[International Conference on Medico-Ecological Problems of Reproductive Health of Workers (Moscow, December 9-10, 1998)].
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The art of medicine provides a rare opportunity to understand human values and to contribute toward the well-being of one's fellow humans--women in the case of ob-gyn--a contribution that fits in with the mission of the International Federation of Gynaecology Obstetrics (FIGO). Obstetricians and gynecologists should indeed take it upon themselves to improve conditions for women, since the bond and respect between the two is a significant one. It is obstetricians-gynecologists who can provide the much needed technical information to throw light on justifying services that deal with devastating, debilitating, degenerating, and devaluating situations, such as neglected pregnancy, disregard toward cancer detection, and humiliating genital mutilation. Indeed, this can be termed as "terrorism in ob-gyn," neglected by those who should deal with it. Those in ob-gyn and other medical professions clearly witness gender inequality and its ugly aftermath, a degradation of women's reproductive rights. Ob-gyn must look a little beyond just the lucrative practice of the plain science of obstetrics and gynecology and undertake the responsibility to help and protect the health and life of women around the world. A conscientious doctor cannot practice medicine on women's bodies alone, but must also "practice" against several social evils, the prevention of which is crucial to women's health. Obstetricians and gynecologists can utilize their access to policymakers and health "builders" to carry this brief for women's health, and can urge governments to take a second look at women's rights to ensure that they are on par with the accepted norms of human rights, to be protected and propagated.
Recent studies have suggested that female flight attendants may experience increased rates of spontaneous abortion. We conducted a survey of female flight attendants who were pregnant at any time between January 1, 1990, and December 31, 1991 (n = 418) using a mailed self-administered interest survey (response rate, 60 %) and follow-up questionnaire regarding reproductive outcomes and potential risk factors for adverse outcomes (response rate, 64%). The cumulative hazard of spontaneous abortion was 17% when maternal age, smoking, alcohol use, and prior spontaneous abortions were control led for, using a Cox life-table regression model. Of the female flight attendants who worked outside the home, 47 of 321 (15%) experienced a spontaneous abortion, compared with 6 of 73 (8%) who did not work outside the home during the pregnancy period (odds ratio [OR] = 1.91, 95 % confidence interval [CI] = 0.78-4.66). Flight attendants who experienced a spontaneous abortion during their first pregnancy during the study period reported working significantly more flight hours per month during their pregnancy (74 hours per month) than did flight attendants who delivered a live birth (64 hours per month) (Student's t = -3.30, P = 0.002). We conclude that although the results of this study must be considered preliminary because of the relatively low overall response rate (38%), we did not find an overall increased risk for spontaneous abortion among flight attendants, compared with other working women (10%-20%). Women who continue working as flight attendants during pregnancy and those who work relatively higher numbers of flight hours during pregnancy may, however, be at increased risk for spontaneous abortion, compared with flight attendants who do not perform such work.
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The research that has been conducted to date on Vietnamese adolescents has focused on unprotected and unsanctioned sexual activity and its health consequences, specifically abortion and sexually transmitted diseases, especially HIV. The question we pose in this article is whether this concern is warranted. Is the population community justified in limiting research on this population to early sexual activity and HIV risk? Even if the sexual behavior of young people can be considered problematic, are there perhaps other aspects of young peoples' lives to which more attention should be devoted? The literature on adolescent sexual behavior in Vietnam is reviewed and data on premarital sex and reproductive behavior are analyzed from a 1999 survey conducted in six provinces among nearly 1,500 adolescent boys and girls aged 15-22. Descriptive data on schooling and work are included in order to put the information on sexual activity in perspective. The data analysis reveals that, at least currently, the sexual behavior of unmarried adolescents in Vietnam is not what jeopardizes their health and well-being.
Sterility of married couples appears to be a significant cause of dramatically unfavorable demographic situation in Russian Federation. Value of male sterility in infertile couples exceeds now 45% and tends to increase. Among multiple causes of male infertility (vascular, traumatic, endocrine, autoimmune, iatrogenic and others) nearly 35% account for so-called "idiopathic" infertility. Tremendous significance is associated with studies of effects induced in male reproductive system by environmental hazards, maximal allowable doses and concentrations of ecologic hazards. Works on this problem helps to conduct effective therapeutic and prophylactic measures.
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Main cause of demographic crisis seen in Russian Federation is dramatic decrease of birth rate that depends on many reasons including negative results of Family Planning Program. Extraordinary measures discussed now are: pregnancy payment (instead of parturition payment), lump-sum premium for birth (instead of allowance), snap provision of housing and other encouragements, orientation of Family Planning Program from birth control to birth propaganda and to prophylactics of reproductive disorders.
UNLABELLED: Ileal pouch anal anastomosis is the surgical treatment of choice for ulcerative colitis, offering intestinal continuity and fecal continence. IPAA does not seem to affect menstrual function or gynecologic symptoms. Overall sexual satisfaction may be improved with surgery, although ability to experience orgasm and coital frequency remain essentially unchanged. However, dyspareunia seems to increase postoperatively. Fertility is also adversely affected by IPAA, possibly a result of pelvic adhesions. Pregnancy is characterized by a transient increase in day and night stool frequency and incontinence that resolves after delivery. The ideal route of delivery has not been determined, but vaginal delivery seems safe and does not directly cause pouch dysfunction. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to describe the procedure ileal pouch anal anastomosis, to summarize the effects of IPAA on menstrual function and sexual health, and to outline the association of IPAA and infertility.
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Genital infections in impoverished countries take a heavy toll both in the etiology of childlessness and in pregnancy-related morbidity, both for the carrier (mother) and the passenger (fetus/newborn). Tubal damage is by far the most common single etiology in cases of childlessness. Among the three factors principally contributing to childlessness, infertility, pregnancy wastage and child loss, tubal infertility is the predominant one. Prevalence figures of N. gonorrhoeae among women in reproductive ages range between 5 and 15% in several countries. Similar figures prevail among pregnant/puerperal women. Preliminary figures indicate that prevalence of Chlamydia trachomatis is similar. Genitally acquired infections during pregnancy contribute to pregnancy wastage in the second and third trimesters of pregnancy. There is virtually no data to support that HBV, HSV and HPV significantly contribute to transmitted intra-uterine disease leading to pregnancy wastage. In the third category of childlessness, child loss, HSV and HIV play a well-known role. Maternal and neonatal morbidity is adversely affected by genital infections acquired during pregnancy. While hepatitis in some places is an important contributor to maternal mortality and morbidity, other viral diseases like HSV and HPV do not appear important in pregnancy-related maternal morbidity. Gonorrhea and chlamydia infection give few maternal problems during pregnancy but may be more important as a cause of puerperal endometritis-myometritis, which constitutes one of the leading causes of maternal death in many developing countries. The fetal/neonatal infant morbidity is affected by gonorrhea and chlamydia infection, while HSV is less frequent but extremely serious when it appears.(ABSTRACT TRUNCATED AT 250 WORDS)
Numerous studies have identified specific areas in which the effects of maternal smoking during pregnancy may occur including fetal growth retardation, neonatal deaths, pregnancy complications leading to premature delivery and possible effects on lactation and long-term effects on surviving children. Despite the number of papers which have been published on this subject there is still no clear understanding of the extent to which smoking in general, and various components of cigarette smoke in particular, exert a detrimental effect on the human reproductive potential. Although epidemiological evidence is scanty there are indications that cigarette smoking decreases fertility in women, increases the frequency of menstrual abnormalities and decreases the age of spontaneous menopause. Cigarette smoking in males has also been implicated as a cause of decreased sperm numbers and an increased frequency of abnormal sperm morphology as well as a decrease in sexual performance. Experimental evidence from humans and rodents suggests that nicotine can alter the hypothalamic-pituitary axis through its stimulation of growth hormone, cortisol, vasopressin and oxytocin release which in turn inhibit luteinizing hormone and prolactin release.
The plaintiff physicians and organizations providing abortion-related services challenged the constitutionality of provisions of a Missouri statute that a) state that life begins at conception and that unborn children have a protectable interest in life, health, and well being; b) require a physician to inform a woman seeking an abortion of certain facts; c) require all post sixteen-week abortions to be performed in a hospital; d) require certain tests to be performed in order to determine gestational age and viability; and e) prohibit the use of public funds, public employees, and public facilities for performing or assisting an abortion or encouraging or counseling an abortion except to save a woman's life. The Court ruled that all of these provisions were unconstitutional and in conflict with its previous rulings on a woman's right to obtain an abortion. In a related case the United States District Court, E.D. Missouri, E.D., held that the plaintiff physicians could not attack a statement of intent of the same law, which provides that "It is the intention of the general assembly of the state of Missouri to grant the right to life to all humans, born and unborn, and to regulate abortion to the full extent permitted by the Constitution of the United States, decisions of the United States Supreme Court, and federal statutes." See Women's Health Ctr. of West Cty. v. Webster, 24 September 1987, 670 F.Supp. 845.
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