International Journal of Gynecology & Obstetrics最新文献

Objective: We examined the impact of a codesigned multicomponent implementation strategy on adherence to evidence-based intrapartum care, respectful maternity care, and newborn care practices in 11 medical schools across two states and a union territory in India.

Methods: We conducted pre-post implementation research using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework from July 2019 to October 2021. The implementation strategy was codesigned by researchers and medical school faculty. At baseline and endline, we recruited intranatal (n = 175, 158) and postnatal women (n = 158, 167) with uncomplicated vaginal delivery for observation and interview, respectively. The primary outcome was proportion of uncomplicated deliveries with a composite of avoiding augmentation, avoiding episiotomy, and using alternate birthing positions. We used generalized estimating equations to compare baseline and endline findings and estimated adjusted prevalence odds ratios (APORs).

Results: The primary outcome increased from 5.4% at baseline to 17.4% at endline with APOR 3.55 (95% CI: 1.08, 11.66). A decline was observed in not-recommended practices, namely pubic shaving (APOR 0.05, 95% CI: 0.01, 0.18), enema (APOR 0.07, 95% CI: 0.02, 0.22), fundal pressure (APOR 0.05, 95% CI: 0.02, 0.14), episiotomy (APOR 0.75, 95% CI: 0.38, 1.48). Newborn care practices showed the greatest improvements in early initiation of breastfeeding (APOR 42.35, 95% CI: 5.70, 314.61) and delayed cord clamping (APOR 21.28, 95% CI: 6.00, 75.43). Results from postnatal interviews corroborated those from direct observation in the labor room.

Conclusion: A codesigned multi-component implementation strategy can improve adherence to evidence-based intrapartum and newborn care practices in medical schools.

The prevalence of infertility among couples globally is estimated at 15%. Male factor infertility contributes to 20%-70% of the cases depending on the specific region of the world. Male infertility accounts for up to 22.26% of cases in Africa. Causes are generally categorized as pre-testicular, testicular, or post-testicular, based on the level of dysfunction within the hypothalamic-pituitary-gonadal axis. Primary testicular failure is caused by intrinsic testicular dysfunction, while secondary testicular failure originates from a dysfunction in the hypothalamus or the pituitary gland. Post-testicular causes are attributed to obstructive, ejaculatory, or erectile dysfunction. Evaluation should thus entail a full history followed by a detailed physical exam and stepwise investigation. Semen analysis is recommended as the initial test, followed by hormonal tests, imaging, biopsies, and karyotyping as needed. Treatment is tailored based on the specific cause identified.

Objective: To estimate the prevalence of urinary incontinence (UI), its subtypes, and the associated risk factors in women of reproductive age in Bangladesh.

Methods: Data from the 2016 Bangladesh Maternal Mortality and Health Care Survey was analyzed in a nationally representative sample of 298 284 households that used a multistage sample selection procedure. Data on 183 560 ever-married women aged 15-49 years who had ever given birth were analyzed. Descriptive statistics was used to report the overall prevalence of any UI and its three subtypes: stress, urge, and mixed UI. The wealth index of each household was constructed using principal component analysis. Univariable and multivariable binary logistic regression analyses were conducted to identify the factors associated with each type of UI.

Results: The prevalence of any UI was 15.9% (95% confidence interval [CI]:15.7-16.1). Stress incontinence was the most prevalent UI (8.3%, 95% CI: 8.2-8.4), followed by mixed type (5.5%, 95% CI: 5.4-5.6), and urge incontinence (2.1%, 95% CI: 2.1-2.2). In multivariate logistic regression analysis, older age, no or less education, younger age at first birth, higher parity, lower wealth status, self-reported pelvic organ prolapse (POP), and being Muslim had a significant positive association with the presence of UI.

Conclusions: About one in six women reported to have suffered from any type of UI in this study. Several common risk factors were found, which call for targeted policy and programmatic interventions.

Gestational diabetes mellitus (GDM) is well known to be associated with fetal overgrowth and short- or long-term adverse outcomes in singleton pregnancies; however, its relationship with twin pregnancies remains controversial, posing challenges for clinical management. Despite the heterogeneity in GDM diagnosis and racial differences among populations, two critical issues remain unaddressed. The first issue is methodological, specifically whether data on twins have been analyzed using appropriate approaches. The second issue is the underlying pathophysiology'. Given that both glucose demand and insulin resistance are elevated in twin pregnancies, the optimal level of maternal insulin secretion remains uncertain. In this paper, we summarize the current knowledge on GDM in the context of twin pregnancies, their perinatal outcomes, glucose control, and gestational weight gain management. We then propose methodological considerations for future improvements. Ultimately, we underscore the importance of delving into the glucose requirements of twin pregnancies to gain a profound understanding of their gestational glucose and insulin metabolism. All these questions are key issues in this area, and by answering them we will accelerate the development of high-quality, evidence-based clinical guidelines for GDM management in twin pregnancies.

Objective: To explore the lived experience of women living with infertility in Ethiopia.

Method: We used interpretative phenomenologic analysis with open-ended semi-structured questions, focusing on what living with infertility looks like and what that means to the women. Participants included women who had experienced infertility and were following treatment at St. Paul's Hospital Center for Fertility & Reproductive Medicine in Addis Ababa, Ethiopia. We purposefully recruited 13 women living with infertility and used NVivo version 12 software for data analysis.

Results: The study generated six themes: (1) the reason for wanting a child, (2) the financial sacrifice of accessing treatment, (3) infertility and marriage, (4) estrangement and ostracization in social life, (5) psychological despair and support, and (6) faith and resilience. Further analysis identified the superordinate themes: the meaning of a child; lineage and continuity of life; togetherness; marital discord; reduced social participation; being left out of the world, psychological suffering; support and relationship with healthcare providers; helplessness, acceptance, and hope. A child in the Ethiopian context has significant meaning for women and the community. Being unable to accomplish motherhood brings numerous challenges.

Conclusion: The far-reaching consequences of infertility substantially affect women's psychological, financial, sociocultural, and spiritual lives. However, despite the difficult journey of infertility, women develop coping mechanisms and resilience. Professional psychosocial support is necessary to alleviate the consequences of infertility, yet access to and utilization of these services are inadequate. Infertility needs to receive better attention in the Ethiopian healthcare system as it has significant implications for couples' lives.

Objective: Endometriosis is a chronic disease which has been reported to be associated with distorted immune mechanisms. The alternative pathway is a complement system which plays a role in immune defense. The present study aimed to evaluate whether the level of alternative complement molecules differ in women with endometriosis compared to heathy individuals.

Methods: A total of 58 women participated in this prospective research. Women with a diagnosis of endometriosis confirmed by laparoscopy (n = 32) were compared to healthy women (n = 26) in terms of serum adipsin, properdin, mannose-binding lectin-associated serine protease-3 and complement factor-H (CFH) levels. The peritoneal fluid samples which were taken during the endometriosis surgery were also analyzed in terms of the complement levels. The clinical and demographic data including the serum CA-125 level and pelvic pain were also analyzed. SPSS version 23.0 was used in statistical analysis.

Results: The serum levels of adipsin and CFH were found to be significantly increased in women with endometriosis (P = 0.027 and P = 0.040, respectively). Serum adipsin level was found to significantly correlate with serum CA-125 level (r = 0.320, P = 0.015), serum CFH level (r = 0.705, P < 0.001), and degree of the pelvic pain complaint (r = 0.326, P = 0.013). A strong, positive correlation was also observed between peritoneal fluid levels of adipsin, and CFH (r = 0.593; P < 0.001).

Conclusion: To the best of our knowledge, the present study is the first to evaluate the alternative complement system in women with endometriosis. The current findings may be noteworthy to elucidate the possible role of the key molecules of the alternative pathway in endometriosis pathogenesis.

Objective: To examine patient, physician, and operating room (OR) staff perceptions at an academic institution following the introduction of an explicit, written consent form for medical student participation in the pelvic examination under anesthesia (EUA).

Methods: The study was performed at one urban academic medical center between May 2021 and May 2023. Thirty-one individuals including patients, OR staff, and physicians were interviewed to better understand their perspectives regarding an initiative to explicitly consent patients for the student pelvic EUA. Northwestern University Institutional Review Board approval was obtained.

Results: Patients appreciated being asked to explicitly consent to or refuse the student pelvic EUA and having a dedicated consent form left them with a positive feeling about the hospital and their healthcare providers. OR staff and physicians agreed that the student pelvic EUA is necessary, and almost all supported an explicit consent form. Physicians did not find the additional consent form burdensome and noted only a modest decline in learning opportunities.

Conclusion: Patients and healthcare providers agreed that requiring explicit written consent for the student pelvic EUA respected patient autonomy, improved healthcare quality, and caused minimal disruption to medical education. Our data support the use of an explicit written consent form as standard practice.

Objective: To analyze the rate of vaginal cuff dehiscence (VCD) by surgical approach and surgeons' experience.

Method: In this observational, retrospective, cohort study, rates of VCD were calculated based on surgical approach, and VCD clinical characteristics were analyzed. Surgical routes of laparotomy, laparoscopy, and robotic surgery were compared. All minimally invasive surgeries were performed or supervised by a Japanese Society of Gynecology Obstetrics Endoscopy-certified laparoscopic surgeon.

Results: There were 4864 hysterectomies in total: abdominal hysterectomies (n = 2578, 53.0%), laparoscopic hysterectomies (n = 1840, 37.8%), and robotic hysterectomies (n = 446, 9.2%). Among the 20 (0.411%) patients with VCD, the rate of VCD was highest for laparoscopic hysterectomy (0.706%), followed by robotic surgery (0.224%) and laparotomy (0.233%). Most causes of VCD were due to intercourse (50%), but 8 of 9 (88.8%) cases caused spontaneously or by defecation were laparoscopic cases. Defecation-related and spontaneous cases occurred significantly earlier after surgery than did intercourse-related cases (P = 0.008).

Conclusion: Our data showed a decrease in laparoscopic VCD compared with those of previous reports. VCD occurred more frequently with laparoscopy than with laparotomy, even when performed by experienced surgeons. Laparoscopic VCD often develops early with little external force applied. Problems with vaginal stump rigidity may be related to the surgical procedure.

Objective: To evaluate the effectiveness of a cesarean delivery (CD) bundle including preoperative vaginal preparation, cefazolin and azithromycin administration, compared with cefazolin alone, in reducing postoperative infections, among women undergoing CD during the second stage of labor.

Methods: In August 2016, our departmental protocol for preventing infectious morbidity in second-stage CD was revised from preoperative intravenous 2 g cefazolin alone, to preoperative intravenous 2 g cefazolin, intravenous 500 mg azithromycin, and vaginal cleansing with povidone-iodine. In this before-and-after study, the medical records of women who underwent CD during the second stage of labor were reviewed, comparing two time periods: January 2014 to August 2016 (control group, cefazolin alone) and November 2016 to January 2021 (CD bundle group). Obstetric characteristics, postoperative infections, and neonatal outcomes were compared between groups. Composite infectious morbidity was defined as one or more of: endometritis, surgical-site infection (SSI), abscess, urinary tract infection, and postpartum fever.

Results: During the study period, there were 5265 intrapartum CD, among them 457 were during the second stage of labor. The CD bundle group (n = 331) had lower rates of endometritis, SSI, and composite infectious morbidity compared with the control group (n = 126, 1.2% vs. 4.8%, P = 0.030; 3.0% vs. 7.1%, P = 0.049, 6.9% vs. 14.3%, P = 0.014, respectively). Neonatal outcomes did not differ between groups. Multivariable regression analysis adjusted for confounders revealed that the CD bundle reduced the risk for the composite infectious outcome, with adjusted odds ratio 0.08 (95% confidence interval 0.01-0.50).

Conclusions: In second-stage CD, adding preoperative azithromycin and vaginal cleansing to cefazolin was efficacious in reducing postoperative infections.