Negative sliding sign by ultrasound in repeat cesarean section predicts presence of severe intrabdominal adhesions

Photo courtesy: YouTube video clip by Green Journal

A negative sliding sign by ultrasonography (USG) in patients with previous cesarean section helps alert the surgeon to expect massive intraabdominal adhesions, difficult repeat cesarean section and need of blood transfusion during surgery reports the results of a prospective observational study published ahead of print in the February issue of Journal Obstetrics and Gynecology.

Postoperative adhesion formation is quite prevalent after an abdominal or pelvic surgery and any method which can predict the existence of such adhesion could optimize the outcome of current surgery.

Real-time ultrasound-based technique of ‘slide test’ is the non-invasive way of detecting pelvic and intrabdominal adhesions preoperatively. The test measures the relative motion between abdominal and uterine wall.

The researchers recruited 370 women with previous cesarean section. The women underwent transabdominal sonography and a video-clip was recorded at deep inspiration in sagittal plane lateral to the midline.

The findings of preoperative ultrasonography were correlated with adhesions found during surgery by surgeons who were not aware about the preop USG findings.

Statistical analysis of these findings showed that when less or no movement was detected between the uterus and abdominal wall (negative ‘slide test’), it correctly identified patients with severe adhesion in 56% of cases (sensitivity 56%, 95% CI 35–76). It also predicted absence of severe adhesions correctly in 95% of patients (specificity 95%, 95% CI 93–97).

When the USG findings was combined with history of adhesions in previous surgery, severe adhesions were correctly predicted in 64% of patients and absence of adhesions was predicted in 94% of patients.

The surgeons noted a longer delivery time and significant blood loss in patients with negative sliding sign.

Thus, it was seen that ‘slide test’ is a simple, reliable and non-invasive screening test in repeat cesarean cases to predict technical difficulty during surgery.

Here is a short video of visceral slide test from video gallery of Journal Obstetrics and Gynecology.

This short video clip explains the equipment needed, how to perform, and how to interpret the visceral slide test. An example of a normal test and an abnormal ultrasound visceral slide test are illustrated, including a laparoscopic view of the patient with an abnormal test.

Video courtesy of Erica C. Dun, MD, MPH.

 Abstract 

Shocking revelation of FGM being widely practiced in Indian Dawoodi Bohra Community

Female Genital Mutilation (FGM) is widely prevalent in all forms in Indian Bohra Community and more than three-fourth study participants have undergone the procedure in some form according to a study published on February 5, 2018.

The study results reveal heart wrenching truth about the practice only weeks after Ministry for Women and Child Development submitted an affidavit to the Supreme Court of India on December 2017, denying the existence of any data on such practice in India.

The study was published on the eve of International Day of Zero Tolerance for FGM and supported by WeSpeakOut, the largest survivor led movement to end FGM in Bohra samaj in India and Nari Samata Manch (NSM) working for gender equality and end cruelty cross women in Maharastra.

International Day of Zero Tolerance for FGM is marked on February 6, 2018 to raise awareness of female genital mutilation (FGM) and to encourage abandonment of the procedure worldwide.

The study sampled 94 participants  from thirteen locations across five states in India: Gujarat, Madhya Pradesh, Maharashtra, Rajasthan and Kerala of which 83 were women and 11 were men. The samples also included Bohra expats from western world, traditional circumcisers, healthcare professionals, and teachers.

Data indicated that 81 (97%) women in the sample had been subjected to Khafd or Clitoridectomy. It was seen that both partial or total removal of clitoris and/or clitoral hood (Types 1a and 1b FGM) is widely practiced, as well as other forms (Type 4 FGM/C) like pricking, piercing or cauterization.

The average age at which the girls are cut is 7 years.  

Nearly all the women reported it as a painful experience with immediate and long term genitourinary complications and bleeding following the cut . One-third of women reported that the procedure has affected their sexual lives for ever while other reported many psychological and trust issues later in life.

Besides being a traditional ritual and religious beliefs, FGM also aims at curbing women’s sexual desire and promiscuity and limiting her sexual pleasure.

Traditional circumcisers told the researchers that they have cut thousands of girls. With increasing urbanization FGH is increasingly being practiced by nurses and healthcare providers, with Bohra men being involved passively as well as actively.

The Bohra women are very vocal about the issue and have publicly demanded an end of this dehumanizing practice, but the government of India continues to turn a blind eye. A petition was filed in India’s Supreme court to ban FGM recently.

Meanwhile, the proponents of khafd say that it is just a ‘nick’ unlike the curse in African countries where the entire external genitalia is removed.

Internationally FGM is recognized as violation of human rights against girls and women.

FGM is widely practiced as a ritual in Africa, the Middle East and Asia but it is also rife in some communities from practicing countries across the western world. Often Bohra girls from diaspora communities are brought to India to be cut.

It is estimated that about 200 million women and girls alive have been subjected to some form of genital mutilation(GM) and 200 million more will undergo GM till the year 2030.

FGM study

Media courtesy: Sahiyo.com, Kolkata 24/7

Miscarriage rates tripled in women exposed to higher magnetic field (MF) non-ionizing radiation

Higher exposure to magnetic fields (MFs) non-ionizing radiations nearly triples the risk of miscarriage in pregnant women compared to those who get lower exposure reports the results of prospective cohort study published online in Nature’s Scientific Reports.

The electromagnetic spectrum 

This study reaffirms the findings from earlier studies that non-ionizing radiations are not totally harmless, and they have biological effects on human health.  

The lead author Dr. De-Kun Li, a senior research scientist at the Kaiser Permanente Division of Research in Oakland, California call it a serious public health challenge as humans are ubiquitously exposed to both low frequency MFs generated by home appliances, transformers, powerlines etc and higher frequency MFs from cell phones, wireless networks, smart meter networks, cell towers and wireless devices.

The authors identified 900 women with a positive pregnancy test through the electronic medical record (EMR) laboratory database from bay area counties in Northern California. The MFs exposure was measured in milligauss (mG) through EMDEX Lite meter (Enertech Consultants Inc.) that the women carried throughout 24 hours during pregnancy.

The exposure was further classified as typical or atypical based on the women following her daily schedule or doing something apart from her routine because it was seen that there was a significant difference between exposure on a typical day vs atypical day.  

As the women were followed progressively into pregnancy till 20 weeks since the positive urine pregnancy test, the study was able to detect early miscarriages that earlier studies might have missed.

Women’s personal risk factors and obstetric history was ascertained along with presence or absence of other confounders to rule out bias. They were followed into pregnancy till miscarriages, end of pregnancy due to other reasons like ectopic or till they reach 20 weeks.

Cox Proportional Hazards regression model was used to examine the association between MFs exposures and miscarriage rates.

After adjusting for the known confounders like maternal age, race, education, smoking during pregnancy, and prior miscarriage, overall, pregnant women who had higher MF exposure during pregnancy (higher 3 quartiles) had a 48% greater risk of miscarriage than women who had lower MF exposure (in the lowest quartile): adjusted HR = 1.48, 95% confidence interval (CI): 1.03–2.14 

The association was stronger and significant when the data was examined for typical days vs atypical days, on which no association was observed.

Similarly, no difference was observed between women with (≥2) miscarriages vs women with no prior bad obstetric history. Although, the association was stronger in women who were exposed to the higher quartiles as opposed to women exposed to lowest quartile, no significant dose response relationship was observed.

The association was also consistent across different sources of MFs exposure.

This is the only study that used an objective measuring device (EMDEX Lite meter) to measure the radiations and were able to measure the effects prospectively in months instead of years as in cancer and other chronic diseases.

Prior studies have found an association between long term exposure to non-ionizing radiations and increased risk of brain cancer and low sperm counts.

The lead author Dr. Li stresses the importance of further studies in this subject area. Meanwhile she advices children and young adults, especially pregnant women to stay away from cell phones and other equipments that emit non-ionizing radiations.

Couples who are trying to conceive should also minimize their exposure by maintaining a safe distance from cell phone and other house hold appliances.

Abstract

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Media courtesy: Daily Mirror, Vimeo.com, wireless hygiene