Giordana Campo Braga, Carla Josene Zarabia, Adriana Kelly Soares de S da Trindade, Carolina Sales Vieira
Objective: This study aimed to describe the use of etonogestrel (ENG) implants for menstrual management (i.e., management of bleeding and symptoms associated with menstruation) in individuals with intellectual disabilities.
Methods: This study retrospectively analyzed a cohort of individuals with intellectual disabilities who began using ENG implants between 2003 and 2018, in Joinville, Brazil. We collected sociodemographic, clinical, and reproductive data from the medical records, along with information related to ENG implant use.
Results: In total, 369 implants were placed in 130 individuals with intellectual disabilities. The median age at the first implant was 20 (interquartile range [IQR], 17-26) years, and 43.8% of the patients were adolescents. By December 2018, 90 patients had received two or more subsequent implants. The median duration of current ENG implant use was 19 (IQR, 12.8-22) months. More than 40% of the patients had comorbidities, with epilepsy being the most common. During the use of the current implant, 80% of the patients had a favorable bleeding profile (no bleeding or ≤1 bleeding episode per month), and 53.8% (70/130) had no bleeding within 3 months before their last medical visit. Among patients experiencing dysmenorrhea and premenstrual syndrome (PMS), 79% (64/81) and 82% (54/66) reported complete improvement, respectively. The premature implant removal rate was 8.9% (33/369). Unfavorable bleeding was the main reason for premature implant removal (20 out 33 removals).
Conclusions: ENG implants might be a suitable option for individuals with intellectual disabilities who require management of menstrual bleeding and symptoms associated with menstruation. Most patients had a favorable bleeding profile and experienced significant improvements in dysmenorrhea and PMS, contributing to the high continuation rates of ENG implants.
{"title":"Menstrual management using the etonogestrel implant in individuals with intellectual disabilities in Joinville, Brazil.","authors":"Giordana Campo Braga, Carla Josene Zarabia, Adriana Kelly Soares de S da Trindade, Carolina Sales Vieira","doi":"10.1002/ijgo.15930","DOIUrl":"https://doi.org/10.1002/ijgo.15930","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to describe the use of etonogestrel (ENG) implants for menstrual management (i.e., management of bleeding and symptoms associated with menstruation) in individuals with intellectual disabilities.</p><p><strong>Methods: </strong>This study retrospectively analyzed a cohort of individuals with intellectual disabilities who began using ENG implants between 2003 and 2018, in Joinville, Brazil. We collected sociodemographic, clinical, and reproductive data from the medical records, along with information related to ENG implant use.</p><p><strong>Results: </strong>In total, 369 implants were placed in 130 individuals with intellectual disabilities. The median age at the first implant was 20 (interquartile range [IQR], 17-26) years, and 43.8% of the patients were adolescents. By December 2018, 90 patients had received two or more subsequent implants. The median duration of current ENG implant use was 19 (IQR, 12.8-22) months. More than 40% of the patients had comorbidities, with epilepsy being the most common. During the use of the current implant, 80% of the patients had a favorable bleeding profile (no bleeding or ≤1 bleeding episode per month), and 53.8% (70/130) had no bleeding within 3 months before their last medical visit. Among patients experiencing dysmenorrhea and premenstrual syndrome (PMS), 79% (64/81) and 82% (54/66) reported complete improvement, respectively. The premature implant removal rate was 8.9% (33/369). Unfavorable bleeding was the main reason for premature implant removal (20 out 33 removals).</p><p><strong>Conclusions: </strong>ENG implants might be a suitable option for individuals with intellectual disabilities who require management of menstrual bleeding and symptoms associated with menstruation. Most patients had a favorable bleeding profile and experienced significant improvements in dysmenorrhea and PMS, contributing to the high continuation rates of ENG implants.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juan Wang, Simi Liao, Yanfen Luo, Xiaofeng Pang, Rirong Li, Arshad Mehmood
Objective: To compare the effect of three different surgical approaches: simple terminal salpingostomy, bilateral proximal tubal ligation plus terminal salpingostomy, and bilateral salpingectomy.
Methods: A retrospective analysis was conducted on the clinical data of 292 patients who underwent laparoscopic surgery for hydrosalpinx and embryo transfer within 2 years postoperatively from January 2018 to August 2021. The patients were divided into three groups: Group A (68 cases) underwent simple terminal salpingostomy, Group B (199 cases) underwent ligation plus terminal salpingostomy, and Group C (25 cases) underwent bilateral salpingectomy.
Results: Age, body mass index, surgical time, intraoperative bleeding, length of hospital stay, and infertility type showed no significant differences among the different surgical groups (P > 0.05), except for the age 30-39 group, which showed statistically significant differences in surgical time (P < 0.001) and length of hospital stay (P < 0.001); the age 40 or above group showed statistically significant differences in intraoperative bleeding (P = 0.008). A total of 336 oocyte retrievals and 451 embryo transfers were successfully performed in the 292 patients within 2 years postoperatively.
Conclusion: The choice of surgical approach for hydrosalpinx does not affect pregnancy rates after embryo transfer within the same age group.
{"title":"The outcome of embryo transfer after three different procedures for laparoscopic correction of hydrosalpinx.","authors":"Juan Wang, Simi Liao, Yanfen Luo, Xiaofeng Pang, Rirong Li, Arshad Mehmood","doi":"10.1002/ijgo.15932","DOIUrl":"https://doi.org/10.1002/ijgo.15932","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effect of three different surgical approaches: simple terminal salpingostomy, bilateral proximal tubal ligation plus terminal salpingostomy, and bilateral salpingectomy.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of 292 patients who underwent laparoscopic surgery for hydrosalpinx and embryo transfer within 2 years postoperatively from January 2018 to August 2021. The patients were divided into three groups: Group A (68 cases) underwent simple terminal salpingostomy, Group B (199 cases) underwent ligation plus terminal salpingostomy, and Group C (25 cases) underwent bilateral salpingectomy.</p><p><strong>Results: </strong>Age, body mass index, surgical time, intraoperative bleeding, length of hospital stay, and infertility type showed no significant differences among the different surgical groups (P > 0.05), except for the age 30-39 group, which showed statistically significant differences in surgical time (P < 0.001) and length of hospital stay (P < 0.001); the age 40 or above group showed statistically significant differences in intraoperative bleeding (P = 0.008). A total of 336 oocyte retrievals and 451 embryo transfers were successfully performed in the 292 patients within 2 years postoperatively.</p><p><strong>Conclusion: </strong>The choice of surgical approach for hydrosalpinx does not affect pregnancy rates after embryo transfer within the same age group.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: In the current study, we aimed to establish a quantified scoring system for evaluating consultation quality. Subsequently, using the score system to assess the quality of ChatGPT-4 consultations, we compared them with physician consultations when presented with the same clinical cases from obstetrics and gynecology.
Methods: This study was conducted in the Women and Children's Hospital of Chongqing Medical University, a tertiary-care hospital with approximately 16 000-20 000 deliveries and 8500-12 000 gynecologic surgeries per year. The detailed data from obstetric and gynecologic medical records were analyzed by ChatGPT-4 and physicians; the consultation opinions were then generated respectively. All consultation opinions were graded by eight junior doctors using the novel score system; subsequently, the correlation, agreement, and comparison between the two types of consultation opinions were then evaluated.
Results: A total of 100 medical records from obstetrics and 100 medical records from gynecology were randomly selected. Pearson correlation analysis suggested a noncorrelation or weak correlation between consultations from ChatGPT-4 and physicians. Bland-Altman plot showed an unacceptable agreement between the two types of consultation opinions. Paired t tests showed that the scores of physician consultations were significantly higher than those generated by ChatGPT-4 in both obstetric and gynecologic patients.
Conclusion: At present, ChatGPT-4 may not be a substitute for physicians in consultations for obstetric and gynecologic patients. Therefore, it is crucial to pay careful attention and conduct ongoing evaluations to ensure the quality of consultation opinions generated by ChatGPT-4.
{"title":"Establishing a novel score system and using it to assess and compare the quality of ChatGPT-4 consultation with physician consultation for obstetrics and gynecology: A pilot study.","authors":"Lan Lan, Ling Yang, Jinyan Li, Jia Hou, Yunsheng Yan, Yaozong Zhang","doi":"10.1002/ijgo.15934","DOIUrl":"https://doi.org/10.1002/ijgo.15934","url":null,"abstract":"<p><strong>Objectives: </strong>In the current study, we aimed to establish a quantified scoring system for evaluating consultation quality. Subsequently, using the score system to assess the quality of ChatGPT-4 consultations, we compared them with physician consultations when presented with the same clinical cases from obstetrics and gynecology.</p><p><strong>Methods: </strong>This study was conducted in the Women and Children's Hospital of Chongqing Medical University, a tertiary-care hospital with approximately 16 000-20 000 deliveries and 8500-12 000 gynecologic surgeries per year. The detailed data from obstetric and gynecologic medical records were analyzed by ChatGPT-4 and physicians; the consultation opinions were then generated respectively. All consultation opinions were graded by eight junior doctors using the novel score system; subsequently, the correlation, agreement, and comparison between the two types of consultation opinions were then evaluated.</p><p><strong>Results: </strong>A total of 100 medical records from obstetrics and 100 medical records from gynecology were randomly selected. Pearson correlation analysis suggested a noncorrelation or weak correlation between consultations from ChatGPT-4 and physicians. Bland-Altman plot showed an unacceptable agreement between the two types of consultation opinions. Paired t tests showed that the scores of physician consultations were significantly higher than those generated by ChatGPT-4 in both obstetric and gynecologic patients.</p><p><strong>Conclusion: </strong>At present, ChatGPT-4 may not be a substitute for physicians in consultations for obstetric and gynecologic patients. Therefore, it is crucial to pay careful attention and conduct ongoing evaluations to ensure the quality of consultation opinions generated by ChatGPT-4.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response: Relationship between menopausal hormone therapy and breast cancer: A nationwide population-based cohort study.","authors":"Jin-Sung Yuk","doi":"10.1002/ijgo.15944","DOIUrl":"https://doi.org/10.1002/ijgo.15944","url":null,"abstract":"","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haroun A Rhemtula, Elise Schapkaitz, Barry Jacobson, Lawrence Chauke
Objective: The aim of the present study was to review maternal and fetal outcomes in pregnant women with prosthetic heart valves.
Methods: A retrospective record review of pregnant women with prosthetic heart valves on anticoagulation was performed at the Specialist Cardiac Antenatal Clinic, Johannesburg South Africa from 2015 to 2023.
Results: Fifty pregnancies with mechanical heart valves and three with tissue valves, on anticoagulation for comorbid atrial fibrillation were identified. The majority were of African ethnicity at a mean age of 33 ± 6 years. Anti-Xa adjusted enoxaparin was commenced at 10.5 ± 5.6 weeks' gestation until delivery in 48 (90.6%) pregnancies and warfarin was continued in five (9.4%) pregnancies. The live birth rates on enoxaparin and warfarin were 56.3% (95% confidence interval [CI]: 42.3-69.3) and 20.0% (95% CI: 2.0-64.0), respectively. There were 12 (22.6%) miscarriages at a mean of 11.3 ± 3.7 weeks' gestation, four (7.5%) intrauterine fetal deaths on warfarin and two (3.8%) warfarin embryopathy/fetopathy. The rates of antepartum/secondary postpartum bleeding and primary postpartum bleeding were 29.4% (95% CI: 18.6-43.1) and 5.9% (95% CI: 1.4-16.9), respectively. Maternal complications included anemia (n = 11, 20.8%), arrhythmia (n = 2, 3.8%), heart failure (n = 2, 3.8%) and paravalvular leak (n = 2, 3.8%). There was one (1.9%) mitral valve thrombosis and one (1.9%) stuck valve in pregnancies who defaulted warfarin prior to pregnancy. There were no maternal deaths.
Conclusion: Multidisciplinary management of pregnant women with prosthetic heart valves with anti-Xa adjusted low molecular weight heparin throughout pregnancy represents an effective anticoagulation option for low-middle-income countries.
{"title":"Anticoagulant therapy in pregnant women with mechanical and bioprosthetic heart valves.","authors":"Haroun A Rhemtula, Elise Schapkaitz, Barry Jacobson, Lawrence Chauke","doi":"10.1002/ijgo.15935","DOIUrl":"https://doi.org/10.1002/ijgo.15935","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the present study was to review maternal and fetal outcomes in pregnant women with prosthetic heart valves.</p><p><strong>Methods: </strong>A retrospective record review of pregnant women with prosthetic heart valves on anticoagulation was performed at the Specialist Cardiac Antenatal Clinic, Johannesburg South Africa from 2015 to 2023.</p><p><strong>Results: </strong>Fifty pregnancies with mechanical heart valves and three with tissue valves, on anticoagulation for comorbid atrial fibrillation were identified. The majority were of African ethnicity at a mean age of 33 ± 6 years. Anti-Xa adjusted enoxaparin was commenced at 10.5 ± 5.6 weeks' gestation until delivery in 48 (90.6%) pregnancies and warfarin was continued in five (9.4%) pregnancies. The live birth rates on enoxaparin and warfarin were 56.3% (95% confidence interval [CI]: 42.3-69.3) and 20.0% (95% CI: 2.0-64.0), respectively. There were 12 (22.6%) miscarriages at a mean of 11.3 ± 3.7 weeks' gestation, four (7.5%) intrauterine fetal deaths on warfarin and two (3.8%) warfarin embryopathy/fetopathy. The rates of antepartum/secondary postpartum bleeding and primary postpartum bleeding were 29.4% (95% CI: 18.6-43.1) and 5.9% (95% CI: 1.4-16.9), respectively. Maternal complications included anemia (n = 11, 20.8%), arrhythmia (n = 2, 3.8%), heart failure (n = 2, 3.8%) and paravalvular leak (n = 2, 3.8%). There was one (1.9%) mitral valve thrombosis and one (1.9%) stuck valve in pregnancies who defaulted warfarin prior to pregnancy. There were no maternal deaths.</p><p><strong>Conclusion: </strong>Multidisciplinary management of pregnant women with prosthetic heart valves with anti-Xa adjusted low molecular weight heparin throughout pregnancy represents an effective anticoagulation option for low-middle-income countries.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yan-Hua Zhang, Lu Chen, Hong Zhan, Jiao'e Pan, Li Zhao, Wei Zhao, Qiong-Xin Liang, Xiao-Qing Li, Hong Wen
Objective: We aimed to create specific growth velocity reference charts for monochorionic (MC) twin pregnancies and provide additional information for assessing fetal growth in MC twins.
Study design: This retrospective study collected data from uncomplicated MC twins with serial ultrasound parameters. The four ultrasound parameters, including biparietal diameter, femur length, head circumference, and abdominal circumference, were used to calculate the estimated fetal weight (EFW). Multilevel linear regression models were applied to fit growth velocity charts for each biometric parameter and EFW. Analysis of variance was used to examine differences in birthweight by whether EFW velocity and EFW values were <10th or ≥10th percentiles.
Results: The final analysis encompassed a total of 5956 ultrasound examinations conducted on 487 MC twins. The growth velocity of four biparietal diameters exhibited a gradual decrease in a nearly linear fashion progressing from 18 to 37 gestational weeks. The EFW velocity increased steadily from 18 to 36 gestational weeks, reaching a peak of 178.2 g/week, and then the velocity gradually decreased until delivery. At 32 weeks for illustration, the lightest birth weight was observed when both EFW and EFW velocity were <10th percentile (1899 g). The study also found that birth weight was higher when EFW velocity was ≥10th percentile compared with <10th percentile, regardless of EFW being below or above the 10th percentile (2263 and 1906 g, respectively; P < 0.001).
Conclusion: We developed specific growth velocity reference charts for MC twins, which could provide a valuable reference point for a more precise evaluation of fetal growth in MC twins. Preliminary findings indicate that the inclusion of fetal growth velocity in monitoring fetal growth provides additional information beyond EFW alone.
研究目的我们的目的是为单绒毛膜双胎(MC)妊娠创建特定的生长速度参考图,并为评估 MC 双胎的胎儿生长情况提供更多信息:这项回顾性研究收集了无并发症 MC 双胎的序列超声参数数据。四项超声参数包括双顶径、股骨长、头围和腹围,用于计算估计胎儿体重(EFW)。应用多层次线性回归模型拟合各生物测量参数和 EFW 的生长速度表。根据 EFW 速度和 EFW 值的不同,采用方差分析来检验出生体重的差异:最终分析共对 487 对 MC 双胞胎进行了 5956 次超声波检查。从 18 孕周到 37 孕周,四个双顶径的生长速度以近乎线性的方式逐渐下降。EFW速度从18孕周到36孕周稳步上升,达到178.2克/周的峰值,然后速度逐渐下降,直至分娩。以 32 周为例,当 EFW 和 EFW 速度均为结论时,可观察到最轻的出生体重:我们为 MC 双胎绘制了特定的生长速度参考图,可为更精确地评估 MC 双胎的胎儿生长情况提供有价值的参考点。初步研究结果表明,将胎儿生长速度纳入胎儿生长监测可提供比单纯 EFW 更多的信息。
{"title":"Specific growth velocity reference charts for monochorionic twin pregnancies.","authors":"Yan-Hua Zhang, Lu Chen, Hong Zhan, Jiao'e Pan, Li Zhao, Wei Zhao, Qiong-Xin Liang, Xiao-Qing Li, Hong Wen","doi":"10.1002/ijgo.15933","DOIUrl":"https://doi.org/10.1002/ijgo.15933","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to create specific growth velocity reference charts for monochorionic (MC) twin pregnancies and provide additional information for assessing fetal growth in MC twins.</p><p><strong>Study design: </strong>This retrospective study collected data from uncomplicated MC twins with serial ultrasound parameters. The four ultrasound parameters, including biparietal diameter, femur length, head circumference, and abdominal circumference, were used to calculate the estimated fetal weight (EFW). Multilevel linear regression models were applied to fit growth velocity charts for each biometric parameter and EFW. Analysis of variance was used to examine differences in birthweight by whether EFW velocity and EFW values were <10th or ≥10th percentiles.</p><p><strong>Results: </strong>The final analysis encompassed a total of 5956 ultrasound examinations conducted on 487 MC twins. The growth velocity of four biparietal diameters exhibited a gradual decrease in a nearly linear fashion progressing from 18 to 37 gestational weeks. The EFW velocity increased steadily from 18 to 36 gestational weeks, reaching a peak of 178.2 g/week, and then the velocity gradually decreased until delivery. At 32 weeks for illustration, the lightest birth weight was observed when both EFW and EFW velocity were <10th percentile (1899 g). The study also found that birth weight was higher when EFW velocity was ≥10th percentile compared with <10th percentile, regardless of EFW being below or above the 10th percentile (2263 and 1906 g, respectively; P < 0.001).</p><p><strong>Conclusion: </strong>We developed specific growth velocity reference charts for MC twins, which could provide a valuable reference point for a more precise evaluation of fetal growth in MC twins. Preliminary findings indicate that the inclusion of fetal growth velocity in monitoring fetal growth provides additional information beyond EFW alone.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vincent DeGennaro, Rebecca R Henderson, Cynthia Petterson, Corey Wilson, Delphine Kanyandekwe, Yui Fujii, Rafael Guerrero-Preston, Nanotte Louis, Marie-Carmelle Elie, Nathalie McKenzie
Objective: In Haiti, cervical cancer continues to cause high levels of mortality and morbidity due to lack of resources and political unrest. Haitian women employed in factories are especially vulnerable because they are unable to take time away from work to access health resources. We aimed to describe a low-cost intervention which successfully addressed this need.
Methods: We present a retrospective review of data gathered through a public-private partnership, in which women working in garment factories near Port-au-Prince, Haiti, were offered health education, clinical breast exam, and free human papillomavirus (HPV) self-swab testing at their place of employment. Women testing positive for HPV were subsequently tested using visual inspection with acetic acid (VIA) to inform treatment referrals, and treated with mobile thermocoagulation in factory infirmaries. Factory-employed healthcare workers were trained on cancer screening, including VIA and clinical breast exam.
Results: A total of 6843 out of 6983 (98%) female factory employees attended free reproductive health education sessions, and 4005 out of 4153 eligible women (97%) were screened using HPV self-swab testing; 5176 women received a clinical breast exam. Of the women screened for HPV, 1001 (25%) tested positive and 905 (90%) of HPV-positive women received VIA testing and thermocoagulation. The intervention had a total cost of US$76 000, over half of which was spent on an HPV testing machine.
Conclusions: Innovative approaches to the prevention of cervical cancer are especially necessary in very low-resource, politically unstable environments like Haiti. Self-swab and screen-and-treat programs in the workplace were acceptable to employees and factory owners. This low-cost model was reached vulnerable women through a public-private partnership, and tracked them through screening and treatment. It could be implemented elsewhere or extended to include other health services.
{"title":"Working towards health: A model of cervical cancer screening and treatment for factory employees in Haiti.","authors":"Vincent DeGennaro, Rebecca R Henderson, Cynthia Petterson, Corey Wilson, Delphine Kanyandekwe, Yui Fujii, Rafael Guerrero-Preston, Nanotte Louis, Marie-Carmelle Elie, Nathalie McKenzie","doi":"10.1002/ijgo.15940","DOIUrl":"https://doi.org/10.1002/ijgo.15940","url":null,"abstract":"<p><strong>Objective: </strong>In Haiti, cervical cancer continues to cause high levels of mortality and morbidity due to lack of resources and political unrest. Haitian women employed in factories are especially vulnerable because they are unable to take time away from work to access health resources. We aimed to describe a low-cost intervention which successfully addressed this need.</p><p><strong>Methods: </strong>We present a retrospective review of data gathered through a public-private partnership, in which women working in garment factories near Port-au-Prince, Haiti, were offered health education, clinical breast exam, and free human papillomavirus (HPV) self-swab testing at their place of employment. Women testing positive for HPV were subsequently tested using visual inspection with acetic acid (VIA) to inform treatment referrals, and treated with mobile thermocoagulation in factory infirmaries. Factory-employed healthcare workers were trained on cancer screening, including VIA and clinical breast exam.</p><p><strong>Results: </strong>A total of 6843 out of 6983 (98%) female factory employees attended free reproductive health education sessions, and 4005 out of 4153 eligible women (97%) were screened using HPV self-swab testing; 5176 women received a clinical breast exam. Of the women screened for HPV, 1001 (25%) tested positive and 905 (90%) of HPV-positive women received VIA testing and thermocoagulation. The intervention had a total cost of US$76 000, over half of which was spent on an HPV testing machine.</p><p><strong>Conclusions: </strong>Innovative approaches to the prevention of cervical cancer are especially necessary in very low-resource, politically unstable environments like Haiti. Self-swab and screen-and-treat programs in the workplace were acceptable to employees and factory owners. This low-cost model was reached vulnerable women through a public-private partnership, and tracked them through screening and treatment. It could be implemented elsewhere or extended to include other health services.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yu Pan, Zi Chen, Lujiao Chen, Lingli Ning, Huimin Wan, Ting Chen, Haihong Zhang, Ying Jiang, Qiong Luo
Objective: Supported by remote signal processing techniques and wireless communication technology, remote electronic fetal monitoring (REFM) has emerged as a promising alternative to traditional electronic fetal monitoring (TEFM) in clinical practice. The aim of this study was to evaluate the comparability, accessibility, and clinical utility of REFM in contrast to TEFM.
Methods: This was a multicenter prospective cohort study. A cohort of 2900 pregnant women were enrolled from three medical centers between June 1, 2021 and June 31, 2022. Among them, 800 utilized REFM, with 760 of them completing the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) assessments using the devices for 1 month. The control group comprised 2100 pregnant women who did not use REFM. Additionally, 80 pregnant women concurrently employed both REFM and TEFM, and their respective curve coincidence rates were determined through curve fitting. Primary outcomes encompassed pregnancy outcomes in both groups, average curve coincidence rates between REFM and TEFM, as well as SDS and SAS scores.
Results: Among the 760 pregnant women who completed SAS and SDS assessments, their average SAS scores before and after 1 month of REFM usage were 43.09 ± 8.04 and 41.58 ± 6.59, respectively. Concurrently, the average SDS scores before and after 1 month of REFM usage were 45.45 ± 9.60 and 44.80 ± 9.17, respectively. A statistically significant decrease was observed in SAS scores (P = 0.005), whereas no significant difference was noted in SDS scores (P = 0.340). Furthermore, a statistically significant difference in the rate of adverse pregnancy outcomes (neonatal asphyxia) emerged between the two groups, those who employed REFM and those who did not (P = 0.021). In the subset of 80 pregnant women employing both REFM and TEFM, all 80 results showed precise congruence between the two methods. The average coincidence rate was determined to be 79.45% ± 12.64%.
Conclusion: REFM contributes to improved pregnancy outcomes and exhibits a high level of concordance with TEFM, thereby accurately reflecting the quality of fetal heart monitoring. Additionally, REFM effectively mitigates pregnant women's anxiety. Thus, REFM demonstrates comparability, accessibility, and clinical utility.
{"title":"Fungibility, accessibility and clinical utility of remote electronic fetal monitoring in improving maternal emotional status compared with traditional method: A multicenter prospective cohort analysis.","authors":"Yu Pan, Zi Chen, Lujiao Chen, Lingli Ning, Huimin Wan, Ting Chen, Haihong Zhang, Ying Jiang, Qiong Luo","doi":"10.1002/ijgo.15917","DOIUrl":"https://doi.org/10.1002/ijgo.15917","url":null,"abstract":"<p><strong>Objective: </strong>Supported by remote signal processing techniques and wireless communication technology, remote electronic fetal monitoring (REFM) has emerged as a promising alternative to traditional electronic fetal monitoring (TEFM) in clinical practice. The aim of this study was to evaluate the comparability, accessibility, and clinical utility of REFM in contrast to TEFM.</p><p><strong>Methods: </strong>This was a multicenter prospective cohort study. A cohort of 2900 pregnant women were enrolled from three medical centers between June 1, 2021 and June 31, 2022. Among them, 800 utilized REFM, with 760 of them completing the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) assessments using the devices for 1 month. The control group comprised 2100 pregnant women who did not use REFM. Additionally, 80 pregnant women concurrently employed both REFM and TEFM, and their respective curve coincidence rates were determined through curve fitting. Primary outcomes encompassed pregnancy outcomes in both groups, average curve coincidence rates between REFM and TEFM, as well as SDS and SAS scores.</p><p><strong>Results: </strong>Among the 760 pregnant women who completed SAS and SDS assessments, their average SAS scores before and after 1 month of REFM usage were 43.09 ± 8.04 and 41.58 ± 6.59, respectively. Concurrently, the average SDS scores before and after 1 month of REFM usage were 45.45 ± 9.60 and 44.80 ± 9.17, respectively. A statistically significant decrease was observed in SAS scores (P = 0.005), whereas no significant difference was noted in SDS scores (P = 0.340). Furthermore, a statistically significant difference in the rate of adverse pregnancy outcomes (neonatal asphyxia) emerged between the two groups, those who employed REFM and those who did not (P = 0.021). In the subset of 80 pregnant women employing both REFM and TEFM, all 80 results showed precise congruence between the two methods. The average coincidence rate was determined to be 79.45% ± 12.64%.</p><p><strong>Conclusion: </strong>REFM contributes to improved pregnancy outcomes and exhibits a high level of concordance with TEFM, thereby accurately reflecting the quality of fetal heart monitoring. Additionally, REFM effectively mitigates pregnant women's anxiety. Thus, REFM demonstrates comparability, accessibility, and clinical utility.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Veronica Tius, Martina Arcieri, Cristina Taliento, Giulia Pellecchia, Giampiero Capobianco, Tommaso Simoncini, Giovanni Panico, Daniela Caramazza, Giuseppe Campagna, Lorenza Driul, Giovanni Scambia, Alfredo Ercoli, Stefano Restaino, Giuseppe Vizzielli
Background: Literature is lacking strong evidence about comparisons of efficacy and quality of life-related outcomes between laparoscopic total and/or supracervical hysterectomy (LTH/LSCH) with laparoscopic sacrocolpopexy (LSC) and minimally invasive sacrohysteropexy (LSH).
Objective: To summarize and compare available data on this topic providing a useful clinical tool in the treatment decision process.
Search strategy: We performed a systematic research of PubMed (MEDLINE), Web of Science, and Gooogle Scholar.
Selection criteria: We included studies that compared at least one efficacy outcome (objective or subjective outcome) between LTH/LSCH with LSC and LSH. Data on surgery-related morbidities were also extracted where available.
Data collection and analysis: A random-effect meta-analysis was conducted reporting pooled mean differences and odds ratios (OR) between groups using Review Manager V.7.9.0.
Main results: We included a total of nine observational studies. LTH/LSCH with LSH was associated with a significantly higher objective success (apical compartment OR 7.95; 95% confidence interval [CI] 2.23-28.33; I2 = 0%; P = 0.001; anterior compartment OR 2.23; 95% CI 1.26-4.30; I2 = 12%; P = 0.007) and subjective success (OR 3.19; 95% CI 1.42-7.17; I2 = 39%; P = 0.005). No differences were found regarding intraoperative and postoperative complications, sexual dysfunction, and stress urinary incontinence rate after surgery. Hysteropexy showed shorter operative time and shorter hospital length with a pool mean difference of 27.37 min (95% CI 18.04-32.71; I2 = 0%; P < 0.001) and 0.7 days (95% CI 0.24-1.17; I2 = 75%; P = 0.003), respectively. Concurrent hysterectomy was not associated with a higher rate of mesh-related complications (P = 0.53). No major differences were found regarding recurrence and reoperation rate (P = 0.10 and P = 0.93, respectively).
Conclusions: LTH/LSCH with LSC has better objective and subjective outcomes in pelvic organ prolapse surgery than LSH alone, especially for apical and anterior compartments, and is not associated with higher postoperative sexual dysfunction and mesh-related complications. Adequate preoperative counseling is highly recommended in patients who desire uterine preservation.
{"title":"Laparoscopic sacrocolpopexy with concurrent hysterectomy or uterine preservation: A metanalysis and systematic review.","authors":"Veronica Tius, Martina Arcieri, Cristina Taliento, Giulia Pellecchia, Giampiero Capobianco, Tommaso Simoncini, Giovanni Panico, Daniela Caramazza, Giuseppe Campagna, Lorenza Driul, Giovanni Scambia, Alfredo Ercoli, Stefano Restaino, Giuseppe Vizzielli","doi":"10.1002/ijgo.15891","DOIUrl":"https://doi.org/10.1002/ijgo.15891","url":null,"abstract":"<p><strong>Background: </strong>Literature is lacking strong evidence about comparisons of efficacy and quality of life-related outcomes between laparoscopic total and/or supracervical hysterectomy (LTH/LSCH) with laparoscopic sacrocolpopexy (LSC) and minimally invasive sacrohysteropexy (LSH).</p><p><strong>Objective: </strong>To summarize and compare available data on this topic providing a useful clinical tool in the treatment decision process.</p><p><strong>Search strategy: </strong>We performed a systematic research of PubMed (MEDLINE), Web of Science, and Gooogle Scholar.</p><p><strong>Selection criteria: </strong>We included studies that compared at least one efficacy outcome (objective or subjective outcome) between LTH/LSCH with LSC and LSH. Data on surgery-related morbidities were also extracted where available.</p><p><strong>Data collection and analysis: </strong>A random-effect meta-analysis was conducted reporting pooled mean differences and odds ratios (OR) between groups using Review Manager V.7.9.0.</p><p><strong>Main results: </strong>We included a total of nine observational studies. LTH/LSCH with LSH was associated with a significantly higher objective success (apical compartment OR 7.95; 95% confidence interval [CI] 2.23-28.33; I<sup>2</sup> = 0%; P = 0.001; anterior compartment OR 2.23; 95% CI 1.26-4.30; I<sup>2</sup> = 12%; P = 0.007) and subjective success (OR 3.19; 95% CI 1.42-7.17; I<sup>2</sup> = 39%; P = 0.005). No differences were found regarding intraoperative and postoperative complications, sexual dysfunction, and stress urinary incontinence rate after surgery. Hysteropexy showed shorter operative time and shorter hospital length with a pool mean difference of 27.37 min (95% CI 18.04-32.71; I<sup>2</sup> = 0%; P < 0.001) and 0.7 days (95% CI 0.24-1.17; I<sup>2</sup> = 75%; P = 0.003), respectively. Concurrent hysterectomy was not associated with a higher rate of mesh-related complications (P = 0.53). No major differences were found regarding recurrence and reoperation rate (P = 0.10 and P = 0.93, respectively).</p><p><strong>Conclusions: </strong>LTH/LSCH with LSC has better objective and subjective outcomes in pelvic organ prolapse surgery than LSH alone, especially for apical and anterior compartments, and is not associated with higher postoperative sexual dysfunction and mesh-related complications. Adequate preoperative counseling is highly recommended in patients who desire uterine preservation.</p><p><strong>Prospero registration number: </strong>CRD42024537270.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}