Pub Date : 2023-09-01DOI: 10.1097/ogx.0000000000001199
A.T.N. Tita, W.A. Carlo, E.M. McClure, M. Mwenechanya, E. Chomba, J.J. Hemingway-Foday, A. Kavi, M.C. Metgud, S. S. Goudar, R. Derman, A. Lokangaka, A. Tshefu, M. Bauserman, C. Bose, P. Shivkumar, M. Waikar, A. Patel, P.L. Hibberd, P. Nyongesa, F. Esamai, O.A. Ekhaguere, S. Bucher, S. Jessani, S.S. Tikmani, S. Saleem, R. L. Goldenberg, S.M. Billah, R. Lennox, R. Haque, W. Petri, L. Figueroa, M. Mazariegos, N.F. Krebs, J.L. Moore, T.L. Nolen, M. Koso-Thomas
ABSTRACT A high proportion of peripartum maternal deaths are caused by infection and sepsis, and this proportion continues to rise. In addition, neonatal sepsis is the third most common cause of neonatal death; the 2 conditions are connected in that maternal infection causes an increased risk of neonatal sepsis. Recent studies have shown azithromycin to be effective in reducing instances of maternal infection after an unplanned cesarean delivery, but its effectiveness for infections related to vaginal delivery has not yet been examined. This study, A-PLUS (Azithromycin Prevention in Labor Use Study), was designed to investigate the effectiveness of azithromycin in women planning a vaginal delivery. This study was conducted as a multicountry, double-blind, placebo-controlled, randomized trial over 8 sites in 7 countries. Primary outcomes included maternal sepsis or death within 6 weeks of delivery, as well as stillbirth, neonatal death, or sepsis within 4 weeks of delivery. Secondary maternal outcomes included related components, such as specific infections of chorioamnionitis, endometritis, perineal wound infection, abdominal or pelvic abscess, mastitis or breast abscess, pneumonia, or pyelonephritis, as well as therapeutic use of antibiotics, duration of hospital stay, readmission, admission to a special care unit, and unscheduled health care visits. Secondary outcomes relating to neonates included similar components, specific infection, the duration of hospital stay, readmission, admission to a special care unit, unscheduled health care visits, and safety outcomes (adverse events related to medication). Final analysis included 29,278 women, with 14,590 women (and 14,687 neonates or stillbirths) in the azithromycin group and 14,688 women (and 14,782 neonates or stillbirths) in the placebo group. Maternal sepsis or death was observed in 227 patients in the azithromycin group and 344 patients in the placebo group (adjusted relative risk, 0.67; 95% confidence interval [CI], 0.56–0.79; P < 0.001). Sepsis was the case in 219 in the azithromycin group and 339 in the placebo group (relative risk, 0.65; 95% CI, 0.55–0.77), and death from sepsis was rare. For neonates, stillbirth, death, or sepsis was observed in 1540 in the azithromycin group and 1526 in the placebo group (relative risk, 1.02; 95% CI, 0.95–1.09), with sepsis accounting for 1433 and 1407 cases in the azithromycin and placebo groups, respectively. Both the outcomes of stillbirth and neonatal death were relatively uncommon. Maternal adverse effects experienced from the medication were not significantly different between groups, and the azithromycin group had noticeably reduced risk of endometritis, wound infections, and several others when compared with the placebo group. These results indicate that azithromycin is consistently effective in lowering the risk of infection and sepsis in mothers and infants during vaginal delivery. The number treated to prevent 1 case of maternal death or sep
{"title":"Azithromycin to Prevent Sepsis of Death in Women Planning a Vaginal Birth","authors":"A.T.N. Tita, W.A. Carlo, E.M. McClure, M. Mwenechanya, E. Chomba, J.J. Hemingway-Foday, A. Kavi, M.C. Metgud, S. S. Goudar, R. Derman, A. Lokangaka, A. Tshefu, M. Bauserman, C. Bose, P. Shivkumar, M. Waikar, A. Patel, P.L. Hibberd, P. Nyongesa, F. Esamai, O.A. Ekhaguere, S. Bucher, S. Jessani, S.S. Tikmani, S. Saleem, R. L. Goldenberg, S.M. Billah, R. Lennox, R. Haque, W. Petri, L. Figueroa, M. Mazariegos, N.F. Krebs, J.L. Moore, T.L. Nolen, M. Koso-Thomas","doi":"10.1097/ogx.0000000000001199","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001199","url":null,"abstract":"ABSTRACT A high proportion of peripartum maternal deaths are caused by infection and sepsis, and this proportion continues to rise. In addition, neonatal sepsis is the third most common cause of neonatal death; the 2 conditions are connected in that maternal infection causes an increased risk of neonatal sepsis. Recent studies have shown azithromycin to be effective in reducing instances of maternal infection after an unplanned cesarean delivery, but its effectiveness for infections related to vaginal delivery has not yet been examined. This study, A-PLUS (Azithromycin Prevention in Labor Use Study), was designed to investigate the effectiveness of azithromycin in women planning a vaginal delivery. This study was conducted as a multicountry, double-blind, placebo-controlled, randomized trial over 8 sites in 7 countries. Primary outcomes included maternal sepsis or death within 6 weeks of delivery, as well as stillbirth, neonatal death, or sepsis within 4 weeks of delivery. Secondary maternal outcomes included related components, such as specific infections of chorioamnionitis, endometritis, perineal wound infection, abdominal or pelvic abscess, mastitis or breast abscess, pneumonia, or pyelonephritis, as well as therapeutic use of antibiotics, duration of hospital stay, readmission, admission to a special care unit, and unscheduled health care visits. Secondary outcomes relating to neonates included similar components, specific infection, the duration of hospital stay, readmission, admission to a special care unit, unscheduled health care visits, and safety outcomes (adverse events related to medication). Final analysis included 29,278 women, with 14,590 women (and 14,687 neonates or stillbirths) in the azithromycin group and 14,688 women (and 14,782 neonates or stillbirths) in the placebo group. Maternal sepsis or death was observed in 227 patients in the azithromycin group and 344 patients in the placebo group (adjusted relative risk, 0.67; 95% confidence interval [CI], 0.56–0.79; P < 0.001). Sepsis was the case in 219 in the azithromycin group and 339 in the placebo group (relative risk, 0.65; 95% CI, 0.55–0.77), and death from sepsis was rare. For neonates, stillbirth, death, or sepsis was observed in 1540 in the azithromycin group and 1526 in the placebo group (relative risk, 1.02; 95% CI, 0.95–1.09), with sepsis accounting for 1433 and 1407 cases in the azithromycin and placebo groups, respectively. Both the outcomes of stillbirth and neonatal death were relatively uncommon. Maternal adverse effects experienced from the medication were not significantly different between groups, and the azithromycin group had noticeably reduced risk of endometritis, wound infections, and several others when compared with the placebo group. These results indicate that azithromycin is consistently effective in lowering the risk of infection and sepsis in mothers and infants during vaginal delivery. The number treated to prevent 1 case of maternal death or sep","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/01.ogx.0000979648.94036.ac
Anna Roca, Bully Camara, Joel D. Bognini, Usman N. Nakakana, Athasana M. Somé, Nathalie Beloum, Toussaint Rouamba, Fatoumata Sillah, Madikoi Danso, Joquina C. Jones, Shashu Graves, Isatou Jagne, Pauline Getanda, Saffiatou Darboe, Marc C. Tahita, Ebrahim Ndure, Hien S. Franck, Sawadogo Y. Edmond, Bai L. Dondeh, Wilfried G. J. Nassa, Zakaria Garba, Abdoulie Bojang, Yusupha Nije, Christian Bottomley, Halidou Tinto, Umberto D'Alessandro
ABSTRACT Sepsis is a leading cause of neonatal mortality, and rates have not decreased in recent years despite medical advances. Azithromycin has been shown in previous research to be effective in reducing infection and sepsis; in particular, a recent study showed that administration of the drug during labor reduced gram-positive bacteria over the next 4 weeks, along with reduced disease in mothers and newborns. This study was designed to assess the effectiveness of azithromycin administered during labor in reducing instances of neonatal sepsis and mortality. The primary outcome for this study was neonatal sepsis or death within the first 28 days of life. Deaths that were identifiably due to severe birth asphyxia, low birth weight, and severe congenital malformations were excluded. Secondary outcomes included neonatal sepsis, neonatal mortality, culture-confirmed sepsis, fever, skin infections, bacterially confirmed skin infections, conjunctivitis, umbilical infection/omphalitis, malaria, prescribed antibiotics, and hospitalization. Secondary outcomes for parents included postpartum sepsis, bacterially confirmed postpartum sepsis, mastitis, malaria, puerperal fever, prescribed antibiotics, hospitalization, and mortality. The final analysis included 11,625 parents and 11,783 neonates; baseline characteristics between the azithromycin and placebo groups were not significantly different. Of the total sample, 225 instances of neonatal sepsis or death occurred. The incidence of either mortality or sepsis was similar between groups (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.80–1.38; P = 0.70), as well as the individual outcomes of mortality (OR, 1.05; 95% CI, 0.70–1.60; P = 0.80) and sepsis (OR, 1.02; 95% CI, 0.74–1.40; P = 0.92). Incidence of neonatal skin infections ( P < 0.001), bacterially confirmed skin infections ( P = 0.003), and need for antibiotics ( P < 0.001) were all significantly reduced in the azithromycin group. Azithromycin reduced instances of both mastitis ( P = 0.04) and puerperal fever ( P = 0.04), but there were no other significant differences between groups. These results indicate no effect of azithromycin on neonatal sepsis or mortality. There were reductions in some instances of infection in both parents and newborns, specifically newborn skin infections, but there was no effect on the primary outcome. These results are in contrast to the previous proof-of-concept trial that showed azithromycin to reduce the amount of gram-positive bacteria carried by mothers and infants. Recent studies from different countries have found some conflicting results in longer-term outcomes, but the differing time periods limit comparison of results. This study was limited by underestimation of incidence of infections due to follow-up design, as well as slight differences between the 2 countries involved in the study. Overall, the results of this analysis do not support a change in clinical practice to introduce azithromycin to prevent
{"title":"Effect of Intrapartum Azithromycin vs Placebo on Neonatal Sepsis and Death A Randomized Clinical Trial","authors":"Anna Roca, Bully Camara, Joel D. Bognini, Usman N. Nakakana, Athasana M. Somé, Nathalie Beloum, Toussaint Rouamba, Fatoumata Sillah, Madikoi Danso, Joquina C. Jones, Shashu Graves, Isatou Jagne, Pauline Getanda, Saffiatou Darboe, Marc C. Tahita, Ebrahim Ndure, Hien S. Franck, Sawadogo Y. Edmond, Bai L. Dondeh, Wilfried G. J. Nassa, Zakaria Garba, Abdoulie Bojang, Yusupha Nije, Christian Bottomley, Halidou Tinto, Umberto D'Alessandro","doi":"10.1097/01.ogx.0000979648.94036.ac","DOIUrl":"https://doi.org/10.1097/01.ogx.0000979648.94036.ac","url":null,"abstract":"ABSTRACT Sepsis is a leading cause of neonatal mortality, and rates have not decreased in recent years despite medical advances. Azithromycin has been shown in previous research to be effective in reducing infection and sepsis; in particular, a recent study showed that administration of the drug during labor reduced gram-positive bacteria over the next 4 weeks, along with reduced disease in mothers and newborns. This study was designed to assess the effectiveness of azithromycin administered during labor in reducing instances of neonatal sepsis and mortality. The primary outcome for this study was neonatal sepsis or death within the first 28 days of life. Deaths that were identifiably due to severe birth asphyxia, low birth weight, and severe congenital malformations were excluded. Secondary outcomes included neonatal sepsis, neonatal mortality, culture-confirmed sepsis, fever, skin infections, bacterially confirmed skin infections, conjunctivitis, umbilical infection/omphalitis, malaria, prescribed antibiotics, and hospitalization. Secondary outcomes for parents included postpartum sepsis, bacterially confirmed postpartum sepsis, mastitis, malaria, puerperal fever, prescribed antibiotics, hospitalization, and mortality. The final analysis included 11,625 parents and 11,783 neonates; baseline characteristics between the azithromycin and placebo groups were not significantly different. Of the total sample, 225 instances of neonatal sepsis or death occurred. The incidence of either mortality or sepsis was similar between groups (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.80–1.38; P = 0.70), as well as the individual outcomes of mortality (OR, 1.05; 95% CI, 0.70–1.60; P = 0.80) and sepsis (OR, 1.02; 95% CI, 0.74–1.40; P = 0.92). Incidence of neonatal skin infections ( P < 0.001), bacterially confirmed skin infections ( P = 0.003), and need for antibiotics ( P < 0.001) were all significantly reduced in the azithromycin group. Azithromycin reduced instances of both mastitis ( P = 0.04) and puerperal fever ( P = 0.04), but there were no other significant differences between groups. These results indicate no effect of azithromycin on neonatal sepsis or mortality. There were reductions in some instances of infection in both parents and newborns, specifically newborn skin infections, but there was no effect on the primary outcome. These results are in contrast to the previous proof-of-concept trial that showed azithromycin to reduce the amount of gram-positive bacteria carried by mothers and infants. Recent studies from different countries have found some conflicting results in longer-term outcomes, but the differing time periods limit comparison of results. This study was limited by underestimation of incidence of infections due to follow-up design, as well as slight differences between the 2 countries involved in the study. Overall, the results of this analysis do not support a change in clinical practice to introduce azithromycin to prevent","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/01.ogx.0000979684.30759.bd
Baris Ata, Alberto Linan, Erkan Kalafat, Francisco Ruíz, Laura Melado, Asina Bayram, Ibrahim Elkhatib, Barbara Lawrenz, Human M. Fatemi
ABSTRACT Although numerous studies have examined whether endometrial thickness (ET) independently affects the live birth rate (LBR) after an embryo transfer, contradictory conclusions have resulted in an unclear answer. It has been hypothesized that a thin endometrium decreases implantation rates possibly due to elevated oxygen concentration from spiral arteries; however, this mechanism has not been unequivocally demonstrated. This retrospective analysis aimed to investigate whether ET independently affects the LBR after a frozen embryo transfer cycle. All patients who underwent a single euploid blastocyst transfer between March 2017 and March 2020 at a single-assisted reproductive technology clinic were included. Live birth was defined as the delivery of a live fetus after 22 weeks of gestation. Programmed cycle (PC) or natural cycle (NC) for endometrial preparation was conducted at physician’s and patient’s discretion. The presence of a linear relationship between ET and LBR was assessed by conditional density plots (CDPs), and receiver operating characteristics (ROC) curve analyses were used to identify whether a threshold of the ET existed to predict the occurrence of live birth. The CDPs were analyzed for an optimal range of the ET that could be associated with a higher LBR, and the distribution of cycle characteristics and embryo quality in that range were compared with cycles outside of that range to identify confounders. Logistic regression models were constructed separately for the PC and NC. A total of 959 single euploid FETs were included in this analysis, of which 33% (n = 315) were NC and 67% (n = 644) were PC with an overall LBR of 47.1% (452/959). No linear relationship between the ET and LBR or threshold below which the LBR decreased perceivably was identified. In addition, ROC analysis did not suggest a predictive value of the ET for occurrence of live birth based on endometrial preparation or in the overall cohort. Similarly, logistic regression analyses showed no independent effect of the ET on LBR. The results of this study suggest that there is no linear relationship between the ET and LBR or a clinically significant cutoff for ET below which the LBR decreases in FET cycles. Significantly, the common practice of canceling embryo transfers when the ET is <7 mm is not supported by these data.
{"title":"Effect of the Endometrial Thickness on the Live Birth Rate: Insights From 959 Single Euploid Frozen Embryo Transfers Without a Cutoff For Thickness","authors":"Baris Ata, Alberto Linan, Erkan Kalafat, Francisco Ruíz, Laura Melado, Asina Bayram, Ibrahim Elkhatib, Barbara Lawrenz, Human M. Fatemi","doi":"10.1097/01.ogx.0000979684.30759.bd","DOIUrl":"https://doi.org/10.1097/01.ogx.0000979684.30759.bd","url":null,"abstract":"ABSTRACT Although numerous studies have examined whether endometrial thickness (ET) independently affects the live birth rate (LBR) after an embryo transfer, contradictory conclusions have resulted in an unclear answer. It has been hypothesized that a thin endometrium decreases implantation rates possibly due to elevated oxygen concentration from spiral arteries; however, this mechanism has not been unequivocally demonstrated. This retrospective analysis aimed to investigate whether ET independently affects the LBR after a frozen embryo transfer cycle. All patients who underwent a single euploid blastocyst transfer between March 2017 and March 2020 at a single-assisted reproductive technology clinic were included. Live birth was defined as the delivery of a live fetus after 22 weeks of gestation. Programmed cycle (PC) or natural cycle (NC) for endometrial preparation was conducted at physician’s and patient’s discretion. The presence of a linear relationship between ET and LBR was assessed by conditional density plots (CDPs), and receiver operating characteristics (ROC) curve analyses were used to identify whether a threshold of the ET existed to predict the occurrence of live birth. The CDPs were analyzed for an optimal range of the ET that could be associated with a higher LBR, and the distribution of cycle characteristics and embryo quality in that range were compared with cycles outside of that range to identify confounders. Logistic regression models were constructed separately for the PC and NC. A total of 959 single euploid FETs were included in this analysis, of which 33% (n = 315) were NC and 67% (n = 644) were PC with an overall LBR of 47.1% (452/959). No linear relationship between the ET and LBR or threshold below which the LBR decreased perceivably was identified. In addition, ROC analysis did not suggest a predictive value of the ET for occurrence of live birth based on endometrial preparation or in the overall cohort. Similarly, logistic regression analyses showed no independent effect of the ET on LBR. The results of this study suggest that there is no linear relationship between the ET and LBR or a clinically significant cutoff for ET below which the LBR decreases in FET cycles. Significantly, the common practice of canceling embryo transfers when the ET is <7 mm is not supported by these data.","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/ogx.0000000000001178
{"title":"CME PROGRAM EXAM AND ANSWER SHEET","authors":"","doi":"10.1097/ogx.0000000000001178","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001178","url":null,"abstract":"","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136172440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/01.ogx.0000979680.95107.1b
Jilcha D. Feyisa, Mathewos A. Woldegeorgis, Girum T. Zingeta, Kedir H. Abegaz, Yemane Berhane
ABSTRACT Nonmetastatic cervical cancer is a highly curable malignancy, and radiotherapy (RT) remains the mainstay treatment. Early initiation is critical, and the optimal time to initiate RT for cure is 6 weeks, with a reported 15% decrease in 3-year overall survival for those who wait 40 days. There is considerable variation in the waiting time to initiate RT between countries, with a median time of 27.2 days in Ontario, Canada and 108 days in South Africa. Real-world evidence of cancer progression because of treatment delay is scarce in low-income countries. Ethiopia, a country of 120 million, had a single machine at Tikur Anbessa Specialized Hospital (TASH) until it acquired a linear accelerator very recently. This study aimed to assess the extent of delay in receiving RT and the effect of delay on the natural disease court in patients with cervical cancer treated at TASH. This study was conducted at TASH between January 2019 and May 2020 and evaluated patients at different time points before and after RT. All individuals who were diagnosed with cervical cancer (stage IIB to stage IVA) and booked for RT at TASH were included. Concurrent chemoradiotherapy was administered for cervical cancer with weekly cisplatin as a chemotherapy agent. A total of 115 patients were included in this study. The median time between pathologic diagnosis and booking RT was 19 days, and the median time from booking to RT initiation was 458 days. The total median time from diagnosis to treatment was 477 days, and the median time to disease progression was 51 days. During the waiting period for RT, the stage was reassessed for 105 patients. The number of patients in stage IIB, IIA, and IIIB decreased during this period, whereas the number of patients in stage IVA increased from 20 (17.4%) to 30 (26.1%), 2 (1.8%) developed distant metastasis to the lungs (stage IVB), and 37 died before receiving a phone call for RT. Of 115 patients booked to receive CCRT, only 9 (7.8%) received CCRT, 80 (69.9%) received a single shot of palliative RT due to disease progression, and 25 (21.7%) did not receive RT at all. The mean and median survival times were 20.1 months (95% confidence interval [CI], 18.3–22.7) and 21 months (95% CI, 18.3–23.8), respectively. Waiting time, stage at presentation, distant metastasis during the waiting time, hydronephrosis during the waiting time, and type of treatment were significantly associated with survival. Multivariate cox regression using these variables found that patients with stage IIIB were 2.2 times more likely to die than those with stage IIB (adjusted hazards ratio, 2.2; 95% CI, 1.07–4.48), and patients with stage IVA were 20.95 times more likely to die than patients with stage IIB (adjusted hazards ratio, 20.95; 95% CI, 6.26–70.03). Prolonged waiting time increased the mortality rate of cervical cancer by 2.9 (95% CI, 1.07–4.5). This study provides a significant advancement in our understanding of cervical cancer care in low-income countri
{"title":"Cervical Cancer Progression in Patients Waiting for Radiotherapy Treatment at a Referral Center in Ethiopia: A Longitudinal Study","authors":"Jilcha D. Feyisa, Mathewos A. Woldegeorgis, Girum T. Zingeta, Kedir H. Abegaz, Yemane Berhane","doi":"10.1097/01.ogx.0000979680.95107.1b","DOIUrl":"https://doi.org/10.1097/01.ogx.0000979680.95107.1b","url":null,"abstract":"ABSTRACT Nonmetastatic cervical cancer is a highly curable malignancy, and radiotherapy (RT) remains the mainstay treatment. Early initiation is critical, and the optimal time to initiate RT for cure is 6 weeks, with a reported 15% decrease in 3-year overall survival for those who wait 40 days. There is considerable variation in the waiting time to initiate RT between countries, with a median time of 27.2 days in Ontario, Canada and 108 days in South Africa. Real-world evidence of cancer progression because of treatment delay is scarce in low-income countries. Ethiopia, a country of 120 million, had a single machine at Tikur Anbessa Specialized Hospital (TASH) until it acquired a linear accelerator very recently. This study aimed to assess the extent of delay in receiving RT and the effect of delay on the natural disease court in patients with cervical cancer treated at TASH. This study was conducted at TASH between January 2019 and May 2020 and evaluated patients at different time points before and after RT. All individuals who were diagnosed with cervical cancer (stage IIB to stage IVA) and booked for RT at TASH were included. Concurrent chemoradiotherapy was administered for cervical cancer with weekly cisplatin as a chemotherapy agent. A total of 115 patients were included in this study. The median time between pathologic diagnosis and booking RT was 19 days, and the median time from booking to RT initiation was 458 days. The total median time from diagnosis to treatment was 477 days, and the median time to disease progression was 51 days. During the waiting period for RT, the stage was reassessed for 105 patients. The number of patients in stage IIB, IIA, and IIIB decreased during this period, whereas the number of patients in stage IVA increased from 20 (17.4%) to 30 (26.1%), 2 (1.8%) developed distant metastasis to the lungs (stage IVB), and 37 died before receiving a phone call for RT. Of 115 patients booked to receive CCRT, only 9 (7.8%) received CCRT, 80 (69.9%) received a single shot of palliative RT due to disease progression, and 25 (21.7%) did not receive RT at all. The mean and median survival times were 20.1 months (95% confidence interval [CI], 18.3–22.7) and 21 months (95% CI, 18.3–23.8), respectively. Waiting time, stage at presentation, distant metastasis during the waiting time, hydronephrosis during the waiting time, and type of treatment were significantly associated with survival. Multivariate cox regression using these variables found that patients with stage IIIB were 2.2 times more likely to die than those with stage IIB (adjusted hazards ratio, 2.2; 95% CI, 1.07–4.48), and patients with stage IVA were 20.95 times more likely to die than patients with stage IIB (adjusted hazards ratio, 20.95; 95% CI, 6.26–70.03). Prolonged waiting time increased the mortality rate of cervical cancer by 2.9 (95% CI, 1.07–4.5). This study provides a significant advancement in our understanding of cervical cancer care in low-income countri","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/01.ogx.0000979676.12813.5a
Emily Heer, Cheryl Peters, Rod Knight, Lin Yang, Steven J. Heitman
ABSTRACT Compared with cisgender and heterosexual individuals, members of the LGBTQ+ community experience worse health outcomes. This is due to a combination of structural inequities and life experiences, including higher rates of mental illness and suicidality, sexually transmitted infections, and certain cancers. Men who have sex with men are at higher risk of anal cancer, and lesbian and bisexual women are often diagnosed with breast cancer at younger ages than heterosexual women partly due to lower parity and higher bodyweight. Despite these increased risks, some evidence shows the LGBTQ+ population is less likely to participate in early detection and cancer screening programs; however, the etiology of this is unknown. This review aims to summarize the current literature on cancer screening uptake in the LGBTQ+ population, including barriers and facilitators associated with screening participation. Studies published between January 2001 and April 2022 involving individuals identified as a gender or sexual minority that assessed participation in and/or facilitators and barriers to a cancer screening procedure were included. Barriers and facilitators identified in quantitative studies were reported on the individual-, provider-, and administrative/system-level scale. A total of 50 publications were included, 38 of which were quantitative, 10 were qualitative, and 2 used mixed methods. Among 16 relevant studies, considerable variation was identified when analyzing whether sexual minority women had lower participation in cervical cancer screening programs. Among 15 studies assessing the participation of sexual minority women compared with heterosexual women in breast cancer screening, 5 studies found no difference, whereas the remainder suggested lower rates of screening among sexual minority women. Fewer studies assessed screening among sexual minority men; however, sexual minority men were more likely to report anal cancer screening than heterosexual men. Cervical cancer screening participation among transgender men and gender diverse participants was lower than cisgender participants in almost all studies. Of 9 studies reporting breast cancer screening among gender diverse or transgender individuals, 5 found lower participation among transgender or gender diverse individuals compared with cisgender women. One study identified greater odds of up-to-date mammography among transgender men compared with cisgender women. The most common individual-level barriers to screening are related to knowledge of the screening tests themselves, including screening guidelines, procedures, pain, embarrassment, and a fear of results. One of the strongest correlates in studies was perceived discrimination from health care providers, which often resulted in lack of disclosure of sexual orientation or gender identity. Provider-level factors mostly included provider communication and relationship with the patient, and patients preferred providers experienced with LG
{"title":"Participation, Barriers, and Facilitators of Cancer Screening Among LGBTQ+ Populations: A Review of the Literature","authors":"Emily Heer, Cheryl Peters, Rod Knight, Lin Yang, Steven J. Heitman","doi":"10.1097/01.ogx.0000979676.12813.5a","DOIUrl":"https://doi.org/10.1097/01.ogx.0000979676.12813.5a","url":null,"abstract":"ABSTRACT Compared with cisgender and heterosexual individuals, members of the LGBTQ+ community experience worse health outcomes. This is due to a combination of structural inequities and life experiences, including higher rates of mental illness and suicidality, sexually transmitted infections, and certain cancers. Men who have sex with men are at higher risk of anal cancer, and lesbian and bisexual women are often diagnosed with breast cancer at younger ages than heterosexual women partly due to lower parity and higher bodyweight. Despite these increased risks, some evidence shows the LGBTQ+ population is less likely to participate in early detection and cancer screening programs; however, the etiology of this is unknown. This review aims to summarize the current literature on cancer screening uptake in the LGBTQ+ population, including barriers and facilitators associated with screening participation. Studies published between January 2001 and April 2022 involving individuals identified as a gender or sexual minority that assessed participation in and/or facilitators and barriers to a cancer screening procedure were included. Barriers and facilitators identified in quantitative studies were reported on the individual-, provider-, and administrative/system-level scale. A total of 50 publications were included, 38 of which were quantitative, 10 were qualitative, and 2 used mixed methods. Among 16 relevant studies, considerable variation was identified when analyzing whether sexual minority women had lower participation in cervical cancer screening programs. Among 15 studies assessing the participation of sexual minority women compared with heterosexual women in breast cancer screening, 5 studies found no difference, whereas the remainder suggested lower rates of screening among sexual minority women. Fewer studies assessed screening among sexual minority men; however, sexual minority men were more likely to report anal cancer screening than heterosexual men. Cervical cancer screening participation among transgender men and gender diverse participants was lower than cisgender participants in almost all studies. Of 9 studies reporting breast cancer screening among gender diverse or transgender individuals, 5 found lower participation among transgender or gender diverse individuals compared with cisgender women. One study identified greater odds of up-to-date mammography among transgender men compared with cisgender women. The most common individual-level barriers to screening are related to knowledge of the screening tests themselves, including screening guidelines, procedures, pain, embarrassment, and a fear of results. One of the strongest correlates in studies was perceived discrimination from health care providers, which often resulted in lack of disclosure of sexual orientation or gender identity. Provider-level factors mostly included provider communication and relationship with the patient, and patients preferred providers experienced with LG","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/01.ogx.0000979664.42491.de
M. Pagan, E. F. Magann, N. Rabie, S. C. Steelman, Z. Hu, S. Ounpraseuth
ABSTRACT Amniotic fluid volume (AFV) is examined via ultrasound often several times in pregnancy and can be an indicator of the overall health of a fetus. However, disorders of amniotic fluid can arise without complications for the fetus; excess of amniotic fluid without any accompanying fetal conditions is referred to as idiopathic polyhydramnios. Previous research has shown conflicting results with regard to outcomes related to idiopathic polyhydramnios, with some finding it increases adverse outcomes and others reporting an increase in adverse outcomes only in moderate or severe cases. This study is a systematic review and meta-analysis meant to assess the relationship between idiopathic polyhydramnios and perinatal outcomes for singleton pregnancies. Eligibility criteria included studies that had a control group with normal AFV and defined polyhydramnios as an amniotic fluid index of 24 cm or greater or a single deepest pocket of 8 cm or greater. Similar methods of defining polyhydramnios were considered as long as they were evidence-based. Studies with known causes of polyhydramnios were excluded to ensure cases analyzed for this study were idiopathic. The primary outcome was intrauterine fetal demise, with secondary outcomes of neonatal death, neonatal intensive care unit (NICU) admission, macrosomia, 5-minute Apgar score, malpresentation, and cesarean delivery. Final review and analysis included 12 articles, with a total of 2392 patients with idiopathic polyhydramnios and 160,135 patients with normal AFV. Risk of bias was determined to be low for these studies, although the comparability was not well-defined. Analysis for the primary outcome included 8 of the 12 studies and showed that the risk of intrauterine fetal demise was increased in those with idiopathic polyhydramnios (odds ratio [OR], 7.64; 95% confidence interval [CI], 2.50–23.38). Secondary outcome analysis for neonatal death showed that individuals with polyhydramnios were 8.68 times more likely to experience neonatal death than controls (95% CI, 2.91–25.87). Examining other secondary outcomes, the association between NICU admission and idiopathic polyhydramnios showed that patients with polyhydramnios were more likely to be admitted to the NICU (OR, 1.94; 95% CI, 1.45 – 2.59). When assessing 5-minute Apgar scores, results showed that individuals with polyhydramnios were more likely to have an Apgar score of less than 7 (OR, 2.21; 95% CI, 1.34–3.62). In addition, rates of cesarean delivery were significantly higher with idiopathic polyhydramnios (OR, 2.31; 95% CI, 1.79–2.99), as was macrosomia (OR, 2.93; 95% CI, 2.39–3.59). Malpresentation was also higher in the polyhydramnios group than in the control group (OR, 2.73; 95% CI, 2.06–3.61). The authors of this meta-analysis conclude that in pregnancies with idiopathic polyhydramnios, there is an elevated risk of both intrauterine fetal demise and neonatal death. In addition, all other negative pregnancy outcomes analyzed were mor
{"title":"Idiopathic Polyhydramnios and Pregnancy Outcome: Systematic Review and Meta-analysis","authors":"M. Pagan, E. F. Magann, N. Rabie, S. C. Steelman, Z. Hu, S. Ounpraseuth","doi":"10.1097/01.ogx.0000979664.42491.de","DOIUrl":"https://doi.org/10.1097/01.ogx.0000979664.42491.de","url":null,"abstract":"ABSTRACT Amniotic fluid volume (AFV) is examined via ultrasound often several times in pregnancy and can be an indicator of the overall health of a fetus. However, disorders of amniotic fluid can arise without complications for the fetus; excess of amniotic fluid without any accompanying fetal conditions is referred to as idiopathic polyhydramnios. Previous research has shown conflicting results with regard to outcomes related to idiopathic polyhydramnios, with some finding it increases adverse outcomes and others reporting an increase in adverse outcomes only in moderate or severe cases. This study is a systematic review and meta-analysis meant to assess the relationship between idiopathic polyhydramnios and perinatal outcomes for singleton pregnancies. Eligibility criteria included studies that had a control group with normal AFV and defined polyhydramnios as an amniotic fluid index of 24 cm or greater or a single deepest pocket of 8 cm or greater. Similar methods of defining polyhydramnios were considered as long as they were evidence-based. Studies with known causes of polyhydramnios were excluded to ensure cases analyzed for this study were idiopathic. The primary outcome was intrauterine fetal demise, with secondary outcomes of neonatal death, neonatal intensive care unit (NICU) admission, macrosomia, 5-minute Apgar score, malpresentation, and cesarean delivery. Final review and analysis included 12 articles, with a total of 2392 patients with idiopathic polyhydramnios and 160,135 patients with normal AFV. Risk of bias was determined to be low for these studies, although the comparability was not well-defined. Analysis for the primary outcome included 8 of the 12 studies and showed that the risk of intrauterine fetal demise was increased in those with idiopathic polyhydramnios (odds ratio [OR], 7.64; 95% confidence interval [CI], 2.50–23.38). Secondary outcome analysis for neonatal death showed that individuals with polyhydramnios were 8.68 times more likely to experience neonatal death than controls (95% CI, 2.91–25.87). Examining other secondary outcomes, the association between NICU admission and idiopathic polyhydramnios showed that patients with polyhydramnios were more likely to be admitted to the NICU (OR, 1.94; 95% CI, 1.45 – 2.59). When assessing 5-minute Apgar scores, results showed that individuals with polyhydramnios were more likely to have an Apgar score of less than 7 (OR, 2.21; 95% CI, 1.34–3.62). In addition, rates of cesarean delivery were significantly higher with idiopathic polyhydramnios (OR, 2.31; 95% CI, 1.79–2.99), as was macrosomia (OR, 2.93; 95% CI, 2.39–3.59). Malpresentation was also higher in the polyhydramnios group than in the control group (OR, 2.73; 95% CI, 2.06–3.61). The authors of this meta-analysis conclude that in pregnancies with idiopathic polyhydramnios, there is an elevated risk of both intrauterine fetal demise and neonatal death. In addition, all other negative pregnancy outcomes analyzed were mor","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/ogx.0000000000001196
Jinlin Xie, Na Li, Haiyan Bai, Juanzi Shi, He Cai
ABSTRACT The prevalence of obesity in reproductive age women continues to increase worldwide. Recent meta-analyses suggest that female obesity is negatively associated with live birth rate (LBR) after in vitro fertilization, as well as a higher risk of miscarriage after euploid embryo transfer. The interplay between adiposity and reproductive hormones such as progesterone may be partially responsible, and research shows that obese women may require higher progesterone supplementation in frozen-thawed embryo transfer (FET). Although the vaginal route of progesterone supplementation has predominated in most in vitro fertilization centers globally, the route of supplementation has been gaining interest. Studies comparing different routes have focused on the general infertility population, and it remains essential to investigate the interrelationship between the routes of progesterone supplementation, overweight/obesity, and treatment outcomes. This retrospective cohort study aimed to compare the difference in the LBR between vaginal progesterone and intramuscular progesterone in cryopreserved blastocyst transfer cycles and assess whether obesity may modify these associations. Patients who underwent a single, vitrified-warmed, blastocyst transfer between January 2018 and June 2021 and received exogenous hormone replacement for endometrial preparation were included. The route of progesterone supplementation was based on patient preference. The primary study outcome was live birth, and secondary outcomes included a positive b-hCG test result, clinical pregnancy, miscarriage, and total pregnancy loss. Normal weight was defined as 18.5–24.9 kg/m 2 , overweight was defined as a body mass index (BMI) of 25–29 kg/m 2 , and obese was defined as ≥30 kg/m 2 . Multivariate regression was used to assess the association between the route of progesterone supplementation and LBR while controlling for known potential covariates, and an interaction analysis was performed with overweight/obesity as the interaction term. A total of 6905 FET cycles from 6251 patients were included for this analysis, with 4616 cycles using vaginal progesterone and 2289 cycles using intramuscular progesterone. The proportions of overweight and obese women were comparable between the 2 groups. After adjusting for confounding variables, the LBR in the vaginal and intramuscular progesterone groups were 46.23% (2134/4616) and 48.62% (1113/2289), respectively (adjusted odds ratio [aOR], 0.89; 95% confidence interval [CI], 0.81–0.98). Although the rates of a positive serum hCG result and clinical pregnancy were similar between the 2 groups, miscarriage rate (15.34% vs 11.40%; aOR, 1.40; 95% CI, 1.20–1.63) and total pregnancy loss (22.22% vs 18.90%; aOR, 1.23; 95% CI, 1.08–1.40) per FET were significantly higher in the vaginal progesterone group than in the intramuscular progesterone group. Among normal-weight women, the LBR was lower in the vaginal progesterone group than the intramuscular prog
{"title":"Overweight and Obesity Affect The Efficacy of Vaginal vs. Intramuscular Progesterone for Luteal-Phase Support in Vitrified-Warmed Blastocyst Transfer","authors":"Jinlin Xie, Na Li, Haiyan Bai, Juanzi Shi, He Cai","doi":"10.1097/ogx.0000000000001196","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001196","url":null,"abstract":"ABSTRACT The prevalence of obesity in reproductive age women continues to increase worldwide. Recent meta-analyses suggest that female obesity is negatively associated with live birth rate (LBR) after in vitro fertilization, as well as a higher risk of miscarriage after euploid embryo transfer. The interplay between adiposity and reproductive hormones such as progesterone may be partially responsible, and research shows that obese women may require higher progesterone supplementation in frozen-thawed embryo transfer (FET). Although the vaginal route of progesterone supplementation has predominated in most in vitro fertilization centers globally, the route of supplementation has been gaining interest. Studies comparing different routes have focused on the general infertility population, and it remains essential to investigate the interrelationship between the routes of progesterone supplementation, overweight/obesity, and treatment outcomes. This retrospective cohort study aimed to compare the difference in the LBR between vaginal progesterone and intramuscular progesterone in cryopreserved blastocyst transfer cycles and assess whether obesity may modify these associations. Patients who underwent a single, vitrified-warmed, blastocyst transfer between January 2018 and June 2021 and received exogenous hormone replacement for endometrial preparation were included. The route of progesterone supplementation was based on patient preference. The primary study outcome was live birth, and secondary outcomes included a positive b-hCG test result, clinical pregnancy, miscarriage, and total pregnancy loss. Normal weight was defined as 18.5–24.9 kg/m 2 , overweight was defined as a body mass index (BMI) of 25–29 kg/m 2 , and obese was defined as ≥30 kg/m 2 . Multivariate regression was used to assess the association between the route of progesterone supplementation and LBR while controlling for known potential covariates, and an interaction analysis was performed with overweight/obesity as the interaction term. A total of 6905 FET cycles from 6251 patients were included for this analysis, with 4616 cycles using vaginal progesterone and 2289 cycles using intramuscular progesterone. The proportions of overweight and obese women were comparable between the 2 groups. After adjusting for confounding variables, the LBR in the vaginal and intramuscular progesterone groups were 46.23% (2134/4616) and 48.62% (1113/2289), respectively (adjusted odds ratio [aOR], 0.89; 95% confidence interval [CI], 0.81–0.98). Although the rates of a positive serum hCG result and clinical pregnancy were similar between the 2 groups, miscarriage rate (15.34% vs 11.40%; aOR, 1.40; 95% CI, 1.20–1.63) and total pregnancy loss (22.22% vs 18.90%; aOR, 1.23; 95% CI, 1.08–1.40) per FET were significantly higher in the vaginal progesterone group than in the intramuscular progesterone group. Among normal-weight women, the LBR was lower in the vaginal progesterone group than the intramuscular prog","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/ogx.0000000000001192
Nicole Norby, Amanda B. Murchison, Shian McLeish, Taylor Ghahremani, Megan Whitham, Everett F. Magann
Importance Although not a common occurrence, uterine prolapse during pregnancy can have significant effects for pregnancy outcomes and quality of life of maternal patients. Most data about management exist as case reports; a review of these cases provides some guidance about treatment options. Objectives This review examines current literature about uterine prolapse during pregnancy to assess current information about this condition, prevalence, diagnosis, management, and outcomes. Evidence Acquisition Electronic databases (PubMed and Embase) were searched using terms “uterine prolapse” AND “pregnancy” AND “etiology” OR “risk factors” OR “diagnosis” OR “therapy” OR “management” limited to the English language and between the years 1980 and October 31, 2022. Results Upon review of 475 articles, 48 relevant articles were included as well as 6 relevant articles found on additional literature review for a total of 54 articles. Of those articles, 62 individual cases of uterine prolapse in pregnancy were reviewed including pregnancy complications, mode of delivery, and outcomes. Prevalence was noted to be rare, but much more common in second and subsequent pregnancies. Most diagnoses were made based on symptomatic prolapse on examination. Management strategies included bed rest, pessary use, and surgery (typically during the early second trimester). Complications included preterm delivery, patient discomfort, urinary retention, and urinary tract infection. Delivery methods included both cesarean and vaginal deliveries. Conclusions Although a rare condition, uterine prolapse in pregnancy is readily diagnosed on examination. Reasonable conservative management strategies include observation, attempted reduction of prolapse, and pessary use; if these measures fail, surgical treatment is an option. Relevance Our review compiles literature and known cases of uterine prolapse during pregnancy and current evidence about prevalence, diagnosis, management, outcomes, and complications of uterine prolapse during pregnancy in order to inform our target audience in their clinical practice. Target Audience Obstetricians and gynecologist, family physicians. Learning Objectives After completing this learning activity, the participant should be able to describe the prevalence of uterine prolapse during pregnancy, potential at-risk populations, and presenting symptoms; identify management strategies for uterine prolapse during pregnancy including both surgical and conservative approaches; and assess possible complications of uterine prolapse during pregnancy.
{"title":"Uterine Prolapse in Pregnancy: A Review","authors":"Nicole Norby, Amanda B. Murchison, Shian McLeish, Taylor Ghahremani, Megan Whitham, Everett F. Magann","doi":"10.1097/ogx.0000000000001192","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001192","url":null,"abstract":"Importance Although not a common occurrence, uterine prolapse during pregnancy can have significant effects for pregnancy outcomes and quality of life of maternal patients. Most data about management exist as case reports; a review of these cases provides some guidance about treatment options. Objectives This review examines current literature about uterine prolapse during pregnancy to assess current information about this condition, prevalence, diagnosis, management, and outcomes. Evidence Acquisition Electronic databases (PubMed and Embase) were searched using terms “uterine prolapse” AND “pregnancy” AND “etiology” OR “risk factors” OR “diagnosis” OR “therapy” OR “management” limited to the English language and between the years 1980 and October 31, 2022. Results Upon review of 475 articles, 48 relevant articles were included as well as 6 relevant articles found on additional literature review for a total of 54 articles. Of those articles, 62 individual cases of uterine prolapse in pregnancy were reviewed including pregnancy complications, mode of delivery, and outcomes. Prevalence was noted to be rare, but much more common in second and subsequent pregnancies. Most diagnoses were made based on symptomatic prolapse on examination. Management strategies included bed rest, pessary use, and surgery (typically during the early second trimester). Complications included preterm delivery, patient discomfort, urinary retention, and urinary tract infection. Delivery methods included both cesarean and vaginal deliveries. Conclusions Although a rare condition, uterine prolapse in pregnancy is readily diagnosed on examination. Reasonable conservative management strategies include observation, attempted reduction of prolapse, and pessary use; if these measures fail, surgical treatment is an option. Relevance Our review compiles literature and known cases of uterine prolapse during pregnancy and current evidence about prevalence, diagnosis, management, outcomes, and complications of uterine prolapse during pregnancy in order to inform our target audience in their clinical practice. Target Audience Obstetricians and gynecologist, family physicians. Learning Objectives After completing this learning activity, the participant should be able to describe the prevalence of uterine prolapse during pregnancy, potential at-risk populations, and presenting symptoms; identify management strategies for uterine prolapse during pregnancy including both surgical and conservative approaches; and assess possible complications of uterine prolapse during pregnancy.","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/01.ogx.0000979672.75675.3d
Karen Borchert, Chelsea Thibodeau, Paige Varin, Heidi Wipf, Sarah Traxler, Christy M. Boraas
ABSTRACT Uncertain diagnosis can complicate the evaluation and treatment of patients presenting for undesired pregnancy termination at early gestational ages. Pregnant patients with no ultrasonography-identifiable pregnancy location receive classification of pregnancy of unknown location (PUL). Until receiving a definitive intrauterine pregnancy (IUP), ectopic pregnancy, or early pregnancy loss diagnosis, these patients are often managed expectantly with serial serum human chorionic gonadotropin (hCG) measurements and ultrasonography. Immediate treatment of undesired PUL with low-risk for ectopic pregnancy can be performed in ways that minimize the risk. This retrospective cohort study reviewed outcomes of pregnancies for PUL-diagnosed patients presenting at Planned Parenthood in Minnesota, North Dakota, and South Dakota to receive induced abortions between July 1, 2016, and December 31, 2019. Care of patients with PUL included assessment of health history, counseling, and ectopic pregnancy precaution reviews. Clinicians then proceeded to triage patients into low- and high-risk groups based on transvaginal ultrasonography findings and patient symptoms. For PUL patients deemed low risk for ectopic pregnancy, the choices of expectant management or induced abortion were given. Patients proceeding with induced abortions then proceeded with uterine aspiration or medication abortion. The primary objective compared the diagnosis of pregnancy location to time for 3 groups, which included the groups of patients choosing immediate treatment (via uterine aspiration or medical management), and the group of patients who initially chose expectant management (delay for diagnosis). Time to diagnosis, as measured in days, was recorded from initial PUL diagnosis until final pregnancy location diagnosis. A spontaneous decline of serum hCG after 48–72 hours in the delay-for-diagnosis group was recorded as a spontaneously resolved PUL consistent with spontaneous abortion. Incidence of ectopic pregnancies, complications such as transfusion-requiring hemorrhages, and failure to adhere with follow-up guidelines (greater than 60 days from PUL diagnosis without clinical contact and/or a pregnancy diagnosis) were also recorded. From a total of 19,151 abortion counters across the study period, 2.9% of patients (553) were diagnosed with PUL. High-risk diagnoses were given to 9.4% of patients (52), based on concerns from symptoms and ultrasounds (27 of these had ectopic pregnancies [51.9%]). Low-risk diagnoses were given to 90.6% of the remaining patients (501), who were given a choice of management. When compared with expectant management, results indicated that low-risk patients with undesired PUL experienced fewer days to diagnosis with immediate treatment by uterine aspiration (and a similar time frame to diagnosis with abortion via medication). For uterine aspiration, abortion treatment using simultaneous serial hCG trending was effective. Although this study lacked stat
{"title":"Medication Abortion and Uterine Aspiration for Undesired Pregnancy of Unknown Location: A Retrospective Cohort Study","authors":"Karen Borchert, Chelsea Thibodeau, Paige Varin, Heidi Wipf, Sarah Traxler, Christy M. Boraas","doi":"10.1097/01.ogx.0000979672.75675.3d","DOIUrl":"https://doi.org/10.1097/01.ogx.0000979672.75675.3d","url":null,"abstract":"ABSTRACT Uncertain diagnosis can complicate the evaluation and treatment of patients presenting for undesired pregnancy termination at early gestational ages. Pregnant patients with no ultrasonography-identifiable pregnancy location receive classification of pregnancy of unknown location (PUL). Until receiving a definitive intrauterine pregnancy (IUP), ectopic pregnancy, or early pregnancy loss diagnosis, these patients are often managed expectantly with serial serum human chorionic gonadotropin (hCG) measurements and ultrasonography. Immediate treatment of undesired PUL with low-risk for ectopic pregnancy can be performed in ways that minimize the risk. This retrospective cohort study reviewed outcomes of pregnancies for PUL-diagnosed patients presenting at Planned Parenthood in Minnesota, North Dakota, and South Dakota to receive induced abortions between July 1, 2016, and December 31, 2019. Care of patients with PUL included assessment of health history, counseling, and ectopic pregnancy precaution reviews. Clinicians then proceeded to triage patients into low- and high-risk groups based on transvaginal ultrasonography findings and patient symptoms. For PUL patients deemed low risk for ectopic pregnancy, the choices of expectant management or induced abortion were given. Patients proceeding with induced abortions then proceeded with uterine aspiration or medication abortion. The primary objective compared the diagnosis of pregnancy location to time for 3 groups, which included the groups of patients choosing immediate treatment (via uterine aspiration or medical management), and the group of patients who initially chose expectant management (delay for diagnosis). Time to diagnosis, as measured in days, was recorded from initial PUL diagnosis until final pregnancy location diagnosis. A spontaneous decline of serum hCG after 48–72 hours in the delay-for-diagnosis group was recorded as a spontaneously resolved PUL consistent with spontaneous abortion. Incidence of ectopic pregnancies, complications such as transfusion-requiring hemorrhages, and failure to adhere with follow-up guidelines (greater than 60 days from PUL diagnosis without clinical contact and/or a pregnancy diagnosis) were also recorded. From a total of 19,151 abortion counters across the study period, 2.9% of patients (553) were diagnosed with PUL. High-risk diagnoses were given to 9.4% of patients (52), based on concerns from symptoms and ultrasounds (27 of these had ectopic pregnancies [51.9%]). Low-risk diagnoses were given to 90.6% of the remaining patients (501), who were given a choice of management. When compared with expectant management, results indicated that low-risk patients with undesired PUL experienced fewer days to diagnosis with immediate treatment by uterine aspiration (and a similar time frame to diagnosis with abortion via medication). For uterine aspiration, abortion treatment using simultaneous serial hCG trending was effective. Although this study lacked stat","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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