cramps, or <i>shofukukyuketsu</i> in Japanese, are thought to be one indication to use tokakujokito for the abdominal symptom of <i>oketsu</i>. To clarify the condition, anatomical analysis was performed using 3 D imaging. There were 20 women and11men entered in this study who consulted our hospital for lower abdominal pain or a sense of discomfort. Width and the thickness of the rectus muscle of the abdomen were analyzed. Moreover, gas images and feces in the intestinal tract under the abdominal wall were also observed. In addition, the presence of rectus abdominal muscle separation, or <i>shofukufujin</i> in Japanese, was evaluated. In the women, where lower abdominal cramps were a complaint, young age (53.1 ± 18.3 vs. 30.4 ± 9.8, p < 0.05), low parity (1.5 ± 1.0 vs. 0.25 ± 0.5, p < 0.05), and thickness of the abdominal rectus muscle (8.14 ± 2.5 mm vs. 12.4 ± 1.6 mm, p < 0.05) were confirmed. Also in several cases of lower abdominal cramps, feces were seen at the sigmoid colon. A significant difference was seen in the male group. Cases with lower abdominal cramps suggest involvement of local muscle spasms at the bottom of abdominal rectus muscle, which may contribute to the seemed symptom of abdominal formation. On the other hand, a mechanism different from that in women was considered in the men. This suggests that it is necessary to consider gender differences when making a Kampo diagnosis.

Anatomical Evaluation of Shofukukyuketsu by 3D Image Analysis / 日本東洋医学雑誌

Lower abdominal cramps, or <I>shofukukyuketsu</I> in Japanese, are thought to be one indication to use tokakujokito for the abdominal symptom of <I>oketsu</I>. To clarify the condition, anatomical analysis was performed using 3 D imaging.There were 20 women and11men entered in this study who consulted our hospital for lower abdominal pain or a sense of discomfort. Width and the thickness of the rectus muscle of the abdomen were analyzed. Moreover, gas images and feces in the intestinal tract under the abdominal wall were also observed. In addition, the presence of rectus abdominal muscle separation, or <I>shofukufujin</I> in Japanese, was evaluated. In the women, where lower abdominal cramps were a complaint, young age (53.1 ± 18.3 vs. 30.4 ± 9.8, p < 0.05), low parity (1.5 ± 1.0 vs. 0.25 ± 0.5, p < 0.05), and thickness of the abdominal rectus muscle (8.14 ± 2.5 mm vs. 12.4 ± 1.6 mm, p < 0.05) were confirmed. Also in several cases of lower abdominal cramps, feces were seen at the sigmoid colon. A significant difference was seen in the male group. Cases with lower abdominal cramps suggest involvement of local muscle spasms at the bottom of abdominal rectus muscle, which may contribute to the seemed symptom of abdominal formation. On the other hand, a mechanism different from that in women was considered in the men. This suggests that it is necessary to consider gender differences when making a Kampo diagnosis.