Obstetrics and Gynaecology Forum - Volume 17, Issue 4, 2007
Volume 17, Issue 4, 2007
Author S. IsaacsSource: Obstetrics and Gynaecology Forum 17, pp 97 –102 (2007)More Less
Nausea and vomiting affect 60-80% of all pregnant women and have a wide spectrum of clinical presentation, depending on the severity and the length of time from the onset of the symptomatology. Most patients do not require treatment but the extreme clinical presentation is hyperemesis gravidarum, which accounts for an estimated 1% of all cases.
Author D. DaveySource: Obstetrics and Gynaecology Forum 17, pp 105 –110 (2007)More Less
The Women's Health Initiative (WHI) trial was a major contribution to the understanding of the risks and benefits of hormone therapy (HT) in postmenopausal women. Further analyses of the results of the WHI trial and a seminal review by Kuhl and Stevenson have put a new perspective on the benefits and risks of HT.1 It is suggested that
(A) Breast cancer
(i) Body mass and prior HT are important factors in determining the risk of breast cancer associated with HT.
(ii) The increased risk of breast cancer with CEE+MPA in the WHI trial is an artefact due to the low incidence of breast cancer in the placebo group of women.
(iii) The, so far, unexplained reduction in risk of breast cancer with CEE only in women age 50-59 could be due to the estrogen-induced reduction in insulin levels in the women who were overweight or obese, the majority of whom probably had the "metabolic syndrome" and hyperinsulinaemia.
(B) Coronary Heart Disease (CHD)
(i) CEE only in younger healthy postmenopausal women decreases the incidence of CHD but CEE+MPA in older women increases the incidence of CHD.
(ii) Addition of MPA to CEE in postmenopausal women increases the risk of CHD possibly due to an MPAinduced upregulation of thrombin receptors in the coronary arteries.
(iii) The effect of HT on the incidence of CHD is determined by age and by time since menopause on initiating HT. It is hypothesised that "HT in younger postmenopausal women prevents atherosclerosis and reduces the risk of cardiovascular disease BUT in older postmenopausal women increases the risk of thrombosis and inflammation and of cardiovascular disease in women with atherosclerotic plaques".
(C)Stroke and Total Mortality
(i) The increased incidence of stroke in women over age 60 with both the CEE+MPA and CEE only arms of the WHI trial is the main reason for caution in the use of HT in older postmenopausal women
(ii) The reduction in total mortality in women under 60 with both CEE+MPA and CEE only is an important new finding and requires further investigation.
(iii) The significant reduction in total mortality provides reassurance, if any is needed, of the safety and benefits of HT in younger postmenopausal women
Author C. Rockliffe-FidlerSource: Obstetrics and Gynaecology Forum 17, pp 113 –115 (2007)More Less
Determining 'abnormality' in the arena of sexual behaviour can be problematic. Sexual desire exemplifies these difficulties for a number of reasons. A range of prevalence figures are cited, and, depending on the definition and duration of 'desire difficulties' experienced, between 11% and 53.8% of women report such problems. How can up to half of the female population at any one time be abnormal?
Author G. PetroSource: Obstetrics and Gynaecology Forum 17, pp 117 –121 (2007)More Less
Malaria is a protozoan disease transmitted by the bite of an infected female Anopheles mosquito. It is the most important of the parasitic diseases of humans. Malaria is one of the diseases specifically mentioned as a target in the World Health Organisation Millennium Development Goals (MDG No. 6. is to "Combat HIV / AIDS, malaria and other diseases").
Source: Obstetrics and Gynaecology Forum 17, pp 123 –124 (2007)More Less
Bone fragments within the cervix uteri are a rare occurrence, however, they may be occasionally found within the endometrial cavity and body of the uterus. We report the case histories of two single, sexually active women who each presented with a history of repeated termination of pregnancy, dyspareunia, post-coital bleeding and penile bleeding in their partners. Examination revealed a hard sharp object embedded within the cervix uteri at the cervical os. Tissue histology confirmed bone fragments.