Haleh Sangi-Haghpeykar

Epidemiology of endometriosis among parous women

Objective To report the prevalence of endometriosis and its associated risk factors among multiparous women, and to determine the relationship between the location and depth of this disease and certain medical and behavioral characteristics. Methods Over a 6-year period, 3384 multiparous women underwent laparoscopy for tubal sterilization. Endometriosis was detected in 126 patients (3.7%), who were consequently evaluated for severity of the disease. To conduct a casecontrol study, 504 patients with no evidence of endometriosis were randomly selected from a group of women who underwent sterilization. Information obtained through physical examination and a self-administered questionnaire was studied by multivariate logistic regression analysis. Results Most endometriosis lesions were minimal. Factors associated with an increased risk for endometriosis included: advanced age (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.1–3.7), Asian race (OR 8.6, 95% CI 1.4–20.1), long cycle length (OR 1.8,95% CI 1.1–2.7), one live birth (OR 2.2, 95% CI 1.1–4.3), long duration of intrauterine device use (OR 3.0, 95% CI 1.1–8.1), and long duration of uninterrupted menstrual cycles (OR 2.9, 95% CI 1.3–6.4). Present oral contraceptive use was protective for disease (OR 0.5, 95% CI 0.2–0.9). The role of these factors varied among different disease locations (ovary, uterus and tubes, posterior broad ligaments and cul-de-sac), and depth (superficial or deep). Conclusions The prevalence of endometriosis is relatively low among multiparous women, and certain menstrual and reproductive characteristics are associated with its development. Furthermore, the relationship between various factors and endometriosis appears to be site and depth specific. Our findings suggest that asymptomatic endometriosis may be clinically important.

Experiences of injectable contraceptive users in an urban setting

Objective To examine method-related experiences and acceptability of depot medroxyprogesterone acetate (DMPA) among women using this contraceptive for the first time. Methods Five hundred thirty-six women who received an injection of DMPA from any of seventeen clinical settings in southeast Texas, United States, were followed for 1 year. At each follow-up visit, patients were asked about their experiences with DMPA during the past 3 months and their plans to use this method in the future. Results Amenorrhea, irregular bleeding, and weight gain were the conditions reported most frequently. Reports of amenorrhea, weight gain, and acne or skin problems increased over time, but complaints of longer periods decreased (P <.001). Two pregnancies occurred during the study period. However, of these, one existed before the first injection. Depot medroxyprogesterone acetates continuation rate at 1 year was 28.6%. Heavier and more frequent bleeding, increased cramping, amenorrhea, weight gain, headaches, depression, and nervousness were more frequent complaints of women who discontinued DMPA (P <.05), whereas lighter and less frequent bleeding were reported more often by those who continued to use this method (P <.05). Women who discontinued use of DMPA were more likely to be married and have a concern about injectable contraceptives than those who continued to use this method. Conclusion Intolerable side effects and changes in menstrual pattern are the most frequently indicated reasons for discontinuing DMPA use. Our results suggest that DMPAs 1-year continuation rate may be lower than previously reported.

Minimally Invasive Hysterectomies—A Survey on Attitudes and Barriers among Practicing Gynecologists

STUDY OBJECTIVE To explore attitudes and hysterectomy practices among gynecologists in the United States and to identify potential barriers to offering minimally invasive hysterectomies. DESIGN Mixed-mode (online and on-paper) survey of a random sample of 1500 practicing obstetrician-gynecologists. SETTING Nationwide survey in the United States. PARTICIPANTS Nonretired obstetrician-gynecologists identified through a physician list from the American Medical Association. INTERVENTIONS Postal and online survey. MEASUREMENTS & MAIN RESULTS: We received a response from 376 physicians (25.8% response rate). The average age of respondents was 47.9 years, and 87% were generalists. Participants performed on average 4 surgical cases per week and 32 hysterectomies per year, most of which were abdominal hysterectomies. When asked for preferred mode of access for themselves or their spouse, 55.5% chose vaginal hysterectomy (VH), 40.6% chose laparoscopic hysterectomy (LH), and 8% chose abdominal hysterectomy (AH). Younger physicians (<40) and high surgical volume physicians were significantly more likely to chose a laparoscopic approach and identified significantly fewer barriers for performing LH. The main barriers to performing VH were technical difficulty, potential for complications, and caseload of VH. The main barriers for performing LH were training during residency, technical difficulty, personal surgical experience and operating time. The majority of gynecologists wanted to decrease their AH rates and increase their LH rates. The most significant identified contraindications to VH were prior laparotomy, a uterus larger than 12 weeks, narrow introitus, adnexal mass, and minimal uterine descent. CONCLUSIONS While a large majority of gynecologists would prefer a VH or LH for themselves or their spouse, AH remains the most common hysterectomy method in the United States. A generation gap appears to be brewing with younger gynecologist more in favor of the laparoscopic approach. More emphasis should be placed on training gynecologists in performing minimally invasive hysterectomies, given their desire to change their surgical mode of access.

Prospective trial on obstructive sleep apnea in pregnancy and fetal heart rate monitoring.

OBJECTIVE Obstructive sleep apnea (OSA) involves episodic nocturnal apneas. Using polysomnography, we examined the predictive capacity of screening questionnaires (Berlin) in pregnancy. Incorporating simultaneous fetal heart rate monitoring (FHM), we examined the association of maternal apnea with FHM abnormalities. STUDY DESIGN We enrolled 100 pregnant women at 26-39 weeks of gestation with OSA screening and baseline data ascertainment who underwent polysomnography and FHM for > or =3 hours. The relationship between maternal characteristics, OSA, and FHM was explored with multivariate analyses that were controlled for potential confounders. RESULTS When compared with polysomnography, sensitivity and specificity by Berlin screening was 35% and 63.8%, respectively; the snoring component of the Berlin correlated better with oxygen desaturation <95% (P = .003). Body mass index was a significant confounder (r(s) = 0.44; P < .0001). No association was observed between FHM abnormalities and OSA parameters. CONCLUSION In pregnancy, the Berlin questionnaire poorly predicts OSA. It is unclear whether fetal compromise during maternal apnea is a mechanism in OSA that is related to pregnancy outcome.

HPV vaccine acceptability in Ghana, West Africa

OBJECTIVE Cervical cancer is a leading cause of cancer-related mortality among women in Ghana. As of this writing no data are available concerning knowledge, attitudes and acceptability of human papillomavirus (HPV) vaccination by women in Ghana. METHODS Between November and December 2009, a self-administered survey was used to elicit information from 264 Ghanaian women, ages 18-65. RESULTS Overall, 40% had heard about HPV vaccine and 94% were willing to vaccinate themselves or their daughters. Ideal age for vaccination was 12.7 years. Most women (75%) thought the vaccine should be received regardless of ones number of sex partners. The most prevalent concerns were whether the vaccine would be administered safely using clean needles (82%), and possible future side effects (77%). Concerns about cost and vaccine encouraging earlier sex were reported by nearly half. Significant barriers to vaccine acceptance were womens lack of knowledge about the gravity of cervical cancer in Ghana and utility of Pap test in detecting it, low perceived risk for cervical cancer, low social support to vaccine use, and low self-efficacy to find a doctor or clinic to get vaccinated (p<05). About 55% of the women did not know the vaccine only works among those who are not yet infected with HPV. Schools and television were the most preferred methods of educating the public and cervical cancer prevention ranked as the ideal message (80%). Most respondents believed the decision to vaccinate their daughter should be made by both parents (34%) or in conjunction with the daughter (37%), as opposed to the government (17%). CONCLUSIONS Educational programs addressing specific barriers identified in the current study have the potential to significantly improve HPV vaccine uptake in Ghana.

Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'.

To document perinatal outcomes following use of the ‘Solomon technique’ in the selective photocoagulation of placental anastomoses for severe twin–twin transfusion syndrome (TTTS).

Obstructive sleep apnea screening in pregnancy, perinatal outcomes, and impact of maternal obesity.

We employed accepted, validated symptom-based screening measures to discern attributable risk of obstructive sleep apnea (OSA) to adverse pregnancy outcomes, taking into account potential maternal confounders. Commonly employed OSA screening measures (Berlin and Epworth scales) were performed in the second and third trimesters; maternal and neonatal outcome data were thereafter obtained. The relationship between OSA and outcomes of interest were explored in stratified and multivariate models controlling for potential confounders. The overall prevalence of OSA was 25.4%. Given a nonlinear increase by body mass index (BMI) strata (8.9%, 46%; p < 0.0001), stratified multivariate analysis was subsequently performed. Among nonobese (BMI <30) gravidae, frequency of preeclampsia was significantly higher among women with OSA (adjusted odds ratio = 6.58, 95% confidence interval = 1.04, 38.51; p = 0.035). Among the obese (BMI ≥30) gravidae, infant birth weight ratio (or birth weight by gestational age) was higher with OSA + screening than OSA - (1.099 versus 1.035; p = 0.04), and this association remained significant after adjustment for potential confounders (p = 0.05). OSA prevalence increases significantly among obese gravidae, raising concerns for the overall validity of commonly employed screening measures in pregnancy. Nevertheless, OSA status continues to exert an independent influence, as obese and nonobese gravidae are at increased risk for a limited number of adverse perinatal outcomes in multivariate models.

Fetal intervention for severe lower urinary tract obstruction: a multicenter case–control study comparing fetal cystoscopy with vesicoamniotic shunting

To evaluate the efficacy of fetal intervention using fetal cystoscopy or vesicoamniotic shunting in the treatment of severe lower urinary obstruction (LUTO).

The Use During Pregnancy of Prescription, Over‐the‐Counter, and Alternative Medications Among Hispanic Women

BACKGROUND Despite lack of scientific evidence about the safety of complementary and alternative medicines, the reported use of such remedies during pregnancies has increased. This study was undertaken to investigate the use of herbs, vitamins, and over-the-counter and prescription medications among pregnant Hispanic women and reasons for use, and to assess physician-patient level of communication about womens use. METHODS A total of 485 Hispanic women were surveyed by means of a self-administered questionnaire immediately postpartum in a public hospital in Houston, Texas. The primary outcome was use of alternative therapies during the prenatal period. RESULTS During their pregnancies, 19 percent of the participants took herbs and 47 percent took vitamin supplements, other than prenatal vitamins. The most common reason for using herbs and vitamins was to improve the womans general health and energy level (59%); a few women (12%) had used them for specific pregnancy-related problems. Overall, 77 percent took prenatal vitamins and 21 percent supplemented with folic acid. The rates of use of over-the-counter and prescription medications were 23 and 29 percent, respectively. The use of prescription medication was two-and-a-half times higher among women with history of medical problems (adjusted OR = 2.59, 95% CI = 1.59-4.25, p = 0.0001). No other factor studied was independently associated with supplement or medication use. One in five women (20%) believed that herbs and vitamins were safer to use than prescription medication or were better at treating medical problems than prescription medicine, and one-third had not disclosed information about supplement use to their physicians. CONCLUSIONS Use of herbal remedies does not appear to be a replacement for conventional medicine among most pregnant Hispanic women. Patient education about the risks of alternative therapies may lead to a reduction in intake of alternative medicines and greater disclosure to medical practitioners among this ethnic group.

Factors associated with unintended pregnancy

This research was designed to identify determinants of unintendedpregnancy among women attending family practice or family planning clinics.Survey data were collected from 95 women who were categorized according towhether or not they had experienced an unintended pregnancy. Women reportingunintended pregnancy were younger, reported earlier sexual debut and agreater number of sexual partners than those not having experienced anunintended pregnancy. Those who had avoided unintended pregnancy displayedhigher levels of preventive sexual self-efficacy, had more confidence intheir ability to use contraceptive methods, perceived more negativeconsequences associated with having children in the near future, andbelieved pregnancy among unmarried women to be less acceptable than didwomen who had had unintended pregnancies.