Intimate partner violence and sexually transmitted disease symptoms in a national sample of married Bangladeshi women.

OBJECTIVES: To assess associations of intimate partner violence (IPV) with women's sexually transmitted disease (STD) symptoms, and to clarify biological and behavioral mechanisms underpinning heightened STD rates among abused women. METHODS: A cross-sectional investigation of married couples (n=2865) sampled via the Bangladesh Demographic Health Survey. RESULTS: Over one third (38%) of married Bangladeshi women experienced physical or sexual IPV in the 12 months preceding the survey. Victimization was bivariately associated with vaginal irritation/discharge, pelvic pain during intercourse, genital sores/ulcers, and vaginal discharge with odor (OR 1.39-2.09). IPV demonstrated an independent effect on vaginal irritation with discharge (adjusted OR 1.34) and vaginal discharge with odor (adjusted OR 2.08) after accounting for STD exposure (i.e., husbands' recent STD). CONCLUSIONS: IPV elevates married Bangladeshi women's STD symptoms beyond the risk represented by husbands' STD alone, suggesting that high rates of STD among abusive men and the context of violence itself both relate to abused women's STD risk.     

Risk factors associated with the rupture of tubal ectopic pregnancy

OBJECTIVE: To identify risk factors that may lead to the rupture of ectopic pregnancies. STUDY DESIGN: A retrospective chart review was performed on patients with ectopic pregnancies at the University of Miami/Jackson Memorial Hospital between 1/1/1995 and 3/1/2002. 738 patients were identified with ectopic pregnancies. Women with tubal rupture were compared to those without rupture. Variables analyzed were demographic data, patient-related risk factors (history of pelvic surgery, bilateral tubal ligation, history of pelvic inflammatory disease, previous ectopic pregnancy, intrauterine device use) and beta-human chorionic gonadotropin (betahCG) measurement. RESULTS: There were 439 (59%) cases with a ruptured and 299 (41%) cases with an unruptured ectopic pregnancy. Multivariate logistic regression analysis revealed that previous ectopic pregnancy (OR 2.88; 95% CI 1.92, 4.33) and betahCG level >or=5,000 mIU/ml (OR 1.85; 95% CI 1.12, 3.06) were the only significant risk factors for tubal rupture. CONCLUSION: Patients with betahCG levels >or=5,000 mIU/ml and patients with a history of a previous ectopic pregnancy are significantly more likely to experience a tubal rupture.     

Risk factors for cervical squamous intraepithelial lesions among HIV-1 seropositive women in Dar es Salaam, Tanzania.

OBJECTIVES: To determine the prevalence and risk factors for cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Dar es Salaam, Tanzania. METHODS: Between July 1996 and December 1997 we interviewed 691 HIV-infected women to obtain information about risk factors for SIL. Cervical smears and samples for lymphocyte subsets and sexually transmitted diseases (STD) diagnosis were collected. RESULTS: The prevalence of SIL was 2.9% (20/686) (95% CI = 1.7-4.2%). Eleven women had low-grade SIL while nine women had high-grade SIL. The number of lifetime sexual partners and live births was associated with a marginally non-significant increased risk of SIL. The risk of SIL was significantly increased among women with CD4+ cell count < 200/mm3 (multivariate odds ratio (OR) = 6.15, 95% CI = 1.19-41.37) and decreased by 68% for each 5-cm increase in mid-upper arm circumference (multivariate OR = 0.32, 95% CI = 0.10-0.93). CONCLUSIONS: HIV-related immunosuppression and wasting and long-term sexual behavior were the major determinants of SIL in this population. Federation of Gynecology and Obstetrics.     

Risk factors for pelvic organ prolapse repair after hysterectomy

OBJECTIVE: To estimate the incidence and identify the risk factors for pelvic organ prolapse repair after hysterectomy. METHODS: We conducted a case-control study. We identified 6,214 women who underwent hysterectomy in our gynecology department from 1982 to 2002. Cases (n=114) were women who required pelvic organ prolapse surgery after hysterectomy from January 1982 through December 2005. Controls (n=236) were women randomly selected from the same cohort who did not require pelvic organ surgery during the same period. We performed a univariable and a multivariable analysis among 104 cases and 190 controls to identify the variables associated with prolapse repair after hysterectomy. RESULTS: The incidence of pelvic organ prolapse that required surgical correction after hysterectomy was 1.3 per 1,000 women-years. The risk of prolapse repair was 4.7 times higher in women whose initial hysterectomy was indicated by prolapse and 8.0 times higher if preoperative prolapse grade 2 or more was present. Risk factors included preoperative prolapse grade 2 or more (adjusted odds ratio [OR] 12.6, 95% confidence interval [CI] 4.6-34.7), previous pelvic organ prolapse or urinary incontinence surgery (adjusted OR 7.9, 95% CI 1.3-48.2), history of vaginal delivery (adjusted OR 5.0, 95% CI 1.3-19.7), and sexual activity (adjusted OR 6.2, 95% CI 2.7-14.5). Vaginal hysterectomy was not a risk factor when preoperative prolapse was taken into account (adjusted OR 0.7, 95% CI 0.4-1.1). CONCLUSION: Preoperative pelvic organ prolapse and other factors related to pelvic floor weakness were significantly associated with subsequent pelvic floor repair after hysterectomy. Vaginal hysterectomy was not a risk factor. LEVEL OF EVIDENCE: II.     

Risk factors for ectopic pregnancy: an Italian case-control study.

OBJECTIVE: To analyze risk factors for ectopic pregnancy in a population at low risk for the disease. METHODS: Between September 1989 and February 1991 in Milan, we conducted a case-control study on 120 cases of ectopic pregnancy and 209 controls. The control subjects gave birth at term (more than 37 weeks' gestation) to healthy infants on randomly selected days at the same hospitals where the cases had been identified. RESULTS: The risk of ectopic gestation was about 40% higher in smokers than in controls, and the risk estimates increased with the number of cigarettes smoked per day (chi 2(1) trend 4.21, P = .04) and the duration of smoking (chi 2(1) trend 7.31, P < .01). However, smoking was not associated with the risk of ectopic pregnancy after adjustment for potential confounding factors (including history of pelvic inflammatory disease) in a multivariate analysis (relative risks [RRs] for ten or fewer and more than ten cigarettes per day versus no smoking were 0.8 and 1.1, respectively; chi 2(1) trend 0.10, P = not significant). Infertility problems or difficulty in conception were reported by 32% of the cases and 10% of the controls; the corresponding multivariate RR was 4.7 (95% confidence interval [CI] 2.3-9.5). A history of abdominal surgery was associated with about double the risk of ectopic pregnancy (multivariate RR 2.4, 95% CI 1.4-4.2). Similar estimates were found when the analysis was performed considering various types of surgery separately such as appendectomy, cesarean delivery, and other abdominal surgery. Finally, the risk of ectopic pregnancy was higher in women reporting a history of pelvic inflammatory disease (RR 2.7, 95% CI 0.9-8.7) and increased with the number of sexual partners (chi 2(1) trend 4.51, P = .03). CONCLUSIONS: Problems of infertility or difficulties in conception, history of pelvic inflammatory disease/salpingitis, and abdominal surgery are the main risk factors for ectopic pregnancy in this Italian study. Sexual habits also appear to have some independent effect.     

性传播盆腔炎性疾病的诊断规范化治疗和预后

性传播疾病病原体与盆腔炎性疾病的相关性日益明显：性传播疾病的流行伴随而来的急性盆腔炎的流行,如延误治疗最终将导致慢性盆腔痛、异位妊娠和不孕等一系列严重后遗症。性传播盆腔炎性疾病需要采用综合治疗方案：抗生素治疗为主,必要时手术治疗,同时患者性伴侣应进行相应的检查与治疗,避免重复感染。     

Associations between Religiosity and Sexual and Contraceptive Behaviors

Study ObjectiveTo determine associations between religiosity and female adolescents' sexual and contraceptive behaviors.DesignWe conducted a secondary analysis on data from a randomized controlled trial comparing interventions designed to prevent pregnancy and sexually transmitted diseases (STDs). Multivariable modeling assessed the association between a religiosity index consisting of items related to religious behaviors and impact of religious beliefs on decisions and sexual outcomes.Participants572 female adolescents aged 13 to 21, recruited via a hospital-based adolescent clinic and community-wide advertisements.Main Outcome MeasuresSexual experience, pregnancy, STDs, number of lifetime partners, frequency of sexual activity, previous contraceptive use, and planned contraceptive use.ResultsMean participant age was 17.4 ± 2.2 years and 68% had been sexually active. Most (74.1%) had a religious affiliation and over half (52.8%) reported that their religious beliefs impact their decision to have sex at least “somewhat.” Multivariate analyses showed that, compared with those with low religiosity, those with high religiosity were less likely to have had sexual intercourse (OR = 0.23, 95% CI = 0.14, 0.39). Among sexually active participants, those with high religiosity were less likely to have been pregnant (OR = 0.46, 95% CI = 0.22, 0.97), to have had an STD (OR = 0.42, 95% CI = 0.22, 0.81), or to have had multiple (≥4) lifetime partners (OR = 0.38, 95% CI = 0.21, 0.68) compared to those with low religiosity. Levels of religiosity were not significantly associated with frequency of intercourse, contraception use at last intercourse, or planned contraceptive use.ConclusionIn this cohort, religiosity appeared to be a protective factor rather than a risk factor with regard to sexual behavior and was not associated with contraception use.     

Are risk factors for stillbirths in low-income countries associated with sensorineural hearing loss in survivors?

Objectives.?To determine associated risk factors for stillbirths in Lagos, Nigeria and to examine possible relationships between these factors and the risk of sensorineural hearing loss (SNHL).

Methods.?Stillbirths in an inner-city maternity hospital from June 2005 to May 2007 were matched with live-birth controls at ratio 1:2. Risk factors and their associated adjusted odds ratio (OR) at 95% confidence interval (CI) were first determined by multiple logistic regression and then correlated with hearing screening failure among survivors who received a two-stage hearing screening with automated otoacoustic emissions and auditory brainstem response.

Results.?Of 201 cases examined and matched with 402 live births, 101 (50.2%) were fresh stillbirths and 100 (49.8%) macerated. Multiparity (OR: 1.92; CI: 1.16–3.20), lack of antenatal care (OR: 7.23; CI: 3.94–13.26), hypertensive conditions (OR: 6.48; CI: 2.94–14.29), antepartum haemorrhage (OR:18.84; CI: 6.96–51.00), premature rupture of membrane (OR:3.36; CI: 1.40–8.05), prolonged obstructed labour (OR: 22.25; CI: 10.07–49.16) and prematurity (OR: 2.30; CI: 1.2–4.01) were associated with increased risk of stillbirths whereas caesarean section (OR: 0.24; CI: 0.12–0.48) was associated with lower risk of stillbirths. Infants delivered by mothers with hypertensive conditions during pregnancy were at risk of SNHL (OR: 2.97; CI: 1.15–7.64).

Conclusion.?Hypertensive conditions during pregnancy increase the risk of stillbirths and place survivors at greater risk of SNHL.     

Ectopic pregnancy risk with assisted reproductive technology procedures

OBJECTIVE: To assess the ectopic pregnancy risk among women who conceived with assisted reproductive technology (ART) procedures. METHODS: The ectopic rate for ART pregnancies was calculated from population-based data of pregnancies conceived with ART in U.S. clinics in 1999-2001. Variation in ectopic risk by patient and ART treatment factors was assessed by using bivariate analyses and multivariable logistic regression. RESULTS: Of 94,118 ART pregnancies, 2,009 (2.1%) were ectopic. Variation was observed by procedure type. In comparison with the ectopic rate (2.2%) among pregnancies conceived with in vitro fertilization and transcervical transfer of freshly fertilized embryos from the patient's oocytes (fresh, nondonor IVF-ET), the ectopic rate was significantly increased when zygote intrafallopian transfer (ZIFT) was used (3.6%) and significantly decreased when donor oocytes were used (1.4%) or when a gestational surrogate carried the pregnancy (0.9%). Among fresh nondonor IVF-ET procedures, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.7-2.4; referent group = ART for male factor), endometriosis (OR 1.3, 95% CI 1.0-1.6), and other nontubal female factors of infertility (OR 1.4, 95% CI 1.2-1.6) and decreased among women with a previous live birth (OR 0.6, 95% CI 0.5-0.7). Transfer of embryos with an indication of high implantation potential was associated with a decreased ectopic risk when 2 or fewer embryos were transferred (OR 0.7, 95% CI 0.5-0.9), but not when 3 or more embryos were transferred. CONCLUSION: Ectopic risk among ART pregnancies varied according to ART procedure type, reproductive health characteristics of the woman carrying the pregnancy, and estimated embryo implantation potential. LEVEL OF EVIDENCE: II-2.     

Is induced abortion a contributing factor to tubal infertility in Mexico? Evidence from a case-control study

OBJECTIVE: To determine the contribution of induced abortion to tubal infertility in Mexico. DESIGN: Population- and hospital-based case-control study. SETTING: Tertiary hospitals in Mexico City. SAMPLE: Women between 20 and 40 years with infertility and controls of the same age: 251 cases, 502 hospital controls, 502 neighbourhood controls. METHODS: A case-control study was conducted in four tertiary hospitals in Mexico City with 251 cases and 1004 controls (two hospital and two neighbourhood controls per case, matched by age [+/-2 years]). Cases were infertile women, aged 20-40, with tubal occlusion confirmed by laparoscopy. Controls were fertile women, who had carried a pregnancy to term within the last two years. Participants completed a previously validated questionnaire asking about reproductive history and induced abortion. RESULTS: Our study did not show an association between induced abortion and tubal infertility among women that did not relate both events (cases vs hospital controls: OR = 1.57, 95% CI: 0.29-8.65; cases vs neighbourhood controls: OR = 0.82, 95% CI: 0.07-8.99) using conditional logistic models adjusting by marital status, number of pregnancies, age at first sexual intercourse and history of pelvic inflammatory disease. In contrast, early age at sexual debut and history of pelvic inflammatory disease significantly increased the risk of tubal infertility. CONCLUSIONS: In Mexico, the lack of association between induced abortion and tubal damage causing infertility observed in this population might be explained by a shift toward "safer" abortion practices.     

Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate

OBJECTIVE: To determine variables that predict treatment failure after methotrexate (MTX) treatment of ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Canadian teaching hospital. PATIENT(S): Sixty patients diagnosed with and treated for ectopic pregnancy. INTERVENTION(S): A single dose of methotrexate (50 mg/m(2)) by i.m. injection. MAIN OUTCOME MEASURE(S): Resolution of serum beta-hCG or clinical evidence of treatment failure. RESULT(S): Treatment failure was observed following methotrexate administration in 65% of cases when initial beta-hCG was >4000 IU/L, but in only 7. 5% of patients when serum beta-hCG was <4000 IU/L (OR = 52.06, 95% CI 4.88-555.56). Patients who presented with pelvic pain without tenderness had treatment failure 56% of the time versus only 17% in those without pain (OR = 9.20, 95% CI 1.02-82.60). Treatment failure also occurred in 53% of patients presenting with vaginal bleeding versus 16% without bleeding (OR = 6.18, 95% CI 0.73-51.93). CONCLUSION(S): Methotrexate should not be used to treat ectopic pregnancy when initial beta-hCG is >4000 IU/L. Caution should also be exercised in using methotrexate for ectopic pregnancy when the patient presents with bleeding or pain even without tenderness.     

Perceived health, sick leave, psychosocial situation, and sexual life in women with low-back pain and pelvic pain during pregnancy

BACKGROUND: Low-back pain and pelvic pain (LBPP) is a common problem during pregnancy. The aim of the study is to investigate perceived health, sick leave, psychosocial situation, and sexual life among women experiencing LBPP during pregnancy. METHODS: All women who gave birth at one of two hospitals in northern Sweden from 1 January 2002 to 30 April 2002 were invited to complete a questionnaire on their obstetric history, pregnancy, and delivery. Univariate and multivariate logistic regressions were performed in order to calculate odds ratio (OR) and its 95% confidence interval (CI) where applicable. Pearson's chi-square test was performed where applicable. RESULTS: Most women were married or cohabiting (98%), and reported a 'very good' or 'good' partner relationship (96%) and a satisfying sexual life before pregnancy (91%). Only a few women reported perceived health as 'quite poor' or 'poor' before pregnancy (2%); however, this proportion increased during pregnancy (13%). In general, satisfying sexual life declined during pregnancy, which was also the case for the assessment of perceived health during pregnancy. Women with LBPP during pregnancy had an increased risk of reporting poor health (OR = 3.05, 95% CI = 1.70-5.46). Overall, 68% of women had been on sick leave, and 22% had received maternity allowance. Women with LBPP reported sick leave in 72% of the participants. CONCLUSIONS: LBPP demonstrates a negative impact on perceived health and sexual life during pregnancy. A great majority of pregnant women were on sick leave at some time during pregnancy. These consequences make LBPP a major public health issue.     

Pre-pregnant body mass index, weight gain and the risk of delivering large babies among non-diabetic mothers.

OBJECTIVE: Pre-pregnancy overweight and excess weight gain during pregnancy have each been associated with an increased risk of delivering large babies. However, previous studies have focused on the separate effects of these two indices of weight in diabetic women. METHOD: This study analyzed both separate and combined effects of pre-pregnant body mass index and weight gain in relation to macrosomia (> or =4000 g) in offspring among 815 non-diabetic women, using data collected from a retrospective study. RESULT: Compared to mothers with normal pre-pregnancy BMI and pregnancy weight gain, risk of macrosomia in offspring was significantly elevated only in overweight women with excess weight gain (adjusted OR=2.6, 95% CI [1.2,5.4]) but not among normal weight mothers with excess gain (adjusted OR=1.1, 95% CI [0.5,2.4]) or overweight mothers with normal or low gain (adjusted OR=1.1, 95% CI [0.4,3.1]). CONCLUSION: Given the complications that are associated with delivering large babies, overweight women may benefit from not gaining excess weight in pregnancy.     

Risk factors for placental abruption in an Asian population

The objective of this study was to identify risk factors for placental abruption in an Asian population. The authors conducted a retrospective review of 37 245 Taiwanese women who delivered between July 1990 and December 2003. Pregnancies complicated by placenta previa, multiple gestation, and fetal anomalies were excluded. Multivariable logistic regression was used to adjust for potentially confounding variables and to identify independent risk factors for placental abruption. Three hundred thirty-two women had placental abruption (9 per 1000 singleton deliveries). Women who smoked during pregnancy (adjusted odds ratio [OR] = 8.4; 95% confidence interval [CI] = 3.0-23.9), had gestational hypertensive diseases (adjusted OR = 4.9; 95% CI = 3.3-7.3), pregnancies complicated by oligohydramnios (adjusted OR = 4.2; 95% CI = 2.7-6.7), polyhydramnios (adjusted OR = 3.3; 95% CI = 1.4-7.7), preterm premature rupture of membranes (adjusted OR = 1.9; 95% CI = 1.1-3.1), entanglement of umbilical cord (adjusted OR = 1.6; 95% CI = 1.2-2.1), were of or more than 35 years of age (adjusted OR = 1.5; 95% CI = 1.1-2.0), and had a low prepregnancy body mass index (adjusted OR = 1.3; 95% CI = 1.0-1.6) were at increased risk for placental abruption. Some risk factors for placental abruption among Taiwanese women are the same as those of other ethnic groups, whereas some of the risk factors are different.     

Pelvic inflammatory disease in adolescents

PURPOSE OF REVIEW: We discuss the epidemiology, risk factors, microbiology, diagnosis, treatment and prevention of pelvic inflammatory disease in adolescents. RECENT FINDINGS: Young age is one of the most important risk factors for sexually transmitted diseases and pelvic inflammatory disease. Sexually active adolescents have the highest incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and pelvic inflammatory disease of any sexually active age group. Long-term sequelae of pelvic inflammatory disease include ectopic pregnancy, tubal factor infertility, tubo-ovarian abscesses and chronic pelvic pain. Subclinical pelvic inflammatory disease is responsible for a significant portion of these long-term sequelae. New (2006) Centers for Disease Control and Prevention treatment guidelines for pelvic inflammatory disease are available. One of the best methods of prevention of pelvic inflammatory disease is to screen and treat sexually active adolescents for chlamydial infection. Implementation of nucleic acid amplification assays allows screening of adolescents via self-collected urine or vaginal swab samples. SUMMARY: Pelvic inflammatory disease is a highly preventable source of reproductive morbidity for adolescents. It is prudent that clinicians provide counseling regarding healthy sexual behaviors, STD prevention, and contraception whenever an adolescent presents in need of STD screening or evaluation for pelvic inflammatory disease.     

Multiple sexual partnership mediates the association between early sexual debut and sexually transmitted infection among adolescent and young adult males in Nigeria

Objectives To assess the relationship between early sexual debut, risky sexual behaviours and sexually transmitted infections (STIs) among young males.

Methods The study was cross-sectional analytical in design and involved 1278 Nigerian males aged 15–24 years. Logistic regression was used in assessing the statistical relationship between early sexual debut (<16 years) and self-reported STIs (history of at least one of three symptoms – painful urination, genital discharge, and genital ulcer/sore – within the past 12 months), with demographic factors, sexual behaviours and psychosocial measures controlled for.

Results The prevalence of self-reported symptoms was 4.2% for genital discharge, 4.1% for painful urination, and 2.0% for genital sore/ulcer. Overall, 6.8% had STI symptom(s). At bivariate analysis, early sexual debut (p = 0.021), multiple partners (p < 0.001), concurrent partners (p = 0.002), and sex with casual/commercial partners (p = 0.013) were associated with STIs. At multivariate analysis, early sexual debut (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.17–3.84) remained significantly associated with STIs. Multiple sexual partnership (OR = 2.00, 95% CI = 1.13–3.52) was also significantly associated with STIs, and is a mediator of the association between early debut and STI.

Conclusions Multiple sexual partners and early sexual debut are associated with STIs among adolescent and young adult males.     

Sexual behaviour and contraceptive use among secondary school students in Ilesha south west Nigeria.

Data from several parts of Nigeria point to increasing sexual activity among single adolescents of both sexes with progressive decreasing age at initiation and poor contraceptive use. This paper investigates the sexual behaviour and contraceptive use among teenage secondary school students in Ilesha, southwest Nigeria. This is a cross-sectional population survey of 300 male and female secondary school students within the age group of 13-19 years. The setting is secondary school coaching classes in Ilesha, southwest Nigeria. The outcome measures include prevalence of sexual activity, age at first sexual debut, circumstances leading to first sexual debut, number of sexual partners and family planning use. The result shows that out of the 300 studied, 50% were sexually active, the predominant age at first coitus was 15-19 years, and circumstances leading to sexual debut included mutual agreement, coercion and curiosity. Predominant proportion of sexually active teenagers (86.7%) did not use contraception at the time of first coitus and most of them had more than one sexual partner. The conclusion from this study is that 50% of teenage secondary school girls in this part of Nigeria are sexually active; 68.7% whom, have multiple sexual partners, and 86.7% of them did not use contraception at sexual debut. This unsafe sexual behaviour therefore put them at a great risk of acquiring STDs including HIV infection, and unwanted pregnancy. This study therefore recommends sex education/family life education for young people to encourage them to delay sexual activity as much as possible and practice safe sex when it eventually commences. There is also the need to sensitise the young people, parents, teachers, the community and all stake holders on the magnitude of the problem and to open up dialogue that will break the social, cultural and other mysteries hindering adolescents and youth reproductive health education and services in Nigeria.     

Fear of an Intimate Partner and Women’s Health in Early Pregnancy: Findings from the Maternal Health Study

ABSTRACT: Background: Intimate partner violence affects 1 in 4 women at some stage in their lives. Exposure to violence has short‐ and long‐term consequences for women themselves and their children. The objective of this study was to examine associations between fear of an intimate partner and maternal physical and psychological morbidity in early pregnancy. Method: This paper reports baseline measures from a prospective pregnancy cohort study of 1,507 nulliparous women recruited at six public hospitals in Melbourne, Australia. Results: The study showed that 18.7 percent (280/1,497) of women reported being afraid of an intimate partner at some stage in their lives; 3.1 percent (47/1,497) were afraid in early pregnancy and 15.6 percent (233/1,497) had been afraid before but not during the current pregnancy. Compared with women who had never been afraid of an intimate partner, women who reported being afraid of an intimate partner in early pregnancy (≤ 24 wk gestation) were at increased risk of urinary incontinence (adjusted OR = 1.64, 95% CI 0.9–3.1), fecal incontinence (adjusted OR = 3.32, 95% CI 1.2–9.2), vaginal bleeding (adjusted OR = 2.84, 95% CI 1.5–5.5), anxiety (adjusted OR = 10.22, 95% CI 5.0–21.2), and depression (adjusted OR = 4.43, 95% CI 2.1–9.7). Women afraid of an intimate partner before but not during pregnancy experienced a similar pattern of morbidity. Conclusions: Women afraid of an intimate partner both before and during pregnancy have poorer physical and psychological health in early pregnancy. (BIRTH 35:4 December 2008)     

Sexually transmitted diseases and risk of HIV infection in men attending a sexually transmitted diseases clinic in Dakar, Senegal

This cross-sectional study was carried out among male outpatients with symptoms of STDs at the STD reference centre at the Institute of Social Hygiene (IHS), Dakar, Senegal, from March 1989 through May 1991. This study was used to determine the prevalence of STDs and HIV among male patients attending an STD clinic and to identify their socio-demographic characteristics and risk factors. A total of 975 patients were enrolled in the study. The most common syndromes were urethritis (76%) and genital ulcers (22%). Considering single infections, the major STD agents were Neisseria gonorrheae (N.gonorrheae, 30%), Chlamydia trachomatis (C.trachomatis, 15%), Treponema pallidum (T.pallidum, 12%), and Haemophilus ducreyi (H.ducreyi, 7%). HIV prevalence was 2.6 percent (25/975). After multivariate analysis, the risk factors associated with HIV infection were a history of sex with prostitutes (odds ratio [OR] = 8.6, 95% confidence interval [CI] = 2.0-37.8), unprotected sexual contact (OR = 5.6, 95% CI = 1.2-25.0), a history of urethritis (OR = 3.4, 95% CI = 1.3-8.9), current STDs due to H.ducreyi or T.pallidum (OR = 6.1, 95% CI = 2-18.8), and mixed STD infection (OR = 5.3, 95% CI = 1.3-21.8). HIV prevalence was quite low in this population compared to similar studies of STD patients from other sub-Saharan African countries. Neisseria gonorrheae and Chlamydia trachomatis were the leading causes of STDs. A history of risky sexual behaviour, previous STDs, current genital ulcers, and mixed STD infections were associated with HIV infection. Further studies are necessary to determine changes in the relationship of STDs and HIV infection in this population.     

Risk factors associated with blood transfusion in ectopic pregnancy.

OBJECTIVE: To determine the risk factors associated with blood transfusion in ectopic pregnancy. STUDY DESIGN: A retrospective chart review of the presentation and hospital course of ectopic pregnancies managed over five years at two hospitals was undertaken. Thirty-two variables, including demographics, presenting signs and symptoms, and intraoperative findings, were examined with univariate and multivariate logistic modeling. RESULTS: Among 185 patients with histologically confirmed ectopics who were managed surgically, 8.6% (16 women) required transfusion. Multivariate analysis of risk factors for blood transfusion demonstrated a statistically significant association with (1) initial hemoglobin < 10 g/dL (odds ratio [OR] 38.8, 95% confidence interval [CI] 6.0-356.8); (2) human chorionic gonadotropin levels > or = 6,500 mIU (OR 18.1, 95% CI 3.6-158.1); and (3) abnormal bleeding on presentation (OR 0.08, 95% CI 0.007-0.42). The presence of two of these factors had a sensitivity of 82% (95% CI 48-98%) and a positive predictive value of 33% (95% CI 16-54%). No case had all three factors. CONCLUSION: This study was, to our knowledge, the first regression analysis of risk factors for transfusion associated with ectopic pregnancy. It demonstrated that initial hemoglobin and human chorionic gonadotropin levels as well as abnormal bleeding on presentation are independent risk factors for blood transfusion in ectopic pregnancy.