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Does Luteal Phase Support Effect Pregnancy Rates in Intrauterine Insemination Cycles? A Prospective Randomised Controlled Study in a Tertiary Center. 黄体期支持是否影响宫内人工授精周期的妊娠率?一项高等教育中心的前瞻性随机对照研究。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-08-05 eCollection Date: 2020-01-01 DOI: 10.1155/2020/6234070
Müge Keskin, Ruşen Aytaç

Intrauterine insemination (IUI) is a common treatment for couples with subfertility. Clomiphene citrate, gonadotropins, and letrozole are used for ovulation induction in IUI cycles. It has been well documented that luteal support with exogenous progesterone after in vitro fertilization is associated with higher pregnancy and live birth rates. Yet, luteal phase support in IUI cycles has become a debatable issue. The aim of this prospective controlled study was to assess the effect of luteal phase vaginal progesterone supplementation on β-hCG positivity and clinical pregnancy rates in women undergoing IUI. This prospective controlled randomised study was conducted at a tertiary infertility center. 87 patients with unexplained infertility or male subfertility who were treated with IUI using gonadotropins were enrolled. Patients in the study group (n = 44) received luteal phase vaginal progesterone supplementation. Patients in the control group (n = 43) did not receive any luteal phase support. There was no statistical difference between two groups in terms of β-hCG positivity and clinical pregnancy rates. Our findings do not show any beneficial effect of luteal phase support in IUI cycles stimulated with gonadotropins. Although luteal phase support in IUI cycles stimulated with gonadotropins is widely adopted, there is a lack of robust evidence.

宫内人工授精(IUI)是不孕夫妇的常用治疗方法。克罗米芬、促性腺激素和来曲唑在人工授精周期中用于促排卵。有充分的证据表明,体外受精后外源性黄体酮支持黄体与较高的妊娠率和活产率有关。然而,在人工授精周期中黄体期的支持已经成为一个有争议的问题。本前瞻性对照研究的目的是评估黄体期阴道孕酮补充对宫内人工授精妇女β-hCG阳性和临床妊娠率的影响。这项前瞻性对照随机研究在一家三级不孕症中心进行。87例不明原因不孕症或男性低生育能力患者采用促性腺激素人工授精治疗。研究组患者(n = 44)接受黄体期阴道孕酮补充。对照组(n = 43)患者未接受任何黄体期支持。两组间β-hCG阳性及临床妊娠率差异无统计学意义。我们的研究结果没有显示在促性腺激素刺激的IUI周期中支持黄体期有任何有益的作用。虽然促性腺激素刺激的IUI周期中黄体期支持被广泛采用,但缺乏有力的证据。
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引用次数: 4
Prevalence, Indications, and Community Perceptions of Caesarean Section Delivery in Ngora District, Eastern Uganda: Mixed Method Study. 乌干达东部恩戈拉地区剖宫产的患病率、适应症和社区观念:混合方法研究。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-07-20 eCollection Date: 2020-01-01 DOI: 10.1155/2020/5036260
Isaac Waniala, Sandra Nakiseka, Winnie Nambi, Isaac Naminya, Margret Osuban Ajeni, Jacob Iramiot, Rebecca Nekaka, Julius Nteziyaremye

Background: Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda.

Methods and materials: It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12.

Results: Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route.

Conclusion: Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5-15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.

背景:乌干达的产妇死亡率(MMR)很高,为336/10万活产。剖腹产对于实现产科急诊服务的公平和平等至关重要。尽管它是一种挽救生命的干预措施,但它与风险有关。在一些地区,剖腹产率激增,但其他地区仍然服务不足。研究表明,超过15%的比率并不能改善孕产妇和新生儿的发病率和死亡率。本研究旨在确定乌干达东部剖宫产的患病率、适应症和社区对剖宫产的看法。方法和材料:在乌干达东部恩戈拉县进行以卫生设施和社区为基础的横断面描述性研究。采用混合数据收集方法,通过回顾性审查2018年4月至2019年3月期间在两家综合产科急诊服务机构分娩的所有母亲的所有图表,收集定量数据。定性数据通过焦点小组讨论收集到饱和点。数据录入EpiData(3.1版本),使用SPSS软件(24版本)进行分析。定性数据分析是通过逐字抄录并翻译成英文,然后借助NVIVO 12进行主题和副主题分析。结果:2573例分娩中,14%(357/2573)采用CS分娩。主要的单一适应症为难产17.9%,胎儿窘迫15.3%,大婴儿11.6%,头骨盆失调(CPD) 11%。虽然被认为可以挽救年轻母亲、疾病患者和反复发生的宫内胎儿死亡的生命,但其他人认为CS是一种诅咒、婚姻破裂、不幸、赚钱的人,是卫生工作者无能的标志,是懒惰妇女和富有的公务员的标志。这一增长还归因于肌肉注射和避孕措施的使用。总体而言,阴道分娩是首选途径。结论:发现了一些可能阻碍CS获得的误解,需要更多的咨询和男性参与。虽然以设施为基础,但比率高于预期的5-15%。这比预计的到2021年36%的增长率要高。它强调了男性参与CS咨询和同意的必要性,并共同努力消除社会对女性接受CS的误解。这些误解可能会阻碍你接触CS。
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引用次数: 16
Menstrual Morbidities, Menstrual Hygiene, Cultural Practices during Menstruation, and WASH Practices at Schools in Adolescent Girls of North Karnataka, India: A Cross-Sectional Prospective Study. 印度北卡纳塔克邦少女的经期发病率、经期卫生、经期文化习俗和学校讲卫生运动:一项横断面前瞻性研究。
IF 1.6 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-07-16 eCollection Date: 2020-01-01 DOI: 10.1155/2020/6238193
Rajasri G Yaliwal, Aruna M Biradar, Shreedevi S Kori, Subhashchandra R Mudanur, Shivakumar U Pujeri, Mohd Shannawaz

Background: Issues of menstrual morbidities, menstrual hygiene, and cultural practices are rarely discussed by adolescents. The burden of menstruation and cultural practices which the adolescent girls have to face has been less quantified. This study aims to assess the issues related to menstruation in school girls.

Method: A cross-sectional prospective study was conducted on 1016 school-going adolescent girls in January 2020. A questionnaire in English and in Kannada was distributed to girls of class 8-12 of ages between 10 and 19 years.

Results: 70.5% of the girls attained menarche by 12 to 14.9 years, 37.2% of the girls had their periods every 28-34 days, and 12.2% of the girls said they have heavy periods. 61.95% of the girls had dysmenorrheal, and 9.7% of the girls said that they required medications for the pain. 70.7% of the girls were using commercial sanitary napkins, 12.7% were using cloth, and 15.3% were using both. 55.5% of the girls who were using cloth as an absorbent were not drying the cloth in sunlight. 57.1% of the girls were washing their genitals more than 2 times a day. 93.8% were having bath during menses and 87.2% were using soap along with water. 37.7% of the girls disposed their pads by burning them, 50.8% of then disposed them in the dust bin, and 4.9% of them buried them. 8.6% of the girls said that they remained completely absent from school during periods. 17.85% said that they remained absent for a day. 53.4% of the respondents said that they have difficulty in concentrating at school. 76.1% said that they had adequate water and sanitation facilities at school. 22.3% said that there was adequate facility to change their pads at school. 73.2% said that they could get a spare pad at school. 43.3% of the girls said they avoided cultural functions during their periods, and 38.5% said that they avoided religious ceremonies and practices during their periods. 8.7% of the girls were made to sit outside the house during their periods. The girls from rural areas had poorer hygienic habits, in comparison to the urban girls. Cultural restrictions such as sitting outside the house during menstruation and restricting play were more in the rural girls than the urban girls.

Conclusion: Menstrual morbidities, menstrual hygiene management, and cultural beliefs all play a role in school absenteeism in adolescent girls. Improvement of facilities at school and conducting awareness programs can help adolescent girls to attend schools.

背景:青少年很少讨论月经疾病、月经卫生和文化习俗等问题。少女必须面对的月经负担和文化习俗也较少被量化。本研究旨在评估与在校女生月经有关的问题:方法:2020 年 1 月,对 1016 名在校少女进行了横断面前瞻性研究。向 10 至 19 岁的 8 至 12 年级女生发放了英语和卡纳达语调查问卷:70.5%的女孩在 12-14.9 岁时月经初潮,37.2%的女孩每 28-34 天来一次月经,12.2%的女孩表示月经过多。61.95%的女孩有痛经,9.7%的女孩说她们需要药物止痛。70.7%的女孩使用商业卫生巾,12.7%的女孩使用布制卫生巾,15.3%的女孩两种卫生巾都用。55.5%使用布作为吸收剂的女孩没有将布在阳光下晒干。57.1% 的女孩每天清洗外阴 2 次以上。93.8%的女孩在经期洗澡,87.2%的女孩使用肥皂和水。37.7% 的女孩通过焚烧的方式处理护垫,50.8% 的女孩将护垫扔进垃圾桶,4.9% 的女孩将护垫掩埋。8.6% 的女孩说她们在经期完全不上学。17.85%的女孩说她们旷课一天。53.4% 的受访者表示在学校难以集中注意力。76.1% 的受访者表示学校有足够的水和卫生设施。22.3% 的受访者表示学校有足够的换尿布设施。73.2% 的人说她们可以在学校得到备用护垫。43.3% 的女孩说她们在经期避免参加文化活动,38.5% 的女孩说她们在经期避免参加宗教仪 式和活动。8.7% 的女孩在月经期间被迫坐在屋外。与城市女孩相比,农村女孩的卫生习惯较差。农村女孩比城市女孩受到更多的文化限制,如经期坐在屋外和限制玩耍:结论:月经疾病、经期卫生管理和文化信仰都是造成少女旷课的原因。改善学校设施和开展宣传活动可以帮助少女入学。
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引用次数: 0
Perception of Women regarding Respectful Maternity Care during Facility-Based Childbirth. 妇女在设施分娩期间对尊重产妇护理的看法。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-07-04 eCollection Date: 2020-01-01 DOI: 10.1155/2020/5142398
Pratima Pathak, Bijaya Ghimire

Background: Respectful care during childbirth has been described as "a universal human right that encompasses the principles of ethics and respect for women's feelings, dignity, choices, and preferences." Many women experience a lack of respectful and abusive care during childbirth across the globe.

Objective: This study aimed to determine women's perception of respectful maternity care (RMC) during facility-based childbirth.

Method: A descriptive cross-sectional study was conducted among 150 mothers admitted to the maternity ward of Nepal Medical College and Teaching Hospital using a purposive sampling technique. Data were collected through an interview technique by using a validated tool containing 15 items each measured on a scale of 5. Statistical Package for Social Science (SPSS) version 16 was used for data analysis. Frequency, percentage, mean score, standard deviation, chi-square test, and binary logistic regression were used to analyze descriptive and inferential statistics.

Results: In total, 84.7% of the women reported that they have experienced overall RMC services with a mean score ± SD (61.70 ± 12.12). Though the majority of the women reported that they have experienced RMC services, they also revealed that they have experienced disrespectful care in various forms such as being shouted upon (30.0%), being slapped (18.7%), delayed service provision (22.7%), and not talking positively about pain and relief during childbirth (28.0%). Likewise, length of stay, parity, and time of delivery were found as factors that influenced friendly care (COR = 0.383, 95% CI: 0.157-0.934), abuse-free care (COR = 3.663, 95% CI: 1.607-8.349), and timely care (COR = 2.050, 95% CI: 1.031-4.076) dimensions of RMC, respectively.

Conclusion: Even though RMC emphasizes eliminating disrespectful and abusive environment from health facilities, 15.0% of participants perceived that they have not experienced overall RMC services. So, the health facility should focus on the interventions which ensure that every woman receives this basic human dignity during one of the most vulnerable times in their lives.

背景:分娩期间的尊重性护理被描述为“一项普遍的人权,包括道德原则和尊重妇女的感情、尊严、选择和偏好。”在全球范围内,许多妇女在分娩过程中缺乏尊重和虐待。目的:本研究的目的是确定妇女的感知尊重产妇护理(RMC)在设施分娩。方法:采用有目的抽样方法,对尼泊尔医学院和教学医院产科病房收治的150名母亲进行描述性横断面研究。数据通过访谈技术收集,使用一个经过验证的工具,其中包含15个项目,每个项目按5分进行测量。数据分析采用SPSS (Statistical Package for Social Science)第16版。采用频率、百分比、均分、标准差、卡方检验和二元logistic回归分析描述性统计和推理统计。结果:总共有84.7%的女性报告她们经历了RMC服务,平均评分±SD(61.70±12.12)。虽然大多数女性报告说她们经历过RMC服务,但她们也透露她们经历过各种形式的不尊重照顾,如被大喊大叫(30.0%),被打耳光(18.7%),延迟服务(22.7%),以及不积极谈论分娩时的疼痛和缓解(28.0%)。同样,住院时间、胎次和分娩时间分别是影响RMC友好护理(COR = 0.383, 95% CI: 0.157-0.934)、无虐待护理(COR = 3.663, 95% CI: 1.607-8.349)和及时护理(COR = 2.050, 95% CI: 1.031-4.076)维度的因素。结论:尽管RMC强调消除卫生设施中的不尊重和虐待环境,但15.0%的参与者认为他们没有体验到RMC的整体服务。因此,卫生机构应侧重于采取干预措施,确保每一位妇女在其生命中最脆弱的时期之一获得这种基本的人的尊严。
{"title":"Perception of Women regarding Respectful Maternity Care during Facility-Based Childbirth.","authors":"Pratima Pathak, Bijaya Ghimire","doi":"10.1155/2020/5142398","DOIUrl":"10.1155/2020/5142398","url":null,"abstract":"<p><strong>Background: </strong>Respectful care during childbirth has been described as \"a universal human right that encompasses the principles of ethics and respect for women's feelings, dignity, choices, and preferences.\" Many women experience a lack of respectful and abusive care during childbirth across the globe.</p><p><strong>Objective: </strong>This study aimed to determine women's perception of respectful maternity care (RMC) during facility-based childbirth.</p><p><strong>Method: </strong>A descriptive cross-sectional study was conducted among 150 mothers admitted to the maternity ward of Nepal Medical College and Teaching Hospital using a purposive sampling technique. Data were collected through an interview technique by using a validated tool containing 15 items each measured on a scale of 5. Statistical Package for Social Science (SPSS) version 16 was used for data analysis. Frequency, percentage, mean score, standard deviation, chi-square test, and binary logistic regression were used to analyze descriptive and inferential statistics.</p><p><strong>Results: </strong>In total, 84.7% of the women reported that they have experienced overall RMC services with a mean score ± SD (61.70 ± 12.12). Though the majority of the women reported that they have experienced RMC services, they also revealed that they have experienced disrespectful care in various forms such as being shouted upon (30.0%), being slapped (18.7%), delayed service provision (22.7%), and not talking positively about pain and relief during childbirth (28.0%). Likewise, length of stay, parity, and time of delivery were found as factors that influenced friendly care (COR = 0.383, 95% CI: 0.157-0.934), abuse-free care (COR = 3.663, 95% CI: 1.607-8.349), and timely care (COR = 2.050, 95% CI: 1.031-4.076) dimensions of RMC, respectively.</p><p><strong>Conclusion: </strong>Even though RMC emphasizes eliminating disrespectful and abusive environment from health facilities, 15.0% of participants perceived that they have not experienced overall RMC services. So, the health facility should focus on the interventions which ensure that every woman receives this basic human dignity during one of the most vulnerable times in their lives.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"5142398"},"PeriodicalIF":1.9,"publicationDate":"2020-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5142398","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38177868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 23
Severe Life-Threatening Pregnancy Complications, "Near Miss" and Maternal Mortality in a Tertiary Hospital in Southern Nigeria: A Retrospective Study. 尼日利亚南部一家三级医院严重危及生命的妊娠并发症、“险些错过”和孕产妇死亡率:一项回顾性研究
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-07-01 eCollection Date: 2020-01-01 DOI: 10.1155/2020/3697637
Ubong Bassey Akpan, Udeme Asibong, Ezukwa Omoronyia, Kazeem Arogundade, Thomas Agan, Mabel Ekott

Background: Investigating severe life-threatening pregnancy complications that women encounter and the maternal morbidities (near miss) may help to evaluate the quality of care in health facility and recommend ways to improve maternal and infant survival especially in low-income countries. The aim of this review was to identify, classify, and determine the frequency and nature of maternal near miss events and the maternal and perinatal outcomes.

Methods: A retrospective facility-based review of cases of near miss and maternal mortality occurring between 1st January 2012 and 31st December 2016 at the University of Calabar Teaching Hospital was conducted. Near miss case definition was based on the WHO disease specific criteria. The main outcomes included the maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality index, maternal morbidities, and perinatal outcome.

Results: There were 10,111 pregnancy-related admissions, 790 life-threatening pregnancy complications that resulted in 99 maternal deaths, and 691 near miss cases. The maternal mortality ratio was 979 maternal deaths per 100,000 live births, and the maternal near miss ratio was 6,834 per 100,000 maternities. The MMR to MNMR ratio was 1 : 8. Sepsis and severe anaemia had high case-specific mortality indices of 0.4 and 0.53, respectively. The perinatal outcome was poor compared to that of uncomplicated pregnancies: perinatal mortality rate (PMR) 266 per 1000 live births (OR 7.74); neonatal intensive care (NIC) admissions 11.6 percent (OR 1.83); and low birth weight (LBW) (<2.5 kg) 12.19 percent (OR 1.89).

Conclusion: Antenatal care and early recognition of danger signs in pregnancy as well as prompt referral and early institution of essential obstetrics care are important for maternal and infant survival.

背景:调查妇女遇到的严重危及生命的妊娠并发症和孕产妇发病率(接近漏诊)可能有助于评估卫生机构的护理质量,并建议改善孕产妇和婴儿生存的方法,特别是在低收入国家。本综述的目的是识别、分类和确定孕产妇未遂事件的频率和性质以及孕产妇和围产期结局。方法:回顾性分析2012年1月1日至2016年12月31日在卡拉巴尔大学教学医院发生的未遂漏诊和孕产妇死亡病例。接近漏诊病例的定义基于世卫组织疾病特定标准。主要结局包括孕产妇死亡率(MMR)、孕产妇近漏率(MNMR)、死亡率指数、孕产妇发病率和围产期结局。结果:共有10111例妊娠相关入院,790例危及生命的妊娠并发症导致99例孕产妇死亡,691例险些漏诊。产妇死亡率为每10万例活产979例产妇死亡,产妇未遂率为每10万例产妇6834例。MMR与MNMR比值为1:8。败血症和严重贫血的病例特异性死亡率指数较高,分别为0.4和0.53。与无并发症妊娠相比,围产期结局较差:围产期死亡率(PMR) 266 / 1000活产(OR 7.74);新生儿重症监护(NIC)住院11.6% (OR 1.83);结论:产前保健和早期识别妊娠危险体征,及时转诊和早期建立产科基本护理对母婴生存至关重要。
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引用次数: 6
Hormone Replacement Therapy: Lebanese Women's Awareness, Perception, and Acceptance. 激素替代疗法:黎巴嫩妇女的意识、感知和接受。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-06-16 eCollection Date: 2020-01-01 DOI: 10.1155/2020/5240932
A Anastasia Salame, Mohammad J Jaffal, Fatin Khalifeh, Dalia Khalife, Ghina Ghazeeri

Objectives: Hormone replacement therapy (HRT) had been the gold standard for the treatment of menopausal symptoms until the publication of the World Health Initiative (WHI) study. After the WHI study, the use of HRT changed among the physicians and patients all over the world despite newer more reassuring data. This study aimed to investigate the knowledge and attitudes of women towards HRT and the factors affecting it for better counseling. Study design. A clinic-based cross-sectional study using a survey was offered to women aged 40 years and above coming to the women's health center at the American University of Beirut Medical Center (AUBMC) from October 1st, 2017, till March 31st, 2018. The questionnaire included questions about demographics and menopausal symptoms in addition to knowledge and attitudes towards menopause and HRT. Main outcome measures. Our main hypothesis was that women would be aware of HRT as a treatment modality; however, the majority would have a negative attitude towards its usage.

Results: The response rate was 87.8%. Seventy-three percent of the respondents had already heard about HRT with 57.9% supporting the use of HRT; however, 47.9% did not know when to use it. The significant predictor for having heard about HRT and a positive attitude towards HRT were having HRT prescribed as a part of treatment and employment status, respectively.

Conclusions: Lebanese women are aware of HRT as a treatment option; however, a lack of both proper information and positive attitude towards HRT use was noted.

目的:在世界卫生倡议(WHI)研究发表之前,激素替代疗法(HRT)一直是治疗更年期症状的金标准。在WHI研究之后,尽管有更新的更令人放心的数据,但世界各地的医生和患者对HRT的使用发生了变化。本研究旨在了解女性对激素替代疗法的认知、态度及影响因素,以便更好地进行咨询。研究设计。对2017年10月1日至2018年3月31日在贝鲁特美国大学医学中心(AUBMC)女性健康中心就诊的40岁及以上女性进行了基于临床的横断面研究。问卷包括人口统计学和更年期症状的问题,以及对更年期和激素替代疗法的知识和态度。主要结果测量。我们的主要假设是女性会意识到激素替代疗法是一种治疗方式;然而,大多数人对它的使用持否定态度。结果:有效率为87.8%。73%的受访者已经听说过激素替代疗法,57.9%的受访者支持使用激素替代疗法;然而,47.9%的人不知道何时使用它。听说过HRT和对HRT持积极态度的显著预测因子分别是将HRT作为治疗和就业状况的一部分。结论:黎巴嫩妇女意识到HRT是一种治疗选择;但是,注意到缺乏适当的信息和对使用激素替代疗法的积极态度。
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引用次数: 6
Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya. 肯尼亚不一致夫妇接受常规艾滋病毒护理的孕前护理和直接结果
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-06-09 eCollection Date: 2020-01-01 DOI: 10.1155/2020/1675987
Nyawira Gitahi, Sheila Juliet Eshiwani, Kenneth Mutai, Jared Ongechi Mecha, James Njogu Kiarie

Introduction: A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care uptake. This study aimed at documenting fertility desire (desire to conceive), determining the uptake of preconception care, identifying HIV prevention strategies used during preconception care, and determining immediate conception outcomes among HIV discordant couples in Kenya.

Methods: We retrospectively extracted electronic medical record data on discordant couples at an HIV care discordant couples' clinic. We included data on couples who expressed a desire to conceive and were offered preconception care and followed up for 29 months. We collected data on sociodemographic characteristics, preconception prevention methods, and associated outcomes.

Results: Among couples, with male HIV-positive partners, there was a twofold likelihood of accepting preconception services (OR = 2.3, CI 95% (1, 1, 5.0)). A shorter discordant union was independently associated with the uptake of preconception services (OR = 0.92, CI 95% (0.86, 0.98)). The most used prevention intervention (38.5%) among discordant couples was a combination of pre-exposure prophylaxis (PrEP) by the uninfected partner, alongside HAART by the partner living with HIV. Pregnancy rates did not significantly (p  =  0.06) differ among those who took up preconception care versus those who did not. HIV-negative partners of couples who declined preconception care had a significantly (p  =  0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.

Conclusion: The study demonstrates the feasibility of implementing safe and effective preconception servicesas part of routine HIV care for discordant couples living in low resource settings. The provision and the utilisation of safer conception services may be hindered by the poor retention to follow-up and care of HIV-negative partners. This challenge may impede the expected benefits of preconception care as an HIV prevention intervention.

导言:很大一部分新的艾滋病毒感染发生在不协调的伙伴关系中,使不协调成为非洲新的艾滋病毒感染的一个重要因素。尽管孕前护理对艾滋病毒不一致的夫妇有作用,但关于生育愿望和孕前护理吸收的数据很少。本研究旨在记录生育欲望(怀孕欲望),确定孕前护理的吸收,确定孕前护理期间使用的艾滋病毒预防策略,并确定肯尼亚艾滋病毒不一致夫妇的即时受孕结果。方法:我们回顾性地提取HIV护理不协调夫妇诊所的不协调夫妇的电子病历数据。我们纳入了表达怀孕愿望的夫妇的数据,并提供了孕前护理,随访了29个月。我们收集了社会人口学特征、孕前预防方法和相关结果的数据。结果:在男性hiv阳性伴侣的夫妇中,接受孕前服务的可能性是男性的两倍(OR = 2.3, CI 95%(1,1,5.0))。较短的不和谐结合与孕前服务的接受独立相关(OR = 0.92, CI 95%(0.86, 0.98))。在不一致的夫妇中,使用最多的预防干预措施(38.5%)是未感染伴侣的暴露前预防(PrEP)与感染艾滋病毒的伴侣的HAART相结合。妊娠率在接受孕前护理者和未接受孕前护理者之间没有显著差异(p = 0.06)。拒绝孕前护理的夫妇的hiv阴性伴侣在临床随访中有显著的高损失率(p = 0.04)。发生一例确诊的血清转化;艾滋病毒感染率为每100人年0.19例。结论:本研究表明,对生活在资源匮乏环境中的不和谐夫妇实施安全有效的孕前服务作为常规艾滋病毒护理的一部分是可行的。提供和利用更安全的受孕服务可能会因对艾滋病毒阴性伴侣的随访和护理保留不足而受到阻碍。这一挑战可能会阻碍孕前护理作为艾滋病毒预防干预措施的预期效益。
{"title":"Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya.","authors":"Nyawira Gitahi,&nbsp;Sheila Juliet Eshiwani,&nbsp;Kenneth Mutai,&nbsp;Jared Ongechi Mecha,&nbsp;James Njogu Kiarie","doi":"10.1155/2020/1675987","DOIUrl":"https://doi.org/10.1155/2020/1675987","url":null,"abstract":"<p><strong>Introduction: </strong>A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care uptake. This study aimed at documenting fertility desire (desire to conceive), determining the uptake of preconception care, identifying HIV prevention strategies used during preconception care, and determining immediate conception outcomes among HIV discordant couples in Kenya.</p><p><strong>Methods: </strong>We retrospectively extracted electronic medical record data on discordant couples at an HIV care discordant couples' clinic. We included data on couples who expressed a desire to conceive and were offered preconception care and followed up for 29 months. We collected data on sociodemographic characteristics, preconception prevention methods, and associated outcomes.</p><p><strong>Results: </strong>Among couples, with male HIV-positive partners, there was a twofold likelihood of accepting preconception services (OR = 2.3, CI 95% (1, 1, 5.0)). A shorter discordant union was independently associated with the uptake of preconception services (OR = 0.92, CI 95% (0.86, 0.98)). The most used prevention intervention (38.5%) among discordant couples was a combination of pre-exposure prophylaxis (PrEP) by the uninfected partner, alongside HAART by the partner living with HIV. Pregnancy rates did not significantly (<i>p</i>  =  0.06) differ among those who took up preconception care versus those who did not. HIV-negative partners of couples who declined preconception care had a significantly (<i>p</i>  =  0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.</p><p><strong>Conclusion: </strong>The study demonstrates the feasibility of implementing safe and effective preconception servicesas part of routine HIV care for discordant couples living in low resource settings. The provision and the utilisation of safer conception services may be hindered by the poor retention to follow-up and care of HIV-negative partners. This challenge may impede the expected benefits of preconception care as an HIV prevention intervention.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"1675987"},"PeriodicalIF":1.9,"publicationDate":"2020-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/1675987","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38068199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know? 非产褥期子宫内翻:妇科医生需要知道什么?
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-06-01 eCollection Date: 2020-01-01 DOI: 10.1155/2020/8625186
R P Herath, M Patabendige, M Rashid, P S Wijesinghe

Introduction: Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. The objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment.

Materials and methods: A comprehensive literature review was carried out on MEDLINE and Google Scholar databases to look for NPUI using the term "non-puerperal uterine inversion," and further went through the cross-references of the published articles. Data are published case reports from 1911 to September 2018. Of the 153 published cases, 133 reports had adequate details of surgery for analysis. These reports were analyzed, concerning the clinical presentation, methods of diagnosis, and surgical treatment.

Results: Mean age of the women was 46.3 years (standard deviation: 18, N = 153). Leiomyoma remained the commonest (56.2%) aetiology. While malignancies contributed to 32.02% of cases, 9.2% were idiopathic. High degree of clinical suspicion and identification of unique features on ultrasonography and magnetic resonance imaging enable prompt diagnosis. In cases of uncertainty, laparoscopy or biopsy of the mass was used to confirm the diagnosis. Hysterectomy or repositioning and repair of the uterus are the only treatment options available. The surgical methods implemented were analyzed in three aspects: route of surgical access, method of repositioning, and final surgical procedure undertaken. The majority (48.8%) had only abdominal access, while 27.1% had both abdominal and vaginal access. Haultain procedure was the most useful procedure for reposition (18.0%) of the uterus. The majority (39.7%) required abdominal hysterectomy with or without debulking of the tumour abdominally, while 15.0% had uterine repair after repositioning. We reviewed the different surgical techniques and described and proposed a treatment algorithm.

Conclusions: Fibroids were the commonest cause for NPUI. Malignancies accounted for one-third of cases. A combined abdominal and vaginal approach, followed by hysterectomy or repair after repositioning, seems to be better for nonmalignant cases.

简介:非产褥期子宫内翻(NPUI)是一个罕见的临床问题,诊断和手术挑战。我们研究的目的是回顾NPUI的文献,描述病因病理、诊断和不同的手术治疗方案。材料和方法:在MEDLINE和Google Scholar数据库中进行全面的文献检索,寻找使用“非产后子宫反转”一词的NPUI,并进一步对已发表的文章进行交叉参考。数据为1911年至2018年9月公布的病例报告。在153例已发表的病例中,133例报告有足够的手术细节供分析。对这些报告进行分析,包括临床表现、诊断方法和手术治疗。结果:女性平均年龄46.3岁(标准差:18,N = 153)。平滑肌瘤仍然是最常见的病因(56.2%)。恶性肿瘤占32.02%,其中特发性占9.2%。临床高度怀疑,超声和磁共振成像的独特特征识别,使诊断及时。在不确定的情况下,腹腔镜检查或肿块活检被用来确认诊断。子宫切除术或子宫重新定位和修复是唯一的治疗选择。从手术通路、复位方法、最终手术方式三方面分析手术方法。大多数(48.8%)只有腹部通道,而27.1%有腹部和阴道通道。牵引手术是子宫复位最有用的手术(18.0%)。大多数(39.7%)需要腹部子宫切除术,伴有或不伴有腹部肿瘤缩小,而15.0%的患者在重新定位后进行子宫修复。我们回顾了不同的手术技术,描述并提出了一种治疗算法。结论:子宫肌瘤是NPUI最常见的病因。恶性肿瘤占三分之一。腹腔和阴道联合入路,然后子宫切除术或重新定位后修复,似乎对非恶性病例更好。
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引用次数: 21
Midgut Volvulus: A Rare but Fatal Cause of Abdominal Pain in Pregnancy-How Can We Diagnose and Prevent Mortality? 中肠扭转:一种罕见但致命的妊娠腹痛原因——我们如何诊断和预防死亡?
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-05-26 eCollection Date: 2020-01-01 DOI: 10.1155/2020/2185290
Eelyn Chong, David S Liu, Neil Strugnell, Vishnupriya Rajagopal, Krinal K Mori

Midgut volvulus in pregnancy is rare but life-threatening, resulting in high maternal and fetal mortality. This surgical emergency commonly masquerades as symptoms of pregnancy, which together with its low incidence often leads to delay in diagnosis and definitive treatment. Here, we review the last three decades of the literature, discuss the challenges in managing this rare condition, and raise awareness among clinicians to minimise loss of life.

妊娠期中肠扭转罕见,但危及生命,导致产妇和胎儿死亡率高。这种外科紧急情况通常伪装成怀孕的症状,加上发病率低,往往导致诊断和最终治疗的延误。在这里,我们回顾了过去三十年的文献,讨论了管理这种罕见疾病的挑战,并提高了临床医生的认识,以尽量减少生命损失。
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引用次数: 4
Quality of Life among Obstetric Fistula Patients at Kitovu Mission Hospital: A Health Facility-Based Cross-Sectional Study in Masaka District, Uganda. Kitovu教会医院产科瘘患者的生活质量:乌干达马萨卡地区基于卫生设施的横断面研究。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-05-20 eCollection Date: 2020-01-01 DOI: 10.1155/2020/7953915
Samuel Kakembo, Christine Atuhairwe, Ivan Mugisha Taremwa

Background: Obstetric fistula (OF) remains a silent neglected maternal challenge associated with devastating life consequences. Living with OF presents far-reaching physical, social, psychosocial, and emotional concerns, which negatively impact a woman's quality of life. This study evaluated the quality of life among obstetric fistula patients in Masaka district, Uganda.

Method: A cross-sectional study was conducted among 63 women diagnosed with OF at Kitovu Mission Hospital. Data were collected using a questionnaire, observation, in-depth interviews, and focus group discussions. Data were analyzed at univariate, bivariate, and multivariate levels, where the ordinal logistic regression model was applied. The qualitative data was transcribed and analyzed using qualitative content analysis.

Results: Majority (87%) of the women diagnosed with OF reportedly had a poor quality of life. Bivariate analysis indicated that level of education (P < 0.001), employment status (P < 0.001), energy for everyday life (P < 0.001), capacity to work (P < 0.001), satisfaction with personal relationships (P < 0.001), feelings of loneliness (P < 0.001), negative feelings (P = 0.002), and self-confidence (P < 0.001) were significantly associated with good QoL. Multivariate analysis showed increased odds of good QoL increased among women with self-confidence (OR = 32.320; CI = 2.019-517.467), formal education (OR = 9.9497; CI = 1.075-92.048), women who did not experience difficulties in mobility (OR = 19.144; CI = 0.149-2456.770), and women who were satisfied with their personal relationships (OR = 5.785; CI = 0.447-74.824).

Conclusion: A holistic fistula treatment approach is required that takes into consideration all aspects of life to address the consequences of obstetric fistula to realize improved quality of life among patients.

背景:产科瘘(OF)仍然是一个沉默的被忽视的产妇挑战与毁灭性的生活后果。患有OF会对身体、社会、心理和情感产生深远的影响,对女性的生活质量产生负面影响。本研究评估了乌干达马萨卡地区产科瘘患者的生活质量。方法:对63名在Kitovu教会医院诊断为OF的妇女进行横断面研究。数据收集采用问卷调查、观察、深度访谈和焦点小组讨论。在单变量、双变量和多变量水平上分析数据,其中应用了有序逻辑回归模型。对定性数据进行转录和定性内容分析。结果:据报道,大多数(87%)被诊断为of的女性生活质量较差。双变量分析显示,教育水平(P < 0.001)、就业状况(P < 0.001)、日常生活精力(P < 0.001)、工作能力(P < 0.001)、人际关系满意度(P < 0.001)、孤独感(P < 0.001)、消极情绪(P = 0.002)和自信心(P < 0.001)与良好生活质量显著相关。多因素分析显示,自信女性获得良好生活质量的几率增加(OR = 32.320;CI = 2.019-517.467),正规教育(OR = 9.9497;CI = 1.075-92.048),没有活动困难的女性(OR = 19.144;CI = 0.149-2456.770),对个人关系满意的女性(OR = 5.785;ci = 0.447-74.824)。结论:需要一种全面的瘘管治疗方法,考虑到生活的各个方面,以解决产科瘘的后果,实现患者生活质量的提高。
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引用次数: 2
期刊
Obstetrics and Gynecology International
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