International Journal of Gynecology & Obstetrics最新文献

Background: The United Nations (UN) has a target for universal contraception access by 2030. Youth (aged 15-29) still have limited contraception access and lower usage. A unified understanding of the barriers youth face in high-income countries (HIC) remains unclear.

Objectives: Synthesized evidence on youth contraception barriers across HIC to identify continued healthcare inaccessibility and knowledge gaps.

Search strategy: A search strategy, including terms like "youth" and "barriers," was applied to three databases, identifying articles published between January 2013-September 2024.

Selection criteria: Primary peer-reviewed quantitative, qualitative, and mixed-methods studies were included if they focused on youth and contraception barriers.

Data collection and analysis: Following the Joanna Briggs Institute, articles were screened for inclusion, and data was extracted. Analyses included descriptive statistics and summarizing findings for quantitative and qualitative results. All articles were subjected to inductive and deductive content analysis to map barriers. Article quality was appraised by the Mixed Methods Appraisal Tool.

Main results: A total of 41 articles were included, of which 88% were from the USA. Youth struggled to receive quality contraception care from multiple access points from health systems and youth perspectives. Barriers included youth minimal knowledge, poor approachability and care appropriateness, physical barriers, costs, stigma, confidentiality concerns, and service gatekeeping. Youth experiences varied by social identities with those from lower economic, rural, and of younger age facing more obstacles.

Conclusions: Contraception was inaccessible for many. To meet UN targets, efforts need to address described barriers to ensure accessible and equitable contraception care that respects and supports youth's choices.

Objective: To compare the efficacy of different prophylactic oxytocin regimens in preventing postpartum hemorrhage (PPH) after vaginal delivery.

Methods: Single-center retrospective cohort study including all vaginal deliveries between February 1, 2022, and December 31, 2023, at a tertiary referral unit. Throughout the study period, the local protocol for PPH prevention in vaginal delivery was changed from oxytocin 10 IU intramuscular injection (IM) to 5 IU intravenous bolus (IV) and eventually to 10 IU IV. Data regarding base maternal characteristics, pregnancy course, labor, and maternal outcomes were retrospectively collected from institutional labor ward registries. The incidence of PPH was compared among the three historical cohorts who received different oxytocin regimens (10 IU IM, group A; 5 IU IV, group B; and 10 IU IV, group C) following propensity score matching for those variables that proved to be significantly associated with PPH.

Results: During the study period, 3850 women had a vaginal birth at our tertiary care unit (1245 in the 10 IU IM group, 1291 in the 5 IU IV group and 1314 in the 10 IU IV group) and were enrolled in the study population. Of these, 688 (17.8%) had PPH. At multivariable logistic regression nulliparity, second-degree or higher perineal tears, episiotomy, manual placental removal, birth weight, and multiple gestation appeared to be independently associated with PPH. PPH incidence was then compared among the groups following 1:1 propensity score matching for the above cited factors and appeared significantly higher with the use of 10 IU IM (group A) versus 5 IU IV (group B) oxytocin (21.3% versus 11.0%; P < 0.001) and versus 10 IU IV (group C) (22.1% versus 16.8%; P = 0.033); non-significant differences between the incidence of PPH were observed when comparing the two regimens of IV administration.

Conclusion: Intravenous administration of 5 IU or 10 IU is more effective than IM administration of 10 IU in reducing the incidence of PPH after vaginal deliveries. The efficacy of the two IV regimens appears similar.

Objective: To analyze maternal and perinatal outcomes in women with rheumatic valvular heart disease and to evaluate the predictive factors for adverse cardiac outcomes in this cohort.

Methods: A retrospective analysis was performed of pregnant women with rheumatic heart disease (RHD) who delivered at a tertiary care referral hospital over a 5-year period from 2018 to 2023.

Results: A total of 118 pregnant women with RHD were encountered during the study period. The mitral valve was most commonly affected (75/118; 62.7%), 79/118 (66.9%) underwent cardiac interventions, and 39/118 (33%) were on anticoagulation medication. Deterioration in New York Heart Association (NYHA) functional class was noted in 36/118 (30.5%) of these women prenatally, and cardiac failure developed in 18/118 (15.3%). New-onset arrhythmia occurred in 6/118 (5.1%), which was managed medically. Mean gestational age at delivery was 36.73 ± 2.53 weeks, with a cesarean delivery rate of 68/118 (57.6%). Among fetal and neonatal outcomes, average birth weight was 2390.46 ± 574.46 g, with 38/118 (32.2%) being preterm and 61/118 (52.5%) being low birth weight. Key predictors of poor cardiac outcomes included more than one affected valve and a poor NYHA functional class (more than II) at admission. Patients with mechanical heart valves faced higher risks from anticoagulation.

Conclusion: Pregnancy in women with RHD is associated with adverse maternal cardiac, obstetrical, and neonatal outcomes. More than one affected heart valve and a poor NYHA functional class were found to be strong predictors of adverse cardiac outcomes during pregnancy. A specialized cardio-obstetric team is crucial for enhancing pregnancy outcomes.

Objective: To assess whether the use of a handkerchief specifically designed to facilitate skin-to-skin contact (NeoBulle handkerchief) was effective in increasing skin-to-skin contact in mother-newborn dyads.

Methods: A medical intervention study was conducted from 2021 through 2023 in the Hospital Sant Camil (Barcelona). Participants were randomized 1:1 to an intervention (NeoBulle handkerchief) or a standard of care (SoC; towel) group. The primary outcome, to assess whether the intervention could increase the time mother-newborn dyads spent in skin-to-skin contact, was measured in two ways: (1) time in hours of skin-to-skin contact between mother-newborn dyads recorded in a diary and (2) percentage of the total time recorded in the diary that the dyad were in skin-to-skin contact. Secondary outcomes included newborn weight loss, time newborns spent crying and parental satisfaction.

Results: A total of 72 dyads were included in the intervention group and 71 in the SoC group. The mean (SD) time in skin-to-skin contact was significantly longer in the intervention vs. SoC group (Median 6 [IQR: 11.6] vs. 4.5 [IQR: 7.3] h; P = 0.054) and the percentage of hours spent in skin-to-skin contact was higher (18.9 [18.8] vs. 13.3 [14.7]%; P = 0.085). Secondary endpoints were similar between groups.

Conclusion: Use of the Neobulle handkerchief increased the time that mother-newborn dyads spent in skin-to-skin contact and was well accepted by mothers.

Clinical trial registration: NCT04881071. https://clinicaltrials.gov/study/NCT04881071?term=NCT04881071&rank=1.

Objective: To investigate the frequency, etiology, and clinical characteristics of bleeding disorders (BD) in adolescents with heavy menstrual bleeding (HMB) and evaluate treatment outcomes.

Methods: This retrospective study analyzed 515 adolescents (10-19 years) presenting with abnormal uterine bleeding (AUB) at a multidisciplinary clinic. After excluding 24 with chronic diseases, 491 patients were categorized as: anovulatory HMB (HMB-An, n = 305), BD (n = 40), and non-HMB anovulatory cycles (n = 146). All HMB patients underwent hemostatic and endocrine assessments, with coagulation and platelet function tests when indicated.

Results: Among 345 HMB patients, 40 (11.6%) had BD. The most common cause was von Willebrand disease (vWD) (12/40, 30%), followed by coagulation factor deficiencies (11/40, 27.5%), thrombocytopenia (8/40, 20%), and platelet function defects (6/40, 15%). Hospitalization rates were higher in BD than HMB-An (25% vs 16%). Combined oral contraceptives (0.03 mg ethinyl estradiol + 0.15 mg levonorgestrel, tapered over 7-10 days) controlled bleeding in 85% of acute-phase HMB within a median of 3 days. VWD patients had a milder course, with fewer rates of HMB at menarche, prolonged bleeding, and transfusion needs.

Conclusion: Bleeding disorders should be considered in all adolescents with HMB, particularly when hemoglobin is ≤10 g/dL. Persistent bleeding despite treatment requires re-evaluation, even if initial results are normal, with special attention to platelet dysfunction. Early recognition and prompt initiation of hormonal therapy, especially combined oral contraceptives, effectively reduce hospitalizations, transfusions, and improve quality of life.