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A History of Malaria Control in Uganda: The Limiting Effects of Political and Socio-Economic Inequality in Implementing Global Health Programs Grace Akello  

Abstract: Objective: To analyse the extent to which political and social-economic inequality have affected malaria
control programs for prevention and treatment from 1950 to 2011 in Uganda.
Methods: My analysis is based on both ethnographic study findings over a one-year period with children who
experienced war in northern Uganda in 2004-2005. The main objective of the research was to investigate children's
illnesses and quests for therapy during a time of war. Additionally, I conducted a review of all policy documents and
strategic plans by Uganda's Ministry of Health capturing experiences in implementing global and national health policies
in malaria control.
Findings: Wartime children rarely engage in preventive measures, use cheap and affordable antimalarials, most of which
have been scientifically proven to be ineffective. In addition the earlier ‘war’ on the malaria mosquito and the more recent
recommendation of Artemisinin-based Combination Therapy (e.g. Coartem) as the first-line drug for uncomplicated
malaria have been largely unsuccessful ventures, because malaria control requires programmes focusing on the social
determinants of disease, such as poverty, since these factors hinder people's ability to practice recommended measures.
Programmes aimed at the zoonoses, parasites, or vectors and pharmaceutical/technological aspects of control and
management of malaria, like indoor residual spraying, using insecticide treated nets, spraying with DDT and use of
Artemisinin-based Combination Therapies for uncomplicated malaria are short-term approaches which do not contribute
to eradication, as frequently announced and promoted.
Conclusion: Socio-economic and political inequality are obstacles to effective malaria treatment and prevention
programmes in Uganda and other resource-poor settings in sub-Saharan Africa.

Existing Disparities in Injury-related Mortality Rates in China: A Public Health Challenge Divya Talwar Xuewei Chen

Abstract: Injury-related mortality is a major public health concern worldwide. Globally, about 16,000 people die from
injury-related causes every day. In China, after malignant tumors, cardiovascular diseases and respiratory disorders–
injury ranks as the fourth leading cause of death. These mortality rates associated with injury are disproportionately
higher according to demographic factors such as age, gender, geographical location, and occupation-demonstrating a
need for public health interventions among these groups. Increase in injury-related mortality rate leads to loss of
productivity and serious economic burden, such as 3.5 million hospitalizations with total annual economic loss of
approximately U.S. $12.5 billion-almost four times the Chinese public health budget. Our paper aims to explore the
current trends in the area of injury- related deaths, disparities associated with demographic factors along with cultural
factors unique to China, and identify possible approaches that may reduce associated public health implications.
Our literature review identified problems in the existing injury prevention programs in China such as: (a) China has two
mortality registry systems and both have high rates of missing data, problematic content validity, and persistent issues
with data management; (b) There is a lack of knowledge among the public health practitioners who do not consider injury
prevention as a public health goal, an area that requires immense improvement; (c) Neither do medical schools have any
structured courses to deal with injury prevention nor does CDC consider this issue as a routine job; (d) There is a dearth
of training programs for injury prevention at the provincial and central level, thereby, creating a shortage of specialized
workforce; (e) Underreporting of Road Traffic Injury (RTIs) data especially in rural areas points to a surveillance system
of questionable quality.
These existing disparities need to be addressed promptly with a particular focus on the rural population. Evidence-based
models such as Haddon’s matrix and Public Health Approach may be used to develop injury control and prevention
programs along with enforcement of strong governmental policies

Anthropology as an Emerging Global Discipline: A New Research Ethic Serge D. Elie  

Abstract: This article contributes toward the recalibration of the human science disciplines within an emerging historical
conjuncture increasingly free of Western hegemony enabling an “epochal shift” with the re-emergence of Tricontinental
nations of Africa, Asia and Latin America, thus necessitating the reconfiguration of the geopolitics of knowledge
production. The article argues for the delinking of disciplinary practice from the prevailing Euro-American epistemological
hegemony currently in the throes of an epistemic panic induced by the inextricable nexus between Western power’s
post-imperial detumescence and the discipline’s institutional senescence. The discipline’s adoption of neo-liberalism as
its default paradigm has consolidated its surrender to the philosophical purview of “racial liberalism” and its derivative
“epistemology of ignorance.” The latter’s epistemic legacy is the hegemony of metropolitan travelling theories and their
credo of interpretivism that generate knowledge claims as imported theory-mediated mystifications of cultural others. The
article seeks to redeem disciplinary practice from the resulting cognitive dysfunctions and moral liabilities, by proposing
an alternative conception of the practice of anthropology as a field science of the human condition based on mesography
as a new research ethic. Mesography is an integrative research framework for the human/social sciences in quest of
historically embedded and empirically-grounded explanations of human predicaments in an axial era heralding new
vectors of societal transformation. As such, it represents a “paradigmatic leap” that offers a methodological alternative to
the tyranny of an anachronistic ethnography and an epistemological exit from the hegemony of an exhausted Weststream

DNA Prediction in Forensic Anthropology and the Identity Sciences A. Midori Albert Charissa L. Wright

Abstract: The aim of this paper is to report on findings from burgeoning research occurring from 2010 to April 2015,
applicable to forensic anthropology and the growing field of identity sciences (i.e., biometrics), where DNA prediction of
phenotypic traits such as eye color, hair color, skin color, age, and biogeographic origin, is the primary focus. Using the
Cochrane method, over 40,000 articles were identified as potentially related to the research topic; of these, 475 were
deemed most suitable and analyzed. Results indicated 25 publications yielded information most germane to our
research question-where are we in terms of the ability to predict, from DNA, various phenotypic traits and what is the
feasibility of applications to forensic anthropology and the identity sciences. Discussed here is a review of the most
recent and relevant studies. Findings primarily show that eye color is promising for widespread use as a trait reliably and
accurately predicted from DNA. In need are improved methods of DNA extraction and analysis from bones and teeth
such that phenotypic trait prediction can become a viable and widespread tool in forensic anthropological casework. This
review of the literature is meaningful for contemporary global anthropology inasmuch as it raises awareness concerning
the scope of research and applied interests related to anthropology, specifically human biological variability, and
demonstrates new avenues for identification likely available in the near future to practitioners of the field of forensic

Foramen Magnum - New and Old Anthropological Data Franciszek Burdan Anna Dworzanska

Abstract: The foramen magnum is the biggest natural foramen of the neurocranium. It is located within occipital bone
and connects the posterior cranial fossa with the vertebral canal (base of the skull). The structure is surrounded by
various parts of occipital bone and secondary to their growth and development, the shape of the foramen may change
during prenatal and postnatal period. Oval or oval-to-round forms of the foramen are the dominant ones for the
contemporary human. However, numbers of anatomical variances have been already described, including circular, twosemicircular,
heart-like, wide oval, bi-rounded oval, ventrally wide oval, bi-pointed oval and dorsally convergent oval
forms. The structure is also directly or indirectly involved in numbers of pathological processes that may change its
contour/shape. The linear diameters (length and width/breadth) as well as area of the foramen, especially with similar
data of occipital condyles are helpful in sex determination.

The Popular Movement of Coupé-Décalé. Anthropology of an Urban and Coastal Dance Yaya Koné*  

Abstract: This article deals with the development of the popular cultures among the urban societies of the Gulf of
Guinea. In the early 2000s, various Ivory Coast movements know an important success among the African youth. In all
French-speaking Africa people dance on Coupé-Décalé. It’s a fashionable movement inspired by daily life in war time.
Coupé-Décalé is a funny approach of dance. We note more than 120 gestures, some skills consist of an imitation of
football or traditional dance of the ancestors; the different ways of dancing are named Drogba, Dribble, Goal, Zidane,
Bird Flu… Every year an artist invents a new dance.

Perceived Causes of Autism Spectrum Disorders among Taiwanese Parents of Affected Children: A Qualitative Study Lei-Shih Chen* Jia Ye

Abstract: Background: Autism Spectrum Disorders (ASDs) represent a complex group of neurodevelopment and mental
disorders. Currently, the etiologies for ASDs are unclear. Consequently, it is important to assess the perceptions of
ASDs among parents of affected children, as their perceptions can impact parent-child bonding, disease prognosis and
treatment, subsequent education and living environment of the affected child, and interactions with health professionals.
The majority of available research regarding parental perceptions of ASDs has been conducted in the Western countries.
Given that culture plays an important role in parents’ views regarding the causes of ASDs, this study aims to examine
perceptions of the etiology of ASDs among parents in Taiwan – an Asian country strongly influenced by the Chinese
Methods: Participants were recruitment through ASDs organizations in Taiwan. In-depth interviews were performed with
31 mothers and 8 fathers who had at least one child diagnosed with ASDs. All interviews were audio-recorded,
transcribed, and subsequently analyzed via content analysis.
Results: The themes of ASDs etiologies identified by participants from the highest to the lowest frequencies were:
genetics (n=30; 76.9%), problems during mother’s pregnancy (n=18; 46.2%), complications/situations during delivery
(n=13; 33.3%), vaccination (n=11; 28.2%), environmental pollutions (n=10; 25.6%), children’s non-ASDs related health
problems and unintended injuries (n=9; 23.1%), parenting style (n=7; 17.9%), parents’ occupation (n=7; 17.9%), spiritual
or religious factors (n=6; 15.4%), children’s diet (n=2; 5.1%), maternal age at the time of pregnancy (n=1; 2.6%), and
children’s use of traditional Chinese medicine (n=1; 2.6%).
Discussion: Taiwanese parents held diverse views on the causes of ASDs. Overall, parental beliefs were based on
culture, scientific evidence/research and uninformed non-scientific views. Our results may help health professionals and
researchers identify gaps in parents’ knowledge of ASDs and understand commonly held misperceptions about the
causes of ASDs. Further, findings generated from this qualitative research may serve as the foundation for a research
instrument to survey beliefs regarding the causes of ASDs among larger samples of Taiwanese parents who have
children affected by ASDs.

Story of the First Identification in Forensic Dentistry Endorsed by the American Justice System Xavier Riaud*  

Abstract: In 1849, Webster killed Parkman. The latter’s body was never found but his dental prostheses were
discovered and later identified. Webster was arrested and prosecuted for murder. The analysis of the dental prostheses
carried out by Parkman’s personal dentist positively identified the prostheses, resulting in Webster being condemned to
death. This was the first case of identification in forensic dentistry, which was endorsed by the American courts.

An Anthropo-Medical Approch on Stress Among Teenagers and Young People in Romania Adina Baciu*  

Abstract: Objectives: This study aims to determine of multi-inter-disciplinary perspective, the extent to which young
people perceive mental stress, the main factors of stress and its consequences on the human body, highlighting the
electrographic characteristics of the mental stress condition.
Materials and Methods: This cross-sectional study was conducted in 2014, in Bucharest, during the Educational project
of partnership no 812/2013, involving 407 subjects (156 boys, 251 girls), aged 14-21 years. The participants in the study
were 198 adolescents- pupils at college (aged 14-18 years) and 209 young people-students in the first year at Faculty of
Medicine (aged 18-21 years). The subjects were medically and anthropometrically examined and there were created
ordinal, nominal and binar questionnaries, including 67 items, to complete the data. During the study we have used six
items wich refer to mental stress, highlighting the electrophysiological and biophysical features of certain mentally
stressed teenagers and young people. The statistical analysis (Pearson Chi-Square test) was performed with the help of
SPSS version 13.
Results: Most of the participants of both sexes believe that young people are very much exposed to psychological stress
(Chi-Square=2.608, p=0.271). Most of the young participants consider that the main consequences of stress are
illnesses, especially mental ones, followed by digestive and cardiovascular conditions (Pearson Chi-Square=16.224,
p=0.023). A large number of the participant girls consider themselves to be stressed, while most of the boys think they
are not stressed (Pearson Chi-Square=20.308, p= 0.000). Most of the boys and girls believe that drug therapy is less
effective in combating psychological stress (Pearson Chi-Square=0.711, p=0.871), relaxation being considered the most
effective remedy. The electrographic image under stress conditions presents rare and sporadic electric discharges
(streamers), which are asymmetrically distributed on left and right sides and which are common for the individuals with
certain pathological conditions. After a 15 minutes exposure to relaxing music, strong electrical discharges are visible,
which are symmetrically distributed on left and right sides and which are common for the psycho-emotional and somatic
Conclusion: Stress is a real problem found in most countries, which can affect people, causing many diseases and
suffering. It is important that the stress factors are known, along with the remedies of such conditions, because stress,
even if it is not considered a disease, it can hugely affect people in time, causing even death. The response to stress is
influenced by both individual characteristics (personality traits, tolerance, adaptability or vulnerability), as well as external

Role of Hysteroscopy in Infertility – A Retrospective Study Neema Acharya Amruta Gadge

Abstract: Aim: The aim of this study is to assess the results of hysteroscopy done in cases of infertility.
Objective: To determine the incidences of abnormal findings of hysteroscopy in evaluation of infertility.
Material and Methods: This retrospective observational study was carried out at department of Gynaecology AVBRH,
sawangi, over a period of six months from October 2016 to March 2017. After detailed clinical evaluation, all patients of
infertility and subinfertility, irrespective of their obstetric history, coming to AVBRH, sawangi were informed regarding the
procedure and written informed consent was taken. Hysteroscopy was performed in operation theatre by using KARL
STORZZ hysteroscope. It is a rigid continuous flow panoramic hysteroscope 25 cm in length, 5 mm diameter of an outer
sheath and 30° fibroptic lens. All procedures were done under general anaesthesia. Distension of uterine cavity was
achieved with normal saline by pressure bag or Endomat. Endocervical canal followed by whole uterine cavity with all
four walls and bilateral ostias were visualised. Endometrial biopsy was taken for histopathological examination under
direct vision if required. If any pathology like intrauterine adhesions, polyp, myoma or septa was diagnosed, operative
procedure was done at the same sitting.
Data was collected from the medical records department of the hospital. Statistical analysis was done by using
descriptive and inferential statistics using z-test for single proportion and software used in the analysis were SPSS 17.0
version and EPI-INFO 6.0 version and z>1.96 considered as significant.
Results: Hysteroscopy was performed in 85 infertile women, out of which 61 (71.76%) presented with primary infertility
and 24 (28.24%) women were with secondary infertility. Analysis was performed against primary and secondary

Neonatal Outcome in Caesarean Births for Unexplained Fetal Distress S. Chhabra M. Karambelkar

Abstract: Background: Appropriateness of caesarean section (CS) for foetal distress (FD) is proved by neonatal status
at birth. Validity is known after intervention has been done, whether justified CS or not. It provides information about
delays also.
Objectives: Objectives were to know burden of CS for FD in women with no apparent risk factors, factors detected during
CS, accuracy of diagnosis, whether really FD or false alarm.
Material Methods: Five years records of births were analysed for knowing about CS for FD in women with no obvious
risk factors, neither in history, nor clinical examination or day to day investigations which could have lead to diagnosis of
FD. Approval of institute’s ethics committee was taken. Analysis of records of women who had CS (2121) performed for
FD as primary indication, revealed that 38.15%, (809 of 2121 CS for FD), were study subjects, no risk factor.
Clinical diagnosis of unexplained FD contributed to 10.6% of CS, 15.2% of emergency CS, 3.7% of births during study
period. Details of CS, intra-operative findings, status of liquor amnii, placenta, umbilical cord vessels, status of baby at
birth beyond were recorded.
Results: Of 809 cases, 6 (0.8%) were teenagers, 569 (70.33%) of 20-24 yrs, 705 (87.14%) were primigravida, actually
95.67% were nullipara, highly significantly (P<0.01) more primigravida than over all 45% primigravida. 11.99%, (97 of 809) CS were performed at less than 34 weeks gestation. FD was diagnosed by any one or two or all three, nonstress test, moderate or thick meconium in liquor or persisting foetal tachycardia or bradycardia. NST recorded category – III (non reassuring foetal heart) in 395 (48.83%) women, in others 48.83% (395 of 809) it was moderate or thick meconium in liquor amnii, persistent foetal bradycardia, moderate (<100 bpm) or severe (<80 bpm) in 2.6%, (21 of 809), persisting foetal tachycardia (>180 bpm) in 6.18% (50 of 809). Baby was vigorous at birth in 353 (43.63%), 427 (52.78%) required
NICU admission. Of them, 241 (56.44%) improved, survived, but 186 (43.56%) died, 29 (3.58%) were still born. Overall
loss of 26.5% in CBs for FD is, a matter of concern.
Conclusion: Many CS were performed in women without risk factors with diagnosis of FD. In quite a few it was proved
that intervention was needed and also in some delayed too, but in some it seemed to be unwanted intervention. Studies
are needed to search for non-conventional or unknown risk factors for FD, also for authentic modes of knowing nonreassuring
foetal status. Once diagnosed it is essential to have best outcome by quick right, interventions.

Neonatology Nurses’ Problems and Quality of Life Ebru K. Toruner Naime Altay

Abstract: Aim: Working in a shift system can disturb quality of life due to chronic fatigue, sleepiness and somatic
symptoms. This study aimed to determine the working conditions and problems encountered by nurses working in the
neonatal intensive care unit (NICU) and the effect on their quality of life.
Method: Nurses who were a member of the Neonatology Nursing Association of Turkey were included in the study. The
study sample consisted of 256 nurses. Data were collected with the descriptive data form and SF-36 quality of life scale.
The data were evaluated by frequency, percentage, and Spearman's test.
Results: Mean duration of work in the NICU was 4.8±3.97 years. Nurses mostly worked day and night shifts (60.9%); the
mean duration of work was 14.4±3.01 hours per shift. A nurse cared for 5.3±1.27 neonates on average. 9.8% of the
nurses were satisfied with the working environment. Common causes of dissatisfaction were low wages, high newborn
ratio per nurse and the excessive working hours. 97.3% of nurses stated that working in the unit has an effect on their
health. For SF-36 subgroups, the physical function score was high (62.5 ± 23.7), while the scores of the other subgroups
were under 50 points. The lowest score was role-physical (28.5±33.2). The nurses' quality of life scores were low in
Conclusion: This research was made in order to determine the working conditions of neonatology nurses and the effects
of these on their health and life quality

Concepts and Thoughts about Modern Uterine Intramural and Subserosal Myomectomy Andrea Tinelli  

Abstract: Myomectomy is the main conservative uterine operation of modern gynecology, as the percentage of patient
with myomas is ever increasing. In the last century, this operation was performed by “open” technique, then, with the
advent of minimally invasive technologies, it is passed to the endoscopic method. Thus, hysteroscopy and laparoscopy,
until the modern robotically assisted surgery were introduced or the removal of uterine myomas. Many of the concepts of
traditional surgery, in light of modern scientific evidences, were revisited, since the myomectomy have been evaluated
from the morphological-functional side. Therefore, with the forthcoming endocrinal biological discoveries, myomectomy
has slowly changed the technical and surgical planning. Many limits have been widely surpassed, up to the possibility of
applying this method even in older women, over 45 in which is critical of the uterus preservation for assisted procreation.
In the last century, considering to perform a myomectomy in a 45-47 year old woman with myomas was an unlikely
thought; nowadays, with the methods of assisted reproductive technique, many reproductive limits have been largely
overcome, until the menopausal pregnancy. This clinical opinion is based on biologic anatomic morphological evidences,
which allowed knowing better the consequences of uterine myomectomy within the capabilities of the uterus after

Ovarian Fibrothecoma with Acute Torsion and Extensive Cystic Degeneration after Long Quiescence in a Young Patient Suvarna Rai Akina Prakash

Abstract: Ovarian Fibrothecomas are rare tumors of the ovary classified under sex cord stromal tumors. They are
benign solid ovarian tumors that commonly occur in older women. They usually present with menstrual complaints
although rarely asymptomatic tumors also occur. Some of them are known to undergo torsion and cystic degeneration
when they are very big in size. We report a rare case of a young woman with a medium sized ovarian fibrothecoma
which had all the above mentioned in combination interestingly and presented acutely after years of quiescence.

The Effect of Technology-Based Breastfeeding Approach on Adolescent Mothers’ Breastfeeding Situation Rukiye Celik Ebru Kılıçarslan Törüner

Abstract: Adolescent pregnancy is an important health problem worldwide. This study aims to thoroughly investigate the
literature to examine the effects of the technology-based breastfeeding approach on breastfeeding success in
adolescent mothers. To be pregnant and to be an adolescent at the same time increase the risk of mortality and
morbidity in mothers and infants. Such breastfeeding challenges as not breastfeeding or starting but not continuing
breastfeeding, and negative thinking/practices on breastfeeding are more common in adolescent mothers than in adult
mothers. The way education and counselling is delivered is crucial to inform and support the risky adolescent mothers
for breastfeeding. Technology-based approaches has been increasing to improve the effectiveness and length of such
education in recent years. Technology-based approaches include web-based programs, tablets, mobile phones,
messages, and applications. Specific to individual and age-appropriate technology-based breastfeeding approaches with
a multidisciplinary team could provide effective and successful breastfeeding. The integration of breastfeeding
approaches with technology could increase the initiation and continuation of breastfeeding, the rates of breastfeeding of
babies and nutrition information/ behaviors of mothers considering the use of technology by adolescents. Health care
providers have significant roles to maintain, protect, and improve the maternal and infant health and also to prevent
adolescent pregnancies. It is thought that taking into consideration the developmental characteristics of adolescent
mothers, it would be beneficial the constitution of the technology-based breastfeeding programs by health care providers
with the roles of caring, counseling, educating, researching, collaborating, and advocating.

Maternal Serum Insulin in Hypertensive Disorders of Pregnancy and Neonatal Outcome S. Chhabra A. Tembhare

Abstract: Background: Complications of hypertensive disorders, during pregnancy (HDP), labour, postpartum have
been recognized for centuries. Focus has shifted from maternal to materno-neonatal outcome, because effects of HDP
on maternal metabolism have significant impact on perinatal outcome. Possibility of linkage of hyperinsulinemia leading
to hypoglycaemia, growth retardation is real.
Objective: Study was conducted to know relation of maternal serum insulin to the severity of hypertensive disorders and
its effects on neonatal outcome.
Material methods: Case control study was carried out over two years. Fasting blood sugar, insulin, post glucose blood
sugar were estimated.
Results: Overall 13.32% women who delivered during study period had HDP. Of these 964 women, 609(63.17%) had
mild HDP, 12 (1.97%) of them had elevated insulin, 9 (75%) of 12 had LBW, [(2 neonatal deaths, 4(33.33%) still births,
3(25%) admitted to neonatal intensive care NIC)]. Eighty three (8.6%) had severe HDP, 12(14.45%) of them had
elevated serum insulin, 8 (66.33%) of 12 had LBW babies (2 NND, 2 still births, one admitted to NIC), significant
(p<0.001) difference from 71 with severe HDP with normal insulin. One hundred eight (11.2%) had mild preeclampsia, 21(19.44%) with elevated insulin, [17 (81%) of 21 had LBW babies, 4 (19.04%) NND, 3(14.28%) admitted to NIC, one (4.76%) septicemia. 9 (42.85%) still born, perinatal loss significantly higher (p<0.001), than 87 with mild preeclampsia and normal insulin. One hundred fifteen (11.9%) women had severe PE, 52(45.21%) had elevated serum insulin, 16(30.76%) LBW babies, 13(25%) still births, 13 (25%) babies admitted to NIC, one of 13 (1.92%)died (LBW), difference (significant (p<0.05) from 63 severe PE with normal insulin. Fourty nine (5.08%) women had eclampsia, 24 (48.97%) of them had elevated insulin, of them 7 (29.16%) had LBW, 13(54.16%) still births, 13 (54.16%) admitted to NIC, one (4.16%) NND, significantly more than in 25 with normal insulin (p<0.02). In HDP maternal insulin levels correlated significantly with perinatal outcome irrespective of severity of HDP. Conclusion: While there was linkage of maternal serum insulin to the severity of HDP, the change in the insulin level affected the perinatal outcome more than the severity of HDP.

Cornual Ectopic Pregnancy or Angular Pregnancy, Delayed Diagnosis and Treatment of a Pregnancy Complication: A Case Report Cemile Dayangan Sayan Ozlem Banu Tulmac

Abstract: Cornual pregnancy is a rare type of ectopic pregnancy and defines an implantation in the upper and lateral
uterine cavity. Two to four percent of ectopic pregnancies occur in the interstitial portion of the fallopian tube. An angular
pregnancy term is a pregnancy that is located in the lateral angle of the uterine cavity. In the literature there is some
confusion about the terms cornual, interstitial and angular pregnancies.
We reported a female patient presented to our hospital with an eleven-week history of amenorrhea with two ineffective D
and Cs. We were unable to determine whether it was a cornual or angular pregnancy using sonographic examination. A
definitive diagnosis of cornual pregnancy was made by laparoscopy and a cornual resection and repair was performed
by laparotomy. Understanding the difference between cornual and angular pregnancy is clinically important due to their
different management and outcome. Cornual pregnancy, which still remains the most significant cause of maternal
mortality, should be considered, particularly in in cases of missed abortions in the first trimester, which are eccentrically
located in the uterus.

Snoring and Risk of Obstructive Sleep Apnoea in Malaysian Pregnant Women Anitha Vivekanandan Aznal Sharifah Sulaihabinti Syed

Abstract: Chronic hypoxia induced by periods of hypo-oxygenation in obstructive sleep apnoea (OSA) can be
associated with reduced foetal growth in pregnancy. Obesity, hormonal and physiological changes during pregnancy
plus variations in the craniofacial anatomy could increase the incidence of snoring and possibly OSA. In spite of the high
incidence of obesity noted in Malaysia, especially in females, there have been no studies so far conducted to study the
prevalence of OSA during pregnancy in this population. Thus, we sought to determine the prevalence of snoring and
those who are at high risk for OSA among pregnant women in Malaysia.

Maternal ABO Phenotype as a Predictive Factor for Pregnancy Complications Related to Prematurity Renae N. Reisig Phillip J De-Christopher

Abstract: Objective: The ABO blood types are associated with cancers, cardiovascular disease, and Type 2 diabetes in
adult males and females. Associations of ABO blood type and adverse pregnancy outcomes have not been extensively
studied. The purpose of this study was to investigate the relationship with ABO blood groups and risk of adverse
pregnancy outcomes contributing to premature birth.
Study design: Data on ABO phenotypes and pregnancy outcomes were collected from the medical records of 1,462
premature infants (22-34 weeks). Adverse pregnancy outcomes that were studied in relation to maternal blood type
included gestational hypertension (GHTN), preeclampsia (PREE), chorioamnionitis (CA), preterm premature rupture of
membranes (PPROM), and intrauterine growth restriction (IUGR)
Results: 1,462 charts of mothers with premature infants (22-34 weeks) were studied measuring the relative risk by using
standardized statistical software (SPSS).Our study group had 46 mothers with GHTN, 405 with PREE, 282 with CA, 504
with PPROM, and 94 with IUGR. A+ Caucasian mothers had a 28% increased risk of developing preeclampsia (RR=
1.28 (1.09-1.52); 95% CI= .003). B mothers are ata 46% decreased risk of developing chorioamnionitis versus all other
blood groups (RR= 0.54, 95% CI= 0.36-0.81; P= .003). Conversely, O+ Caucasian mothers were 2.53 times more likely
to develop chorioamnionitis compared to all other blood types (RR=2.53, 95% CI= 1.09-5.88; P= .031).
Conclusions: Maternal ABO phenotype significantly influences the incidence of preeclampsia and chorioamnionitis.
Pregnancy is a unique antigen-antibody phenomenon with the fetus serving as an antigen to the mother. We postulate
that blood group antigen expression at the endothelial level may influence maternal disease states.

Permanent Occlusion of Uterine Arteries in Management of Abnormal Uterine Bleeding Adel S. Helal Mohammad E. Ghanem

Abstract: Objectives: To assess the effectiveness of permanent bilateral occlusion of uterine arteries as a treatment
modality of abnormal uterine bleeding.
Design: prospective single arm study.
Setting: Done in Mansoura university hospital, department of Obstetrics and gynecology and private center (Mansoura
Integrated Fertility Center- MIFC) Mansoura- Egypt from October 2011to October 2015 including the study and follow up
Patients: The study includes One hundred eighteen (118) premenopausal patients followed up for thirty six months. All of
them completed their families and needing to preserve their uteri. 68.6 % of them experienced failed medical treatment.
Intervention: permanent bilateral uterine arteries occlusion in management of abnormal uterine bleeding.
Measurements: The primary outcome measures were patient satisfaction, Quality of life and improvements of pain and
bleeding compared with pretreatment one. Secondary outcome measures included postoperative pain, complications,
secondary interventions, and failures.
Results: One hundred and nine patients completed follow up for three years 109/118 (92.4%) reported their satisfaction
as indicated by reduction in days of menstrual flow per cycle (3.7 ± 2.8 vs. 8.8 ± 6.2 days, p < 0.0001) also, significant improvement in quality of life scores (9 ± 1.2 vs. 2.6 ± 1.8 p < 0.0001). with a variable failure rate varies from 5.6% at 6 months to 3.9% at 36 months follow up. Conclusion: permanent bilateral uterine arteries occlusion may be a good alternative to radical surgery in management of abnormal uterine bleeding.

Detection of Fetal Defects in First Trimester by Ultrasound Examination - Abilities and Limitations M. Yankova V. Stratieva

Abstract: The development of prenatal diagnostics in the recent years and the introduction of the new cell free DNA
testing for chromosomal abnormalities raised the question about the effectiveness of the well-known First trimester
screening. The need to reassess and to determine the efficacy of the 11-14 week scans in detecting fetuses with
chromosomal abnormalities and structural defects arose again. Could the First trimester screening be abandoned and
replaced by the new tests? In our practice we find that at 11-14 weeks some abnormalities are always detectable, some
can never be and others are potentially detectable depending on their association with increased Nuchal translucency
(NT). Fetal structural abnormalities can be classified as major or minor and of early or late onset. After the introduction of
a national screening program the prenatal detection rates for all congenital anomalies has increased considerably.
Especially anencephaly, gastroschisis and exomphalos are amenable for early detection (in the first trimester). The aim
of this study was to determine the efficacy of 11-14 week scan in detecting fetuses with structural anomalies that are
almost always detectable in the recent years.

Role of Progesterone in Miscarriage Alokananda Ray  

Abstract: About 10-15% of clinically recognized pregnancies end in a miscarriage. Recurrent miscarriage defined as
loss of three or more consecutive pregnancies complicate about 1-2% of couples trying to conceive. The most common
cause of miscarriage is chromosomal aberration in the fetus. However in a vast majority, the cause of miscarriages
remain unknown. This makes treatment options difficult and often empirical. It has been postulated that a causative
factor in many cases of miscarriage may be inadequate secretion of progesterone during the luteal phase of the
menstrual cycle and in the early weeks of pregnancy. Therefore, progestogens have been used, beginning in the first
trimester of pregnancy, in an attempt to prevent spontaneous miscarriages. In women presenting with a clinical
diagnosis of threatened miscarriage, there is preliminary evidence of a reduction in the rate of spontaneous miscarriage
with the use of progesterone. Larger RCTs may help to validate these findings. Initial reports of favourable outcome with
use of progesterone in recurrent pregnancy loss (RPL) could not be confirmed uniformly by larger randomized trials. This
article aims at reviewing the role of progesterone in treatment of threatened and recurrent miscarriages.

Maternal Mortality Ratio and Universal Access to Reproductive Health Care in the State of Qatar between 1990 and 2012: A PEARL Study Analysis Sajjad Ur Rahman Emirah Latiph

Abstract: Study Aim: The Millennium Development Goal (MDG)- 5 mandates a three quarters reduction in Maternal
Mortality Ratio (MMR) and provision of universal access to reproductive health by 2015. Our study aims to analyze
Qatar’s performance in achieving MDG 5 between 1990 and 2012.
Study Design: A National Prospective cohort-study
Data Source: Qatar Perinatal Registry (Q-Peri-Reg) for 2011 and 2012 data
Methods: National data on total deliveries, total births (live and stillbirths) and maternal mortality (during pregnancy to
day 42 post-delivery) was collected from all public and private maternity units in Qatar (1st January 2011- December,
31st 2012) and compared with historical maternal mortality data (1990-2010) ascertained from the database of maternity
and neonatal units of Women’s Hospital, annual reports of Hamad Medical Corporation and international reports. For
inter country comparison, country data was extracted from World Health Statistics 2011(WHO).
Results: The country wide live births were 20583 during 2011 and 22,225 during 2012 with two maternal deaths
duringeach year giving an MMR of 9.85/100,000 and 8.99/100,000 live births respectively which was more than three
quarters decline from an MMR of 49/100,000 in 1990. During 2011, 74.22% deliveries were normal vaginal (n 15076)
and 25.78% (n 5238) by Caesarean section. 99.45 % of deliveries were attended by a trained birth attendant in a
maternity facility while 0.55 % (n = 114) took place out of hospital. 100% of mothers had made at least one antenatal visit
and 100% of live births were examined by a pediatrician and entered in national birth register. Qatar’s 2011 and 2012
MMR is significantly lower than the current global MMR of 260/100,000 and Eastern Mediterranean Region MMR of
Conclusion: Qatar has achieved its target MDG 5 well before 2015. Qatar’s 2011 and 2012 MMR is comparable to most
high income countries. Qatar’s reproductive health system, with its universal access for all, provides a unique model to
study the correlates and associations of maternal survival which can form the basis of global health systems
improvement strategies.

Neonatal Risk Factor for Seizures in Term Neonate: A Hospital - Based Case Control Study Rajkumar Meshram Saira Merchant

Abstract: Objective: Assessing the neonatal risk factors for seizure in first 72 hours of life in term neonate.
Design: Case control study.
Setting: Department of Paediatrics, Neonatology unit tertiary care centre Govt. Medical College, Nagpur.
Method: A 210 cases i.e. term neonate with seizure within first 72 hours of life and 210 controls i.e. term neonate without
seizure in first 72 hours of life were randomly selected as study subject over a period of two year. Seizures were defined
as per standard definition. Data were collected regarding age of onset of seizure, birth weight, Apgar score at 1 minute
and 5 minute, type of delivery. Appropriate investigation was done and neonates were followed up till discharge or death
Results: In73% neonate’s subtle seizure was most common and occurs within 48-72 hours of life. Neonates with low
birth weight had 0.22 times more risk of seizure than normal weight. Birth asphyxia was most significant risk factor for
seizure and had 4.66 times more risk of seizure (P<0.001). Presence of low Apgar score at 1 minute and 5 minute are found to be significant in univariate analysis but in multiple logistic regression analysis it is found that 5 minute Apgar score is more significant than 1 minute. Low Apgar score at 5 minute had 1.29 times more risk of seizure. In study population 7.1% neonates died in case group compared to 1.4% in control group which was statistically highly significant (OR 3.98, 95% CI 1.23-16.7, P<0.0095) and most common cause of death was severe birth asphyxia and sepsis. Conclusion: Early identification and timely intervention of neonatal risk factor may reduces the seizure in term neonate.

Pediatric Dysphagia: A Rise in Preterm Infants and a Need for More Formal Training for Speech-Language Pathologists Emily Zimmerman  

Abstract: Background: The purpose of this study was to estimate how many master’s programs in speech-language
pathology (SLP) offer a course in pediatric dysphagia and to determine if taking this course improves how prepared
SLPs are to work with this population.
Methods: One hundred SLP master’s programs were examined to determine if they offered a pediatric dysphagia
course. Next, a pediatric dysphagia survey was sent out to SLPs to examine three main questions: 1) if their master’s
program offered a pediatric dysphagia course, 2) if they completed the course, and 3) how prepared they felt to work
with this population.
Results: Of the 100 SLP master’s programs contacted, only 21% of the SLP master’s programs offered a pediatric
dysphagia course. A majority (64.50%) of SLPs who did not completed a pediatric dysphagia course reported feeling
unprepared to work with this population.
Conclusions: There should be an increased focus on adding pediatric dysphagia courses into SLP master’s programs in
an effort to increase the level of preparedness for SLPs and to improve patient outcomes.

A Review on the Link between Psoriasis Vulgaris and Polycystic Ovary Syndrome Selda Isik Meliha Merve Hiz

Abstracts: Psoriasis and polycystic ovary syndrome (PCOS) are both triggered by hormones and chemical messengers.
Psoriatic women are also more prone than the general population to PCOS, and both diseases are tightly associated
with obesity, insulin resistance, diabetes, and metabolic and cardiovascular alterations. The aim of this paper is to review
the current knowledge on the association between psoriasis and PCOS, from immunologic and genetic perspectives.

A Review of the Role of Vitamins in Psoriasis in Pregnancy Meliha Merve Hiz Sevilay Kilic

Abstracts: Psoriasis is an immune mediated chronic inflammatory disorder. Psoriasis treatment regimen is an immune
regulation and inhibition of the cell cycle to prevent hyper proliferation of keratinocytes. Psoriasis does not affect the
reproductive ability of patients; however, psoriatic women in reproductive period should be aware of the side effects of
psoriatic medication. Understanding the molecular mechanisms beyond Psoriasis is crucial in developing effective
treatment options for Psoriasis and preventing birth defects such as spontaneous abortions, intermittent fetal
bradycardia, malformations and miscarriages.
Vitamin A and vitamin D are the skin hormones that regulate the cell cycle of the keratinocytes. Vitamin A and D
deliveries are extensively used in psoriasis treatment. Vitamin A is important for neuronal development; however,
excessive use of vitamin A is teratogenic. Vitamin D is useful for Psoriasis treatment and is required for bone integrity.
Vitamin D is also important for women’s fertility. Both vitamin A and vitamin D play a pleiotropic role in metabolism by
regulating different gene expressions. Thus, the use of the vitamins or their derivatives in psoriasis treatment is vital for
the fetus development. In this review we focus on the vitamin A and D metabolism, particularly molecular and genetic
aspects of psoriasis treatment during pregnancy.

Broken Umbilical Vein Canula- A Rare Unavoidable Complication Iyer Harohalli Venkatesh  

Abstract: Back ground: Sick neonate requires many procedures in neonatal intensive care unit for the survival. Umbilical
vascular catheterization is one such procedure. This procedure though easy and safe, it is not without complications. If
not detected in time it may cause morbidity and mortality.
Characteristics: A term (40 weeks) male baby on ventilator for meconium aspiration syndrome was catheterized with
umbilical venous and arterial canula for fluid management. After stabilization the canulae were about to be removed.
While retrieving umbilical venous canula, a distal part of it got fractured and stayed deep within the umbilical vein. X ray
abdomen demonstrated the broken canula in inferior vena cava below the liver margin.
Message: Utmost care should be taken while retrieving umbilcal canulae. Early retrieval of broken canula with the help of
pediatric surgeon saves baby.

Nesa Days 2015, Conference Report Andrea Tinelli  

The New European Surgical Academy (NESA) Annual Meeting, called NESA DAYS, was held in Berlin on 18-20
September 2015 at the Leonardo Royal Hotel Berlin Alexanderplatz ( nesa/
2015/Default.aspx). The Presidents of the Conference, Prof Michael Stark, Prof, Gian Carlo Di Renzo and Prof. Tahar
Benhidjeb, dedicated the main theme to acute care surgery and emergencies in all surgical fields, as well as novelties in
endoscopy and telesurgery. Participants learned about optimal ways of overcoming unexpected surgical situations in
many specialization fields. Opinion-leaders from various disciplines and countries presented their experience and ideas
about important issues in Obstetrics and Gynecology, General Surgery, Anesthesiology, Oncology, etc. The NESA is an
international, interdisciplinary organization with members in 51 countries and associated with international organizations
like FIGO (International Federation of Obstetrics & Gynecology), the German Gynecological Association, the Danish
Surgical Association and the Hong Kong Medical Academy. The NESA modifies and improves surgical procedures, has
created the first European working group for natural orifice surgery and supports the European telesurgical project. The
NESA initiates and performs surgical workshops in countries with limited resources. The NESA Days are interdisciplinary
surgical conferences, which enable surgeons from different disciplines to learn from each other and implement in their
own daily practices ideas from other disciplines. In ObGyn field, the topics concerned a focus on Cesarean Section, on
Uterine Fibroids, innovative instruments and endoscopic techniques (new hysteroscopic, laparoscopic and robotic
methods), pregnancy surgical complications, endometriosis treatment, gynecological oncology, breast cancer
treatments. The conference consisted in oral and video sessions where leaders in certain areas presented and
discussed the above-mentioned topics, presenting their results from recent years and point out future directions of
medicine. All invited researchers presented their investigations by poster presentations and discussion session. Finally,
participants from 38 countries attended the NESA DAYS conference.

Comparative Study of the Effect of Early Versus Late Initiation of Epidural Analgesia on Labour Trisha Naik Neema Acharya

Abstract: Background: Epidural analgesia also known as regional analgesia has been established as a safe and an
effective method of pain relief during labor. It was thought that epidurals may possibly interfere with labor and
consequently increase the rate of cesarean deliveries or instrumental deliveries or other adverse effect. . A more recent
review concluded that epidural analgesia is not associated with such a risk. But, the timing of placement of epidural
analgesia has been a controversial issue and how early laboring women can benefit from epidural analgesia is still
debated. Hence this comparative study determines the effect of early versus late initiation of epidural analgesia on labor.
Objective: To compare the effect of early versus late initiation of epidural analgesia on the duration of labour and the
mode of delivery.
Methodology: A randomized trial in which 100 term women in early labor at less than3 cm of cervical dilatation were
assigned to either immediate initiation of epidural analgesia at first request (50 women) or delay of epidural until the
cervix was dilated to at least 4 cm (50 women).
Results: At initiation of the epidural, the mean cervical dilatation was 3.1 cm in the early epidural group and 4.4 cm in the
late group (P value 0.0000). The mean duration from initiation to full dilatation was significantly shorter in the early
compared to the late epidural group: 5.57 hours and 6.3hours respectively amongst primigravida (P = 0.0001) and 3.04
hours and 4.07 hours respectively amongst multigravida. The rates of cesarean section were not significantly different
between the groups i.e. 6% and 6% in both early and late groups (P = 0.82) which was not significant. When questioned
after delivery regarding their next labor, the women indicated a preference for early epidural.
Conclusion: Epidural analgesia in the early labour, following the first request for epidural at cervical dilation of 2-3 cm
does not prolong the progression of labor and does not increase the rate of Cesarean deliveries , instrumental vaginal
deliveries , and other adverse effects in laboring women compared with the delayed analgesia at the cervical dilation of
4.0 cm or more. Furthermore, it was associated with shorter duration of the first stage of labor and was clearly preferred
by the women.

Status of Maternal Serum Vitamin D Levels in Rural India Monika K. Kotpalliwar Saunitra A. Inamdar

Abstract: Background: The role of Vitamin D during pregnancy and its effect on maternal and fetal health is just
beginning to be understood. What is clear, however, is that Vitamin D deficiency during pregnancy is rampant throughout
the world. Vitamin D deficiency is prevalent in India, a finding that is unexpected in a tropical country with abundant
sunshine. Various studies have shown an intrinsic relation between various parameters of maternal and fetal wellbeing
with maternal Vitamin D status during pregnancy.
Aim: To determine the status of Vitamin D levels in pregnancy among rural mothers.
Methods: A total of 60 pregnant females, aged 20-35 years were studied during the third trimester of pregnancy. Serum
Vitamin D was measured by chemiluminescent immunoassay.
Results: 65% subjects were found to have Vitamin D deficiency and 26.67% were found to have Vitamin D insufficiency
whereas 8.33% had normal Vitamin D levels. Mean maternal serum Vitamin D level was 15.97±9.216 ng/mL.
Conclusions: We observed a high prevalence of physiologically significant hypovitaminosis D among pregnant women
attending rural hospital. As mentioned in literature, Vitamin D deficiency is associated with adverse fetomaternal
outcome, the magnitude of hypovitaminosis D in antenatal period warrants public health intervention.

Increasing Cesarean Births, Cause for Concern S. Chhabra  

Abstract: Introduction: Relationship between increasing Caesarean section rates (CSRs), maternal-perinatal outcome
continues to be controversial but CSRs, have risen high, regardless of age, babies number etc, higher than necessary
for optimal maternal neonatal outcome with geographic variations. WHO advocates that CSRs should remain 5 - 10%
and with rates higher than 15%, risks increase. Studies reveal higher perinatal mortality with increasing CSRs. There are
many harmful effects on mother too.
Objective: To look into status of CSRs, causes of high CSRs, possibilities of reduction in CSRs.
Material & methods: Literature search with available search engines was done adding personal experiences and
Results: It was revealed that CSRs are increasing globally. Leading factors quoted are genuine needs, more women
asking for CS, liability pressure, continuous electronic fetal monitoring, private care, health problems, race/ethnicity and
other characteristics but none accounts for high CSRs. Upward trends in Caesarean births (CBs) are neither explained
by maternal characteristics nor pregnancy complications. Babies are more likely to have breathing problems, diabetes,
allergies, asthma, exhibit differences in composition of intestinal flora, long-term obesity, immune, endocrine dysfunction
independent of intestinal microbiota, prematurity, respiratory distress syndrome, neonatal intensive care unit admission.
All these lead to high perinatal mortality. CSs done without medical indication represent drain on resources, negative
health equity. Possible interventions to lower CSRs may be partography, vacuum / forceps births, evidence-based
protocols for evaluating fetal status, dysfunctional labour, second opinion for CS decision, auditing indications.
Conclusions: CSRs are increasing with their sequelae. Health authorities, professional associations, institutions, public,
media should work together to reduce maternal sufferings, social, financial burden due to over roofing CSRs.

An Interesting Solid Mass in the Posterior Maxilla of a Pregnant Woman Can Engin Durmaz Aydın Gülses

Abstract: We report a case of a 22 year-old pregnant woman who was considered in the differential diagnosis included
an erupted odontoma and an exposed necrotic bone of the maxilla at the time of the third trimester. During the 4th week
of the postpartum period, an orthopantomography was taken and radiopaque mass and ill-defined impacted molar teeth
were observed. After the surgical operation, the final diagnosis of ossifying fibroma was rendered. Ossifying fibromas
behave like benign bone neoplasms and are often considered to be a type of fibro-osseous lesions. They can affect both
the mandible and the maxilla, particularly the mandible. Fibroosseous lesions with unusual clinical and radiological
presentations might disquieten both the dental practicioner and the patient.

A Rare Pathology, Vulval Leiomyoma: Case Report and Literature Review Rachael Ann Read Aderemi Alalade

Abstract: This is a case of a vulval leiomyoma in a 50-year-old parous patient. There are fewer than a hundred and
twenty cases of vulval smooth muscle tumour reported in literature. This case offers more evidence for this rarely
reported condition, and as a learning point to avoid misdiagnosis.

The Role of Fetal MRI in the Diagnosis of Agenesis of Corpus Callosum (ACC) and other Associated Cerebral Anomalies George Hadjidekov Ivan Plachkov

Abstract: The corpus callosum is the main transverse tract of fibers that connects the two cerebral hemispheres. In rare
conditions an absence of fusion of the main commissural pathway connecting the cerebral hemispheres is observed.
This malformation develops in utero and is classified as partial and complete agenesis or hypoplasia of corpus callosum.
The condition is found in 3 to 7: 1000 live births. Fetal ultrasound (US) is first-line modality in evaluating corpus callosum
by 18-20 weeks of gestation. Fetal magnetic resonance imaging (MRI) is useful for exact assessment of the degree of
malformation as well as for detecting frequently associated anomalies. This pictorial review aims to present the role of
fetal MRI as a valuable adjunct to US in various abnormalities of corpus callosum in fetuses, which is an important issue
for prognostic counseling.

Rural Community Based Caesarean Section Ratesin A Resource Poor Region S. Chhabra V. Pandit

Abstract: Background: Tremendous increase in caesarean section rates (CSR) is reported with controversial
relationship between CSR and maternal-perinatal outcome.
Objective: was to know rural community based CSR, spill over effects of institutional practices and maternal, perinatal
outcome in low resource region.
Material Methods: Nurse Midwives based at institute visit each village, five times a year, provide home based prenatal
care, advocacy for intranatal, postnatal care, create awareness in women, communities about emergencies in high, low
risk, action needed. Records of pregnancy outcome, collected on regular basis were analysed irrespective of place,
delivery mode.
Results: CSR was 4.8% between1987- 1990,( base information), 11.6% between 2008 - 2011, in villages within 25-35
kms from institute, being served since 26 years (old), 1.2% between 1996 - 1999, 5.4% between 2008 - 2011 in villages
75-85 kms from institute, being served since 1996 (new). Perinatal mortality rates (PMR) have decreased, 62 between
1987 - 1990, 26 between 2008 - 2011 (2.38 times reduction) in old villages, 42 between 1996 - 1999 and 23 between
2008 - 2011 (1.82 times reduction) in new villages, with no maternal death due to pregnancy, labour specific disorders,
one death each due to sickle cell disease, murder, suicide in 15 years in this small population. There was
disproportionate increase in CSR midway, parallel to institute's CSR.
While nurse midwives can do a lot for maternal care in community, facility’s everyday practices affect community’s CSR.
Periodic audit is essential at health facility, community for possibilities of improving maternal perinatal outcome, curtailing

Henoch Schönlein Purpura in Pregnancy: a Case with Uncomplicated Maternal and Neonatal Outcome C. McCarey F. Boehlen

Abstract: Introduction: Henoch-Schönlein Purpura (HSP) is a systemic IgA-mediated small-vessel vasculitis. It is
primarily a childhood disease, rarely described in pregnancy. Pregnant women with HSP are at risk for hypertensive and
hemorrhagic complications. Due to the rarity of the condition during pregnancy, there is no consensus about the
preferred course of treatment but concerns regarding optimal management are ongoing.
Case presentation: We report the case of an 18 year-old primigravida, with a 3-year history of HSP, who had an
uneventful pregnancy and term delivery with epidural anesthesia.
Conclusion: Due to the systemic nature of HSP, multidisciplinary management of pregnant HSP patients should be
warranted to prevent complications.

Continence Abdel Karim M. El Hemaly Laila A. S. E. Mousa

Abstract: Continence is self-restraint and self- control especially temperance, sexual behavior and the body excreta
(ability to control one’s bowel and bladder).
Continence is an acquired behavior gained by learning and training. Continence is a nerve-muscle action. An alert
healthy nervous system (NS) and intact reactive muscles are the tools for expressing continence.
To gain continence, is how to control and train your sympathetic nervous system (NS). Most sympathetic nerve endings
secrete nor-epinephrine (NE). NE excites most of the visceral structures. The sympathetic NS mobilizes the body’s
systems during confronting a situation “Fight or flight.”
We gain progressively rising up sympathetic tone from everyday life stress, teaching, and experience. Stimulation of the
sympathetic NS, leads to rise in blood pressure. It dilates the pupil of the eye. It excites the liver to release glucose, and
increases the rate of metabolism of essentially all the cells of the body “fight or flight”. The integrative centers of the brain
can acquire by learning, and training how to master, synchronize, and harmonize different responses according to social
circumstances. Therefore, it is how to control the sympathetic NS is the way to gain continence.
After learning, sympathetic stimulation leads to: holding back (continence) or fight or flight”. If the situation is over –
whelming, the result is sympathetic failure and subsequent incontinence.
Incontinence results from fault in the sympathetic NS, CNS and/or the target organ.
Therefore, correcting the pathology of body’s excreta incontinence is by correcting the sympathetic nerves and their
neurotransmitters medically or treating the target organs (IUS & IAS) surgically.

Systematic Documentation of Fetal Heart Rate (FHR) Patterns and the Correlation with pH Computed in the Umbilical Artery V.M. Roemer R. Walden

Abstract: Introduction: A new computer program was written to analyze FHR-tracings of 601 fetuses from the
Frauenklinik Detmold in Germany. This program is demonstrated in this paper using data of one fetus only.
Material and methods: During a time period of eleven years 601 FHR-tracings were recorded electronically and further
analyzed. To demonstrate the program only one fetal case was further analyzed: 1.) In this case we measured the fetal
heart frequency (FHF) and one broad deceleration, 2.) the micro-fluctuation (micro) of this fetus and the micro during the
large deceleration, 3.) the oscillation amplitude (OZA) during the whole CTG and the OZA during this broad deceleration.
In addition the weighted WAS-score (reference 14) was determined and the actual pH-value was computed (not
measured) for umbilical blood. All these parameters are available in each case of these 601 fetuses.
Results: Besides the electronic CTG-analysis it is new to determine the actual pH-values in umbilical blood using only
the FHF: Both variables are not identical but belong closely together. The FHR helps to determine fetal well being and it
helps to compute the pH-values in umbilical fetal blood. Therefore, micro-blood sampling (MBU) according to E. Saling
seems to be no more necessary. These results are preliminary because our number of MBU’s is still small. The new
program is able to analyze FHR-tracings thoroughly and to determine the pH-values in umbilical blood
continuously.However, FHR-monitoring with a small computer seems to be necessary.
Conclusions: The fetus in utero can be monitored seriously using his FHR together with other parameters. In hypoxic
danger, the foetus can be monitored sufficiently without intermittent control of his actual pH-values in peripheral blood.
Fetal pH-values can be determined approximately and continuously using only the FHR.

Perinatal Outcome in Pregnant Women with Heart Disease Attending a Combined Obstetric and Cardiology Clinic in a Resource Limited Country Catherine Elliott Karen Sliwa

Abstract: Previously published literature has shown a clear relationship between adverse perinatal outcome and the
presence of maternal heart disease even when demographic and obstetric risk factors have been taken into account.
Prospective studies from South Africa or Africa describing pregnancy outcome in mothers with heart disease, where
there is a high prevalence of acquired rheumatic heart disease as well as cardiomyopathies and congenital heart lesions,
are limited. Perinatal data were collected to describe the perinatal outcome in patients with heart disease.
Objectives: The purpose of this study was to describe the perinatal outcome of pregnancies in women with heart disease
attending a multidisciplinary clinic and to compare the perinatal mortality rate with the perinatal mortality rate for the
background population. To determine whether there are any other associated adverse outcomes in babies born to
mothers with heart disease.
Methods: The first eighty-two consecutive pregnant patients with heart disease attending the weekly combined
cardiology and obstetric clinic were studied over eighteen months. Neonatal outcome was recorded. Adverse neonatal
outcome was defined as perinatal mortality, the need for delivery room resuscitation and admission to neonatal intensive
care unit (NICU).
Results: Perinatal mortality was 12.1 per 1000 live births. Only one stillbirth was documented. Adverse neonatal outcome
was 9.7%. Caesarean section rate was 40% with 29% of infants delivered preterm.
Conclusion: Perinatal mortality rate in this cohort was excellent - possibly due to a high level of joint care - but was linked
to a high rate of obstetric intervention.

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