Obstetrics and Gynecology International最新文献

Background: Equitable access to maternal healthcare hinges on overcoming logistical and socio-economic challenges in many low- and middle-income countries (LMICs).

Objectives: This study examines the association of travel time to health facilities and residential areas with the use of antenatal care (ANC) and institutional delivery services in Afghanistan.

Methods: We used data from the Afghanistan Health Survey 2018, focusing on 1051 ever-married women aged 15-49 who had recently given birth and had ≥ 1 ANC session. The study measured the association of travel time and residential location, along with sociodemographic characteristics, on two primary outcomes: institutional deliveries and ANC service frequency. A generalized linear model facilitated the multivariable regression analyses.

Results: The study found that travel time to health facilities and residential locations significantly influenced ANC utilization and institutional deliveries. Women with travel time of 0.5-2 and < 0.5 h to health facilities received 78% and 65% more ANC visits, respectively, than women with travel time of > 2 h to health facilities. Women who lived in rural areas received 50% fewer ANC visits compared to women who lived in urban areas. Women with travel time of 0.5-2 h were more likely to have institutional deliveries (odds ratio [OR] = 2.56, 95% confidence interval [CI]; 1.43-4.59) than those with travel time of > 2 h to health facilities. The likelihood of institutional deliveries was lower among rural resident women (OR = 0.62, 95% CI; 0.40-0.97) than their urban counterparts. Other predictors of ANC visits were women's education level and women's knowledge of complicated pregnancy, and other predictors of institutional deliveries were women's education level, decisions made for women about birthplace choice, and women's access to media.

Conclusion: We have shown for the first time that access to health facilities and geographic disparities significantly influence maternal health service utilization in Afghanistan.

Background and aims: Permanent contraception (PC) is a safe and cost-effective irreversible method of preventing unwanted pregnancy and reducing maternal morbidity and mortality. Only 0.2% of women use PC in Nigeria. This study aimed at assessing women's knowledge, their desire for spousal and future uptake of permanent contraception.

Methods: A cross-sectional survey conducted among 256 antenatal attendees at University College Hospital, Ibadan, Nigeria, using semistructured self-administered questionnaire. Logistic regression analyses were used to determine factors associated with women's desire and spousal uptake of PC at 95% confidence interval (CI) with a p value of ≤ 0.05.

Results: All were aware of PC and majority (180 [70.3%]) had good knowledge of it. About a quarter (26.5%) of the women wish to use PC once they complete their family size with more than half (52.6%) of them willing to use it after four or more children. Only 28.9% will allow their spouse to have vasectomy. Commonest reasons for PC future uptake are completed family size (88.9%) and economic challenges (45.5%). Those with one living child were less likely to have a good knowledge of PC (AOR = 0.527 and 95% CI = 0.278-0.998) and those with fertility issues were twice more likely to have good knowledge (AOR = 2.373 and 95% CI = 1.030-5.466). Respondent's perception of PC (p < 0.001) and "ever had pregnancy complications" (p = 0.014) are associated with their desire for spousal uptake.

Conclusions: There is a high level of awareness and good knowledge of PC; however, just a few will use it or allow their spouse to use it in future. There is a need to strengthen counselling and maternal education on PC with the aim to improve its uptake.

Background: Infertility is a significant global challenge, impacting millions of individuals across the world. In Lebanon, where fertility rates are declining, understanding the knowledge, attitudes, and practices of women experiencing infertility is vital to dispelling misconceptions, improving healthcare, and offering better support for those struggling to conceive.

Methods: A cross-sectional study was conducted between June and September 2024, involving 346 Lebanese women from two fertility centers in Beirut. Participants were randomly selected to complete the questionnaire through individual interviews. Descriptive and bivariate analyses were performed, and generalized linear models were used to explore the influencing factors for each of the knowledge, attitudes, and practice scores.

Results: The results showed that 63.6% of participants had high knowledge, 66.2% had positive attitudes, and 82.1% exhibited good practices. The generalized linear models revealed that being a healthcare provider (β = 0.663), sleeping ≥ 7 h (β = 0.409), and having a history of anxiety (β = 1.258) were associated with higher knowledge scores, while advanced female age as a cause of infertility was linked to lower knowledge (β = -0.997). For attitudes, medical insurance (β = -1.312) and a family income of 1000-2000 USD (β = -2.85) improved attitudes, while smoking (β = 3.874), history of endometrial ablation (β = 5.506), and longer marriage duration (β = 0.135) worsened them. For practices, longer marriage duration (β = 0.012) and a previous assisted reproductive technology (ART) experience (β = 0.154) improved practices, while having a history of respiratory disorder (β = -0.472) decreased practice scores.

Conclusion: This study shows that Lebanese women experiencing difficulty conceiving generally have a high level of knowledge, positive attitudes, alongside good related practices toward infertility. However, knowledge gaps and cultural factors remain, highlighting the need for enhanced reproductive health education and specialized trainings for healthcare providers.

Placenta accreta spectrum (PAS) disorders involve abnormal placental invasion into the uterine wall and neighbouring organs, posing life-threatening risks during and after labour. Catastrophic obstetric haemorrhage remains the main morbidity factor, potentially leading to severe complications, including coagulopathy, acute respiratory distress, cardiac arrest, and, in some cases, death. The traditional, nonconservative approach, caesarean hysterectomy, is widely adopted for managing PAS, but it permanently eliminates fertility and carries a high risk of complications. In response, conservative management methods, such as the expectant approach, one-step conservative surgery and the Triple P procedure, have been developed to address the desire for fertility preservation and reduce surgical complications. Due to limited data in the field, current guidelines do not offer definitive recommendations for the most appropriate management approach in specific clinical situations. Therefore, the management of PAS disorders requires an individualised approach based on various factors, such as the extent of placental invasion, topography, ability to achieve haemostatic control, the patient's desire for future fertility, and the available medical resources and surgical expertise. The current literature review explores the efficacy and safety of both nonconservative and conservative management strategies, highlighting their impacts on maternal and neonatal outcomes, surgical morbidity and future fertility potential.

Background: Biotin (vitamin B7) has been identified as an essential cofactor within metabolism and gene expression. The purpose of this study is to evaluate the level of biotin within serum and follicular fluid aspirates among infertile women undergoing IVF cycles and to compare these levels with ovulation sensitivity and rates of pregnancy.

Methods: In this observational study with 50 patients with infertility receiving intracytoplasmic sperm injection (ICSI) treatment, women were classified according to ovarian responsiveness to anti-Mullerian hormone (AMH) levels and the number of retrieved eggs. At the time of egg retrieval, the levels of biotin in the blood and the ovarian fluid were tested. The study maintained strict reporting according to the STROBE criteria.

Results: There was no significant difference with respect to either serum levels or follicular fluids' biotin among normal responders, poor responders, and hyperresponders. In contrast, there was an inverse correlation between the values of follicular biotin and AMH (p = 0.033) and BMI (p = 0.022). The data revealed that higher numbers of total and mature oocytes had significant influences on the outcome of pregnancies (p = 0.032 and p = 0.014), respectively; however, higher values of either serum fluids' biotin or follicular fluids' biotin had no significant effect.

Conclusion: Concentrations in serum and follicular fluid of biotin do not play any role in IVF outcome. The negative correlation with AMH and BMI levels might indicate the role of biotin in the ovaries as an indicator of ovarian metabolism. The result provides valuable data in understanding the possible role of biotin in the microenvironment of the ovaries and the need to study it further.

Background: Currently, the World Health Organization guidelines recommend universal utilization of optimally timed first obstetric ultrasound (defined as ultrasound before 24 weeks) in low-middle income countries. However, there is inadequate evidence on this topic from these countries. Our study aimed to determine the rate of utilization of optimally timed first obstetric ultrasound among pregnant women who gave birth at three public hospitals in Ethiopia.

Methods: This was a multicenter prospective cross-sectional study conducted on the utilization of optimally timed first obstetric ultrasound among pregnant women who delivered at public hospitals in Ethiopia in 2020. Data were collected prospectively using a structured questionnaire. Data were analyzed using SPSS Version 20. Simple descriptive statistics, chi-squared test, and multiple regression analysis were performed as appropriate. p value less than 0.05 and adjusted odds ratio (AOR) with 95% CI were used to present result significance.

Results: A total of 385 participants were included in this study. Approximately 67.5% of pregnant mothers had optimally timed 1^st ultrasound. Compared to those having antenatal care (ANC) at health centers, those who started their ANC at private clinic were 1.7 times (95 CI: 1.8-7.9) more likely to have optimally timed ANC. Those who had their 1^st ANC at private hospital were 3.2 times (95 CI: 1.8-7.9) more likely to have optimally timed 1^st prenatal care. Those who had their first ANC at private health institutions and government hospitals were much more likely to have optimally timed 1^st prenatal ultrasound with the following AOR for government hospital and private MCH centers: AOR = 7.4 (95 CI: 2.7-23) and AOR = 4.9 (95 CI: 2.8-14.1), respectively. Those who had previous major obstetric problem were 5.2 times (95 CI: 2.7-9.9) more likely to have optimally timed ultrasound than those without major previous obstetric problem.

Conclusion: We found that one-third of pregnant women did not utilize optimally timed first obstetric ultrasound, despite obstetric ultrasound services being accessible at public health institutions. Place of first ANC contact and presence of prior major obstetric complication were associated with utilization of optimally dated first obstetric ultrasound.

Background: Despite its availability, cervical cancer screening services continue to remain underutilized in many regions. This study aimed to assess the prevalence and determinants of cervical cancer screening uptake among women in the north-central area of Bangladesh.

Methods: In this cross-sectional study, between May and October 2022, women aged 30-60 years attending a tertiary care hospital in Gazipur district were approached for inclusion. Face-to-face interviews were conducted using a semistructured questionnaire. A total of 252 women were consecutively recruited within the study period. The self-reported screening practice was recorded and verified by matching with identification numbers provided for screening by the hospital, and reasons for nonutilization were also collected.

Results: Only 12 women (4.76%) had ever been screened for cervical cancer. Lower knowledge scores (OR: 0.26 and 95% CI: 0.08-0.95) were associated with higher odds of nonutilization of cervical cancer screening services on multivariable analysis. Despite high awareness of symptoms and risk factors, only 15.08% knew that screening prevents cancer. The main reasons for not getting screened were fear of pain (98.33%) and feeling shy (52.50%).

Conclusion: Awareness-increasing programs are recommended to improve the utilization of cervical cancer screening among women.

Aim: This study aimed to evaluate the adverse maternal and neonatal outcomes among pregnant women with COVID-19 at King Salman Armed Forces Hospital in Tabuk and examine the relationship between the severity of COVID-19 infection and these outcomes.

Methods: This retrospective cohort study enrolled COVID-19-positive pregnant women. Demographic and obstetric information, clinical characteristics (including symptoms and preexisting comorbid conditions), and maternal and neonatal outcomes were collected from medical records, reviewed, and analyzed.

Results: The study included 138 COVID-19-positive women, with the majority of cases diagnosed in the third trimester (85.5%). Assessment of the severity of COVID-19 infection showed that a large proportion were asymptomatic (39.1%) or had mild disease (39.9%), while 14.5% had moderate disease and 6.5% experienced severe illness. Adverse maternal and neonatal outcomes included preeclampsia (5.1%), gestational diabetes (4.3%), placental abruption, premature rupture of membranes (2.9% each), maternal intensive care unit (ICU) admission (1.4%), preterm births (12.3%), low birth weight (15.2%), and neonatal ICU admission (10.1%). Additionally, the incidences of preeclampsia and maternal ICU admission were significantly higher in women with severe COVID-19 compared to those with milder or asymptomatic cases (p = 0.004 each). Neonatal ICU admission showed the highest incidence (33.3%) among severe cases (p = 0.031). Asthma was significantly linked to a higher risk of neonatal ICU admission (23.1% vs. 7.1%). Diabetes mellitus was associated with an increased rate of maternal ICU admission (13.3% vs. 0%). Hypertension showed significant associations with elevated rates of preeclampsia (35.7% vs. 1.6%), maternal ICU admission (14.3% vs. 0%), and neonatal ICU admission (35.7% vs. 7.3%).

Conclusion: COVID-19 infection during pregnancy was associated with several adverse maternal and neonatal outcomes, including preeclampsia, gestational diabetes, preterm birth, low birth weight, and increased ICU admissions. Severe maternal disease and existing comorbidities further elevated the risks of complications for both mother and newborn.

Background: To validate previous age subgrouping methods and provide an optimal age reference for women planning to delay in vitro fertilization (IVF).

Methods: From July 2014 to March 2018, 3012 patients that received IVF/intracytoplasmic sperm injection (ICSI) were continuously recruited in this retrospective, single-center study. We analyzed the relationships of baseline characteristics and IVF outcomes. A smooth fitting curve depicting the association of age and live birth was plotted using the generalized additive model (GAM) method. We also evaluated the association of age and live birth among different age groups (> 20, ≤ 35; > 35, ≤ 37; > 37, ≤ 40; and > 40).

Results: Age, duration of infertility, and baseline follicle-stimulating hormone (FSH) were significantly related to the live birth rate. The adjusted Odd Ratio (OR) value of age was 0.95 (P < 0.001), indicating the higher occurrence of no live birth with age increasing. The fitting curve showed that the live birth rate decreased with age. And 35.5 (34.5-36.5) was identified as the inflection point of the curve. The slopes before 35.5 and after 35.5 were significantly different (0.9 [0.9, 1.0], P < 0.001). When ≤ 35, live birth rate did not vary with age. For the ages of 35-37 and 37-40, the occurrence of negative outcome increased with age (aOR: 0.73 [0.53, 0.99], 0.80 [0.65, 1.00]; P = 0.0441, 0.0465, respectively).

Conclusion: The age of 35 can be referred to as the safe time point when the IVF success rate does not decline with age. And the risk of IVF failure increases rapidly in the period of 35-37 and 37-40.

Background: No studies have effectively clarified the relationship between uterine contractions and the act of acceleration or driving behaviors in pregnant women.

Aims: To confirm the effect of driving a motor vehicle on physiological changes in pregnant women, we examined uterine contractions while driving.

Materials and methods: Seventeen pregnant women with a gestational age of 30-35 weeks were enrolled in this study. Uterine contractions were monitored remotely using a mobile delivery monitoring device. Triaxial acceleration of the vehicle, vehicle velocity, and vehicle kinematics were monitored using a driving recorder.

Results: The average number of uterine contractions per 30 min in all participants was 1.0 (range, 0.26-2.0). When comparing the median vehicle velocity during a uterine contraction with that when there were no contractions, no significant difference was found (23 km/hour vs. 31 km/hour, p = 0.36). The prevalence of low velocity (20 km/hour or less) was significantly higher, and that of higher velocity (50 km/hour or more) was lower during a uterine contraction than with no contractions (p = 0.023 and 0.012, respectively). When comparing resultant vehicle acceleration, no significant differences were found between women with uterine contractions and those with no contractions. The distributions were similar before and immediately before a uterine contraction and with no contractions.

Conclusions: Driving a motor vehicle should be considered a normal activity of daily life in pregnant women and seems unlikely to predispose to preterm birth.