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Gebreslasie KZ, Gebre G, Zenebe D, Nardos R, Birhane A. Intimate partner violence during pregnancy and its association with birth asphyxia in hospitals of Tigray region, Ethiopia. BMC Pediatr 2024; 24:113. [PMID: 38350920 PMCID: PMC10863259 DOI: 10.1186/s12887-024-04585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Birth asphyxia is the main cause of neonatal mortality and morbidity worldwide. Some studies indicate intimate partner violence during pregnancy is a risk factor for birth asphyxia. In Ethiopia, intimate partner violence during pregnancy is reported to be high. Despite this high prevalence, there is a lack of data about the association of birth asphyxia and intimate partner violence. The aim of this study was to assess the prevalence of intimate partner violence during pregnancy and its associated factors with birth asphyxia in health facilities in the Tigray region of northern Ethiopia. METHODS This was an institutional-based cross-sectional study conducted at select health facilities in the Tigray region of Ethiopia. Random sampling technique was employed to select health facilities and systematic sampling was used to select 648 study participants. Data was entered by using Epi info version 3.5.1 and was analyzed using SPSS version 20. Bivariate and multivariate analysis was done to assess the association between exposure to intimate partner violence during pregnancy and birth asphyxia after adjusting for possible confounders. RESULTS The prevalence of intimate partner violence during pregnancy was 47(7.3%). Eighty two (12.7%) babies were delivered with birth asphyxia. Intimate partner violence during pregnancy had a significant association with birth asphyxia, AOR (95% CI) = 4.4(2-9.8). In addition to this, other factors that were associated with birth asphyxia include place of residence [ AOR (95% CI) = 2.7(1.55-4.8)], age > 19 [AOR (95% CI) = 2.9(1.29-6.5)], age 20-35 [AOR (95% CI) = 3.1(1.06-9.3)], gestational age < 37 weeks [AOR(95% CI) = 7.2(3.5-14.8)] and low birth weight [AOR(95% CI) = 3.9(2.1-7.3)]. CONCLUSIONS The prevalence of birth asphyxia in this study is high and is further increased by intimate partner violence during pregnancy. Health care providers and policy makers should take measures aimed at preventing intimate partner violence during pregnancy to reduce harm to the mother and adverse birth outcomes.
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Affiliation(s)
| | - Gelawdiwos Gebre
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Dawit Zenebe
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Rahel Nardos
- Oregon Health& Science University, USA, Portland
| | - Aklil Birhane
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Siyoum M, Teklesilasie W, Nardos R, Sirak B, Astatkie A. Reliability and validity of the Sidaamu Afoo version of the pelvic organ prolapse symptom score questionnaire. BMC Womens Health 2023; 23:324. [PMID: 37340303 DOI: 10.1186/s12905-023-02478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/13/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Both for clinical and research purposes, it is critical that clinicians and researchers use a tool that is trans-culturally adapted and tested for its psychometric properties. The English version of the Pelvic Organ Prolapse Symptom Score (POP-SS) questionnaire was developed in 2000. Since then it has been translated into other languages and verified. However, the tool has not been adapted for use in Sidaamu Afoo language in the Sidama Region of Ethiopia. OBJECTIVE This study aimed to translate and adapt the Pelvic Organ Prolapse Symptom Score questionnaire into Sidaamu Afoo and evaluate its psychometric properties. METHODS A total of 100 women with symptomatic prolapse completed version-2 of the POP-SS questionnaire during the first round of interviews, and 61 of them completed the questionnaire during the second round of interviews (to establish the test-retest reliability). We adapted the scale translation process recommended by Beaton and his colleagues. The content validity was assessed using the content validity index and the construct validity was done based on exploratory factor analysis using the principal component analysis model. The criterion validity was evaluated by using the Kruskal-Wallis test based on stages of the prolapse established via pelvic examination. The internal consistency reliability of the scale was assessed using Cronbach's alpha value, and test-retest reliability was evaluated using the intraclass correlation coefficient. RESULTS The questionnaire was successfully translated to Sidaamu Afoo, and achieved a good content validity index (0.88), high internal consistency (Cronbach's alpha of 0.79), and test-retest reliability (an intraclass correlation coefficient of 0.83). The exploratory factor analysis revealed two factors based on an eigenvalue of 1. The two factors explained 70.6% of the common variance, and each item loaded well (0.61 to 0.92) to its corresponding factor. There is a significant difference in the median score of prolapse symptoms across different stages of prolapse (Kruskal-Wallis χ2, 17.5, p < 0.001). CONCLUSION The Sidaamu Afoo version of the POP-SS tool is valid and reliable. Further studies that involve a balanced number of women in each stage of prolapse are needed to avoid the ceiling and floor effects.
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Affiliation(s)
- Melese Siyoum
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Wondwosen Teklesilasie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Rahel Nardos
- Department of Obstetrics and Gynecology, and Women's Health, University of Minnesota, Minneapolis, USA
| | | | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Lussiez A, Nardos R, Lowry A. Rectovaginal Fistula Management in Low-Resource Settings. Clin Colon Rectal Surg 2022; 35:390-395. [PMID: 36111077 PMCID: PMC9470294 DOI: 10.1055/s-0042-1746187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Rectovaginal fistula (RVF) is an abnormal connection between the rectum and vagina that affects women globally. In low- and middle-income countries (LMIC), RVF is most commonly due to obstetric complications such as prolonged labor or perineal tears, female genital mutilation and trauma such as sexual violence or iatrogenic surgical injuries. Women affected by this condition suffer from debilitating physical symptoms, social isolation, economic disempowerment, psychological trauma, low self-esteem, and loss of role fulfillment. Lack of accessible, high-quality, and effective healthcare is a major barrier to timely and safe obstetric care and to care for subsequent complications such as RVF. Additionally, social, cultural, financial, and systemic barriers put women at risk of acquiring fistula and contribute to delays in seeking and receiving care. Literature evaluating RVF repair in those able to access care offers limited information about management and outcomes. It is difficult to ascertain which surgical techniques are used. To reduce the burden of this often-preventable disease, appropriate investment in healthcare infrastructure to strengthen maternal care in LMICs is paramount. Furthermore, more standardized reporting of severity and treatment approach along with outcome data are critical to improving the quality of care for patients impacted by RVF.
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Affiliation(s)
- Alisha Lussiez
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Rahel Nardos
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ann Lowry
- Division of Colon and Rectal Surgery, University of Minnesota, Bloomington, Minnesota
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Nardos R, Leung ET, Dahl EM, Davin S, Asquith M, Gregory WT, Karstens L. Network-Based Differences in the Vaginal and Bladder Microbial Communities Between Women With and Without Urgency Urinary Incontinence. Front Cell Infect Microbiol 2022; 12:759156. [PMID: 35402312 PMCID: PMC8988226 DOI: 10.3389/fcimb.2022.759156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background Little is known about the relationship of proximal urogenital microbiomes in the bladder and the vagina and how this contributes to bladder health. In this study, we use a microbial ecology and network framework to understand the dynamics of interactions/co-occurrences of bacteria in the bladder and vagina in women with and without urgency urinary incontinence (UUI). Methods We collected vaginal swabs and catheterized urine specimens from 20 women with UUI (cases) and 30 women without UUI (controls). We sequenced the V4 region of the bacterial 16S rRNA gene and evaluated using alpha and beta diversity metrics. We used microbial network analysis to detect interactions in the microbiome and the betweenness centrality measure to identify central bacteria in the microbial network. Bacteria exhibiting maximum betweenness centrality are considered central to the microbe-wide networks and likely maintain the overall microbial network structure. Results There were no significant differences in the vaginal or bladder microbiomes between cases and controls using alpha and beta diversity. Silhouette metric analysis identified two distinct microbiome clusters in both the bladder and vagina. One cluster was dominated by Lactobacillus genus while the other was more diverse. Network-based analyses demonstrated that vaginal and bladder microbial networks were different between cases and controls. In the vagina, there were similar numbers of genera and subgroup clusters in each network for cases and controls. However, cases tend to have more unique bacterial co-occurrences. While Bacteroides and Lactobacillus were the central bacteria with the highest betweenness centrality in controls, Aerococcus had the highest centrality in cases and correlated with bacteria commonly associated with bacterial vaginosis. In the bladder, cases have less than half as many network clusters compared to controls. Lactobacillus was the central bacteria in both groups but associated with several known uropathogens in cases. The number of shared bacterial genera between the bladder and the vagina differed between cases and controls, with cases having larger overlap (43%) compared to controls (29%). Conclusion Our study shows overlaps in microbial communities of bladder and vagina, with higher overlap in cases. We also identified differences in the bacteria that are central to the overall community structure.
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Affiliation(s)
- Rahel Nardos
- Division of Urogynecology, Oregon Health and Science University, Portland, OR, United States
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Rahel Nardos,
| | - Eric T. Leung
- Division of Bioinformatics and Computational Biomedicine, Oregon Health and Science University, Portland, OR, United States
| | - Erin M. Dahl
- Division of Bioinformatics and Computational Biomedicine, Oregon Health and Science University, Portland, OR, United States
| | - Sean Davin
- Division of Arthritis and Rheumatology, Oregon Health and Science University, Portland, OR, United States
| | - Mark Asquith
- Division of Arthritis and Rheumatology, Oregon Health and Science University, Portland, OR, United States
| | - W. Thomas Gregory
- Division of Urogynecology, Oregon Health and Science University, Portland, OR, United States
| | - Lisa Karstens
- Division of Urogynecology, Oregon Health and Science University, Portland, OR, United States
- Division of Bioinformatics and Computational Biomedicine, Oregon Health and Science University, Portland, OR, United States
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Nardos R, Jacobson L, Garg B, Wall LL, Emasu A, Ruder B. Characterizing persistent urinary incontinence after successful fistula closure: the Uganda experience. Am J Obstet Gynecol 2022; 227:70.e1-70.e9. [PMID: 35283092 DOI: 10.1016/j.ajog.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obstetric fistula is a devastating childbirth injury. Despite successful closure of the fistula, 16% to 55% of women suffer from persistent urinary incontinence after surgery. OBJECTIVE This study assessed the type and severity of persistent incontinence after successful fistula closure and its impact on the quality of life of Ugandan women post-fistula treatment. STUDY DESIGN This cross-sectional study enrolled women with a history of obstetric fistula repair who continued to have persistent urinary incontinence (cases, N=36) and women without incontinence (controls, N=52) after successful fistula closure. Data were collected in central and eastern Uganda between 2017 and 2019. All the participants completed a semistructured questionnaire. Cases underwent a clinical evaluation and a 2-hour pad test and completed a series of incontinence questionnaires, including two novel tools designed to assess the severity of incontinence in low-literacy populations. RESULTS Cases were more likely to have acquired a fistula during their first delivery (63% vs 37%, P=.02), were younger when they developed a fistula (20.3±5.8 vs 24.8±7.5 years old, P=.003), and were more likely to have had >2 fistula surgeries (67% vs 2%, P≤.001). Cases reported a much higher rate of planned home birth for their index pregnancy compared to controls (44% vs 11%), though only 14% of cases and 12% of controls actually delivered at home. Cases reported higher rates of pain with intercourse (36% vs 18%, P=.05), but recent sexual activity status (intercourse within the previous six months) was not significantly different between the groups (47% vs 62%, P=.18). Among cases, 67% reported stress incontinence, 47% reported urgency incontinence, and 47% reported mixed incontinence. The cough stress test was successfully done with 92% of the cases, and of these, almost all (97%) had a positive cough stress test. More than half (53%) rated their incontinence as "very severe," which was consistent with objective findings. The 24-hour voiding diary indicated both high urinary frequency (average 14) and very frequent leakage episodes (average 20). Two-hour pad-tests indicated that 86% of cases had >4 g change in pad weight within 2 hours. Women with more severe incontinence reported a more negative impact on their quality of life. The mean score of the International Consultation on Incontinence Questionnaire-Quality of Life was 62.77±12.76 (range, 28-76, median=67), with a higher score indicating a greater impact on the quality of life. There was also a high mental health burden, with both cases and controls reporting high rates of suicidal ideation at any point since developing fistula (36% vs 31%, P=.67). CONCLUSION Women with obstetric fistulas continue to suffer from severe persistent urinary incontinence even after successful fistula closure. Both stress and urgency incontinence are highly prevalent in this population. Worsening severity of incontinence is associated with a greater negative impact on the quality of life.
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Affiliation(s)
- Rahel Nardos
- Department of Obstetrics and Gynecology-Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN.
| | - Laura Jacobson
- Oregon Health & Science University-Portland State School of Public Health, Portland, OR
| | - Bharti Garg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - L Lewis Wall
- Departments of Obstetrics and Gynecology and Anthropology, Washington University, Saint Louis, MI
| | | | - Bonnie Ruder
- Terrewode Women's Fund, Eugene, OR; Oregon State University, Corvallis, OR
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Contag S, Nardos R, Buhimschi IA, Almanza J. Population based cohort study of fetal deaths, and neonatal and perinatal mortality at term within a Somali diaspora. BMC Pregnancy Childbirth 2021; 21:740. [PMID: 34719388 PMCID: PMC8559350 DOI: 10.1186/s12884-021-04163-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Somali women deliver at greater gestational age with limited information on the associated perinatal mortality. Our objective is to compare perinatal mortality among Somali women with the population rates. Methods This is a retrospective cohort study from all births that occurred in Minnesota between 2011 and 2017. Information was obtained from certificates of birth, and neonatal and fetal death. Data was abstracted from 470,550 non-anomalous births ≥37 and ≤ 42 weeks of gestation. The study population included U.S. born White, U.S. born Black, women born in Somalia or self-identified as Somali, and women who identified as Hispanic regardless of place of birth (377,426). We excluded births < 37 weeks and > 42 weeks, > 1 fetus, age < 18 or > 45 years, or women of other ethnicities. The exposure was documented ethnicity or place of birth, and the outcomes were live birth, fetal death, neonatal death prior to 28 days, and perinatal mortality rates. These were calculated using binomial proportions with 95% confidence intervals and compared using odds ratios adjusted (aOR) for diabetes, hypertension and maternal body mass index. Results The aOR [95%CI] for stillbirth rate in the Somali cohort was greater than for U.S. born White (2.05 [1.49–2.83]) and Hispanic women (1.90 [1.30–2.79]), but similar to U.S. born Black women (0.88 [0.57–1.34]). Neonatal death rates were greater than for U.S. born White (1.84 [1.36–2.48], U.S. born Black women (1.47 [1.04–2.06]) and Hispanic women (1.47 [1.05–2.06]). This did not change after analysis was restricted to those with spontaneous onset of labor. When analyzed by week, at 42 weeks Somali aOR for neonatal death was the same as for U.S. born White women, but compared against U.S. born Black and Hispanic women, was significantly lower. Conclusions The later mean gestational age at delivery among women of Somali ethnicity is associated with greater overall risk for stillbirth and neonatal death rates at term, except compared against U.S. born Black women with whom stillbirth rates were not different. At 42 weeks, Somali neonatal mortality decreased and was comparable to that of the U.S. born White population and was lower than that of the other minorities. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04163-z.
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Affiliation(s)
- Stephen Contag
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota School of Medicine, Medical School MMC 395, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Rahel Nardos
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota School of Medicine, Global Women's Health, Center for Global Health and Social Responsibility, Medical School MMC 395, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Irina A Buhimschi
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL, 60612, USA
| | - Jennifer Almanza
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota School of Medicine, Medical School MMC 395, 420 Delaware St SE, Minneapolis, MN, 55455, USA
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Jacobson LE, Marye MA, Phoutrides E, Nardos R. Provider Perspectives on Persistent Urinary Incontinence Following Obstetric Fistula Repair in Ethiopia. Front Glob Womens Health 2020; 1:557224. [PMID: 34816150 PMCID: PMC8593944 DOI: 10.3389/fgwh.2020.557224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022] Open
Abstract
Each year an estimated 50,000 to 100,000 women worldwide are affected by obstetric fistula. This devastating but preventable maternal morbidity leaves women incontinent, stigmatized, isolated, and often with a still birth. While fistula rates in Ethiopia have declined in recent years, estimates range from 7 to 40 percent of women suffer from persistent urinary incontinence after successful closure of their fistula. Few studies have focused on the unique experiences and challenges that providers face treating fistula patients, particularly those who experience persistent urinary incontinence. The goal of this research is to characterize the fistula provider's accounts of how to manage, support, and understand their patient's experience. Semi-structured interviews were conducted with a purposive sample of fistula care providers in Mekelle and Addis Ababa, Ethiopia. The main themes that emerged were a perceived exacerbated impact on quality of life for women with persistent urinary incontinence; a “double hit” of isolation from both their community and from other recovered fistula patients; how the church both influences how patients internalize their injury and provides them with hope and support; and the need for comprehensive and compassionate fistula care. Understanding how providers perceive and relate to their patients provides valuable insight to the unique challenges of treating this population and may better inform treatment programmes to address the gap between patient needs and current fistula care models.
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Affiliation(s)
- Laura E. Jacobson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, United States
- *Correspondence: Laura E. Jacobson
| | | | - Elena Phoutrides
- Contra Costa Regional Medical Center, Martinez, CA, United States
| | - Rahel Nardos
- Division of Female Pelvic Medicine and Reconstructive Surgery, Director of Global Health in OBGYN, Oregon Health & Science University, Portland, OR, United States
- Kaiser Permanente, Portland, OR, United States
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Nardos R, Ayenachew F, Roentgen R, Abreha M, Jacobson L, Haile A, Berhe Y, Gold K, Gregory WT, Spitznagle T, Payne CK, Wall LL. Capacity building in female pelvic medicine and reconstructive surgery: Global Health Partnership beyond fistula care in Ethiopia. Int Urogynecol J 2020; 31:227-235. [DOI: 10.1007/s00192-019-04197-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/19/2019] [Indexed: 01/01/2023]
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Rudolph MD, Graham AM, Feczko E, Miranda-Dominguez O, Rasmussen JM, Nardos R, Entringer S, Wadhwa PD, Buss C, Fair DA. Maternal IL-6 during pregnancy can be estimated from newborn brain connectivity and predicts future working memory in offspring. Nat Neurosci 2018; 21:765-772. [PMID: 29632361 PMCID: PMC5920734 DOI: 10.1038/s41593-018-0128-y] [Citation(s) in RCA: 222] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 03/06/2018] [Indexed: 12/14/2022]
Abstract
Several lines of evidence support the link between maternal inflammation
during pregnancy and increased likelihood of neurodevelopmental and psychiatric
disorders in offspring. This longitudinal study seeks to advance understanding
regarding implications of systemic maternal inflammation during pregnancy,
indexed by plasma IL-6 concentrations, for large-scale brain system development
and emerging executive function (EF) skills in offspring. Maternal IL-6 was
assessed during pregnancy, functional MRI acquired in neonates, and working
memory (an important component of EF) examined at 2-years-of-age. Functional
connectivity within and between multiple neonatal brain networks can be modeled
to estimate maternal IL-6 concentrations during pregnancy. Brain regions heavily
weighted in these models overlap significantly with those supporting working
memory in a large meta-analysis. Maternal IL-6 also directly accounts for a
portion of the variance of working memory at two-years-of-age. Findings
highlight the association of maternal inflammation during pregnancy with the
developing functional architecture of the brain and emerging EF.
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Affiliation(s)
- Marc D Rudolph
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Alice M Graham
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Eric Feczko
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Oscar Miranda-Dominguez
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Jerod M Rasmussen
- Development, Health and Disease Research Program, University of California, Irvine, Irvine, CA, USA
| | - Rahel Nardos
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Sonja Entringer
- Development, Health and Disease Research Program, University of California, Irvine, Irvine, CA, USA.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Pathik D Wadhwa
- Development, Health and Disease Research Program, University of California, Irvine, Irvine, CA, USA
| | - Claudia Buss
- Development, Health and Disease Research Program, University of California, Irvine, Irvine, CA, USA. .,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.
| | - Damien A Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA. .,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA. .,Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA.
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Ouedraogo I, Payne C, Nardos R, Adelman AJ, Wall LL. Obstetric fistula in Niger: 6-month postoperative follow-up of 384 patients from the Danja Fistula Center. Int Urogynecol J 2017; 29:345-351. [PMID: 28600757 PMCID: PMC5847061 DOI: 10.1007/s00192-017-3375-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/28/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impoverished West African country of Niger has high rates of obstetric fistula. We report a 6-month postoperative follow-up of 384 patients from the Danja Fistula Center and assess factors associated with operative success or failure. METHODS The medical records of 384 women who had completed a 6-month follow-up after fistula surgery were reviewed. Cases were categorized as "easy," "of intermediate complexity," or "difficult" based on a preoperative points system. Data were analyzed using simple chi-squared statistics and logistic regression. RESULTS The patients were predominantly of Hausa ethnicity (73%), married young (average 15.9 years), had teenage first pregnancies (average first delivery 16.9 years), and experienced prolonged labor (average 2.3 days) with poor outcomes (89% stillbirth rate). The average parity was four. Patients commonly developed their fistula during their first delivery (43.5%), but over half sustained a fistula during a subsequent delivery (56.5%). Prior fistula surgery elsewhere (average 1.75 operations) was common. The overall surgical success ("closed and dry") was 54%. When the 134 primary operations were analyzed separately, the overall success rate was 80%. Increasing success was seen with decreasing surgical difficulty: 92% success for "easy" cases, 68% for "intermediate" cases, and 57% success for "difficult" cases. Success decreased with increasing numbers of previous attempts at surgical repair. CONCLUSIONS These data provide further evidence that clinical outcomes are better when primary fistula repair is performed by expert surgeons in specialist centers with the support of trained fistula nurses.
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Affiliation(s)
- Itengre Ouedraogo
- The Danja Fistula Center, Danja, Niger
- The Worldwide Fistula Fund, Chicago, IL, USA
| | | | - Rahel Nardos
- The Worldwide Fistula Fund, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Avril J Adelman
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - L Lewis Wall
- The Worldwide Fistula Fund, Chicago, IL, USA.
- Department of Anthropology, Washington University in St. Louis, Campus Box 1114, One Brookings Drive, St. Louis, MO, 63110, USA.
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.
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Karstens L, Asquith M, Davin S, Stauffer P, Fair D, Gregory WT, Rosenbaum JT, McWeeney SK, Nardos R. Does the Urinary Microbiome Play a Role in Urgency Urinary Incontinence and Its Severity? Front Cell Infect Microbiol 2016; 6:78. [PMID: 27512653 PMCID: PMC4961701 DOI: 10.3389/fcimb.2016.00078] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/12/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Traditionally, the urinary tract has been thought to be sterile in the absence of a clinically identifiable infection. However, recent evidence suggests that the urinary tract harbors a variety of bacterial species, known collectively as the urinary microbiome, even when clinical cultures are negative. Whether these bacteria promote urinary health or contribute to urinary tract disease remains unknown. Emerging evidence indicates that a shift in the urinary microbiome may play an important role in urgency urinary incontinence (UUI). The goal of this prospective pilot study was to determine how the urinary microbiome is different between women with and without UUI. We also sought to identify if characteristics of the urinary microbiome are associated with UUI severity. METHODS We collected urine from clinically well-characterized women with UUI (n = 10) and normal bladder function (n = 10) using a transurethral catheter to avoid bacterial contamination from external tissue. To characterize the resident microbial community, we amplified the bacterial 16S rRNA gene by PCR and performed sequencing using Illumina MiSeq. Sequences were processed using the workflow package QIIME. We identified bacteria that had differential relative abundance between UUI and controls using DESeq2 to fit generalized linear models based on the negative binomial distribution. We also identified relationships between the diversity of the urinary microbiome and severity of UUI symptoms with Pearson's correlation coefficient. RESULTS We successfully extracted and sequenced bacterial DNA from 95% of the urine samples and identified that there is a polymicrobial community in the female bladder in both healthy controls and women with UUI. We found the relative abundance of 14 bacteria significantly differed between control and UUI samples. Furthermore, we established that an increase in UUI symptom severity is associated with a decrease in microbial diversity in women with UUI. CONCLUSIONS Our study provides further characterization of the urinary microbiome in both healthy controls and extensively phenotyped women with UUI. Our results also suggest that the urinary microbiome may play an important role in the pathophysiology of UUI and that the loss of microbial diversity may be associated with clinical severity.
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Affiliation(s)
- Lisa Karstens
- Division of Bioinformatics and Computational Biology, Oregon Health and Science UniversityPortland, OR, USA
- Division of Urogynecology, Oregon Health and Science UniversityPortland, OR, USA
| | - Mark Asquith
- Division of Arthritis and Rheumatology, Oregon Health and Science UniversityPortland, OR, USA
| | - Sean Davin
- Division of Arthritis and Rheumatology, Oregon Health and Science UniversityPortland, OR, USA
| | - Patrick Stauffer
- Division of Arthritis and Rheumatology, Oregon Health and Science UniversityPortland, OR, USA
| | - Damien Fair
- Department of Behavioral Neuroscience, Oregon Health and Science UniversityPortland, OR, USA
- Department of Psychiatry, Oregon Health and Science UniversityPortland, OR, USA
- Advanced Imaging Research Center, Oregon Health and Science UniversityPortland, OR, USA
| | - W. Thomas Gregory
- Division of Urogynecology, Oregon Health and Science UniversityPortland, OR, USA
| | - James T. Rosenbaum
- Division of Arthritis and Rheumatology, Oregon Health and Science UniversityPortland, OR, USA
- Devers Eye Institute, Oregon Health and Science UniversityPortland, OR, USA
| | - Shannon K. McWeeney
- Division of Bioinformatics and Computational Biology, Oregon Health and Science UniversityPortland, OR, USA
| | - Rahel Nardos
- Division of Urogynecology, Oregon Health and Science UniversityPortland, OR, USA
- Kaiser PermanenteClackamas, OR, USA
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Nardos R, Karstens L, Carpenter S, Aykes K, Krisky C, Stevens C, Gregory W, Fair DA. Abnormal functional connectivity in women with urgency urinary incontinence: Can we predict disease presence and severity in individual women using Rs-fcMRI/. Neurourol Urodyn 2015; 35:564-73. [DOI: 10.1002/nau.22767] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/25/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Rahel Nardos
- Division of Female Pelvic Medicine and Reconstructive Surgery; Oregon Health & Science University; Portland Oregon
| | - Lisa Karstens
- Division of Female Pelvic Medicine and Reconstructive Surgery; Oregon Health & Science University; Portland Oregon
| | - Samuel Carpenter
- Department of Behavioral Neuroscience; Oregon Health & Science University; Portland Oregon
| | - Kamari Aykes
- Department of Behavioral Neuroscience; Oregon Health & Science University; Portland Oregon
| | - Christine Krisky
- Division of Female Pelvic Medicine and Reconstructive Surgery; Oregon Health & Science University; Portland Oregon
| | - Corrine Stevens
- Department of Behavioral Neuroscience; Oregon Health & Science University; Portland Oregon
| | - W.Thomas Gregory
- Division of Female Pelvic Medicine and Reconstructive Surgery; Oregon Health & Science University; Portland Oregon
| | - Damien A. Fair
- Department of Behavioral Neuroscience; Oregon Health & Science University; Portland Oregon
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Nardos R, Gregory WT, Krisky C, Newell A, Nardos B, Schlaggar B, Fair DA. Examining mechanisms of brain control of bladder function with resting state functional connectivity MRI. Neurourol Urodyn 2013; 33:493-501. [PMID: 23908139 DOI: 10.1002/nau.22458] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/07/2013] [Indexed: 11/09/2022]
Abstract
AIMS This aim of this study is to identify the brain mechanisms involved in bladder control. METHODS We used fMRI to identify brain regions that are activated during bladder filling. We then used resting state connectivity fMRI (rs-fcMRI) to assess functional connectivity of regions identified by fMRI with the rest of the brain as the bladder is filled to capacity. RESULTS Female participants (n = 20) were between ages 40 and 64 with no significant history of symptomatic urinary incontinence. Main effect of time (MET) fMRI analysis resulted in 20 regions of interest (ROIs) that have significant change in BOLD signal (z = 3.25, P <0.05) over the course of subtle bladder filling and emptying regardless of full versus empty bladder state. Bladder-state by time (BST) fMRI analysis resulted in three ROIs that have significant change in BOLD signal (z = 3.25, P <0.05) over the course of bladder runs comparing full versus empty bladder state. Rs-fcMRI fixed effects analysis identified significant changes in connectivity between full and empty bladder states in seven brain regions (z = 4.0) using the three BST ROIs and sixteen brain regions (z = 7) using the twenty MET ROIs. Regions identified include medial frontal gyrus, posterior cingulate (PCC), inferiolateral temporal and post-central gyrus, amygdale, the caudate, inferior parietal lobe as well as anterior and middle cingulate gyrus. CONCLUSIONS There is significant and vast changes in the brain's functional connectivity when bladder is filled suggesting that the central process responsible for the increased control during the full bladder state appears to largely rely on the how distributed brain systems are functionally integrated.
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Affiliation(s)
- Rahel Nardos
- Oregon Health and Science University, Portland, Oregon; Kaiser Permanente, Clackamas, Oregon
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Nardos R, Menber B, Browning A. Outcome of obstetric fistula repair after 10-day versus 14-day Foley catheterization. Int J Gynaecol Obstet 2012; 118:21-3. [PMID: 22542213 DOI: 10.1016/j.ijgo.2012.01.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/12/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare outcome between 10-day and 14-day bladder drainage after obstetric fistula repair. METHODS In a randomized prospective study at Hamlin Fistula Center, Bahir Dar, Ethiopia, patients presenting with obstetric vesicovaginal fistula between 2007 and 2010 were randomized to undergo 10-day (group 1) or 14-day (group 2) postoperative catheterization. Fistulas were categorized via Goh classification. The inclusion criteria were any type of vesicovaginal fistula except circumferential or recurrent. RESULTS In total, 189 women were enrolled: 107 in group 1, and 82 in group 2. The groups were similar in age, parity, duration of labor, and time from injury to surgical repair. There was no significant difference in fistula stage according to the Goh classification (urethral length, P=0.3; fistula size, P=0.9; and vaginal scarring, P=0.3). There were 3 fistula breakdowns in group 1, and 6 in group 2. The difference in cure was not significant (P=0.15, confidence interval -0.009 to 0.1). There was no significant difference in non-fistula-related incontinence or urinary retention after repair. CONCLUSION The outcome of postoperative catheterization for 10 days was not inferior to that for 14 days. A similar treatment outcome with a shorter duration of catheterization will have a significant impact on reducing infection and cost.
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Gregory WT, Nardos R, Worstell T, Thurmond A. Measuring the levator hiatus with axial MRI sequences: adjusting the angle of acquisition. Neurourol Urodyn 2011; 30:113-6. [PMID: 21046654 DOI: 10.1002/nau.20957] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS We aimed to compare MRI measurements of the female levator hiatus and the most caudal "levator ani" muscles between image slices in a plane axial to the body (AxB) and an axial plane parallel to the direction of the puborectalis muscle (AxPRM). METHODS We performed high-resolution, T2-weighted axial magnetic resonance imaging (in two different planes) on 20 sequentially recruited asymptomatic nulliparous women. Levator hiatus measurements were compared between the two planes. RESULTS The mean tilt angle of the AxPRM slices relative to the AxB slices was 18.9° (SD 8.5) and the area of the levator hiatus was 10% greater (P=0.04) in the AxPRM plane. CONCLUSIONS By rotating the acquisition plane to be parallel to the puborectalis muscle (sometimes called the plane of minimal hiatal dimensions), some of the measurements of the distal and medial pelvic floor muscles (and the hiatus defined by them) are altered. This issue is important because both MRI and 3D ultrasound are increasingly being used to evaluate the pelvic floor hiatus, and its relationship to childbirth injury and pelvic floor disorders. To make meaningful comparisons, it is important that both modalities are measuring the same thing.
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Affiliation(s)
- W Thomas Gregory
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Portland, Oregon 97239, USA.
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Spencer CM, Eckel LA, Nardos R, Houpt TA. Area postrema lesions attenuate LiCl-induced c-Fos expression correlated with conditioned taste aversion learning. Physiol Behav 2011; 105:151-60. [PMID: 21889521 DOI: 10.1016/j.physbeh.2011.08.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 08/17/2011] [Accepted: 08/18/2011] [Indexed: 11/25/2022]
Abstract
Lesions of the area postrema (AP) block many of the behavioral and physiological effects of lithium chloride (LiCl) in rats, including formation of conditioned taste aversions (CTAs). Systemic administration of LiCl induces c-Fos immunoreactivity in several brain regions, including the AP, nucleus of the solitary tract (NTS), lateral parabrachial nucleus (latPBN), supraoptic nucleus (SON), paraventricular nucleus (PVN), and central nucleus of the amygdala (CeA). To determine which of these brain regions may be activated in parallel with the acquisition of LiCl-induced CTAs, we disrupted CTA learning in rats by ablating the AP and then quantified c-Fos-positive cells in these brain regions in sham- and AP-lesioned rats 1 h following LiCl or saline injection. Significant c-Fos induction after LiCl was observed in the CeA and SON of AP-lesioned rats, demonstrating activation independent of an intact AP. LiCl-induced c-Fos was significantly attenuated in the NTS, latPBN, PVN and CeA of AP-lesioned rats, suggesting that these regions are dependent on AP activation. Almost all of the lesioned rats showed some damage to the subpostremal NTS, and some rats also had damage to the dorsal motor nucleus of the vagus; this collateral damage in the brainstem may have contributed to the deficits in c-Fos response. Because c-Fos induction in several regions was correlated with magnitude of CTA acquisition, these regions are implicated in the central mediation of lithium effects during CTA learning.
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Affiliation(s)
- Corinne M Spencer
- Department of Biological Science, King Life Sciences Building, The Florida State University, Tallahassee, FL 32306-4295, United States
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Nardos R, Browning A, Chen CCG. Risk factors that predict failure after vaginal repair of obstetric vesicovaginal fistulae. Am J Obstet Gynecol 2009; 200:578.e1-4. [PMID: 19200932 DOI: 10.1016/j.ajog.2008.12.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 10/08/2008] [Accepted: 12/05/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify anatomic characteristics and method of bladder closure that predict failure after repair of obstetric vesicovaginal fistulae. STUDY DESIGN A retrospective analysis of 1045 patients that underwent vaginal repair of vesicovaginal fistulae from January 2006 to December 2007 at the Addis Ababa Hamlin Fistula Hospital. RESULTS The fistulae were midvaginal (26%), adjacent to ureteral orifice (22%), circumferential (6%), had urethral compromise (10%), or had a combination of different locations (17%). Most had fair or good residual bladder size (83%) and minimal or moderate vaginal scarring (85%). Closure was in 1 layer in 48% and 2 layers in 52% with 89% cure, 11% failure, and 17% urethral incontinence. Failures were significantly associated with complete or partial urethral destruction, severe vaginal scarring, small bladders, and circumferential involvement. The 1-layer fistula closure was associated with failure but not after excluding small bladders. CONCLUSION Risk factors for failure include small bladder size, urethral destruction, circumferential involvement, and severe vaginal scarring.
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Nardos R, Browning A, Member B. Duration of bladder catheterization after surgery for obstetric fistula. Int J Gynaecol Obstet 2008; 103:30-2. [PMID: 18632103 DOI: 10.1016/j.ijgo.2008.05.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 05/30/2008] [Accepted: 05/30/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the surgical outcome at discharge and at 6-months follow up in patients who underwent repair of obstetric fistulae with postoperative bladder catheterization for 10, 12, or 14 days. METHODS A retrospective study of 212 obstetric fistula patients who underwent repair with postoperative bladder catheterization for 10 days (group 1), 12 days (group 2), and 14 days (group 3) at the Bahir Dar Hamlin Fistula Center in Ethiopia. Fistulas were classified according to Goh's system. RESULTS There were 68 women (32%) in group 1, 62 women (29%) in group 2, and 82 women (39%) in group 3. There was a significant difference in the extent of urethral involvement, fistula size, and degree of vaginal scarring among the 3 groups, with the more extensively damaged patients catheterized for longer. Breakdown of repair was seen in 1.5% of patients in group 1, none in group 2, and 2% in group 3 (P=0.47). CONCLUSION Postoperative catheterization for 10 days may be sufficient for management of less complicated obstetric vesicovaginal fistulae.
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Affiliation(s)
- Rahel Nardos
- Bahir Dar Hamlin Fistula Center, Bahir Dar, Ethiopia.
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Khan FG, Willers DM, Allsworth JE, Nardos R, Kizer NT, Boyd BA. Discussion: 'Risk factors for anal sphincter lacerations' by Lowder et al. Am J Obstet Gynecol 2007; 196:e1-5; discussion 415-6. [PMID: 17403382 DOI: 10.1016/j.ajog.2007.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 02/21/2007] [Accepted: 02/21/2007] [Indexed: 11/19/2022]
Affiliation(s)
- Fareesa G Khan
- Division of Urogynecology, Washington University School of Medicine, St. Louis, MO, USA
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Khan FG, Willers DM, Allsworth JE, Nardos R, Kizer NT, Boyd BA. Risk factors for anal sphincter lacerations: a study by Lowder et al. Am J Obstet Gynecol 2007. [DOI: 10.1016/j.ajog.2007.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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