European Journal of Obstetrics and Gynecology and Reproductive Biology: X最新文献

Objective

This study aims to compare the perinatal outcomes of emergency and elective cervical cerclages.

Material and Methods

This retrospective study included a total of 247 patients, with a total of 142 emergency (with a history of mid-trimester miscarriage or vaginal delivery of < 34 weeks and cervical length < 25 mm) and 105 electives cerclage patients (with painless cervical dilation and cervical length <25 mm) who had cerclage with the vaginal cervical McDonald technique between 1.1.2017–1.10.2022. Pregnant women with normal screening tests at weeks 11–14, normal fetal morphology, and singleton pregnancies were included in the study. The study was conducted in a tertiary center providing NICU care for < 1500 g, less than 32 weeks of age, and on a mechanical ventilator. Obstetric and perinatal outcomes were reviewed.

Results

There was no statistical difference between the two groups regarding maternal age or BMI. It was observed that the week of delivery was greater for elective cerclages than for emergency cerclages (mean 34.6 GW versus 30.8 GW). The week of cerclage application was statistically higher in emergency cerclage (19.2 GW versus 16.3 GW p < 0.000). In addition, when we evaluated perinatal complications: prenatal Ex (n34 vs. n8 p < 0.001), C-reactive protein which is a marker of neonatal infection (12.7 mg/L vs. 2.5 mg/L p < 0.022), antibiotic use in the NICU (n 35 vs. n23 p < 0.050), the number of days of antibiotic use in the NICU (mean 15.3 days vs. 10.4 days p < 0.024), rate of NICU intubation (n 27 vs. n 11 p < 0.003), and neonatal sequelae (n 16 vs. n 6 p < 0.016) were significantly higher in the emergency cerclage group than in the elective cerclage group. There was no found significant difference between the progesterone given and not given progesterone after the procedure in term of the weeks of delivery (p < 0.810 emergency cervical cerclage; p < 0681 elective cervical cerclage)

Conclusion

Considering the available information, the results of elective cerclage seem to be more beneficial for the patient than those of emergency cerclage. Therefore, it would be more reasonable to perform elective cerclage in patients with mid-trimester or preterm miscarriage and concomitant cervical shortening before emergency cerclage is required. Furthermore, the benefit of progestin, in addition after surgical intervention, has not been established.

Selecting an appropriate oral contraceptive can be challenging for healthcare professionals due to the abundance of marketed contraceptive options with different clinical and real-world effectiveness and safety profiles. Nomegestrol acetate + 17β-estradiol (NOMAC/E2) is a combined oral contraceptive (COC) that inhibits ovulation by suppressing ovarian function by a 17-hydroxy-progesterone derivative and an estrogen identical to that endogenously produced by the ovaries. This narrative review examines clinical and real-world studies of NOMAC/E2 based on a background literature search using PubMed and Google Scholar. The review outlines the pharmacology of NOMAC/E2, including its progestational activity, pharmacokinetics, and effects on carbohydrate metabolism, lipid metabolism, and coagulation parameters, and summarizes key clinical efficacy and safety data that led to the approval of NOMAC/E2 in Europe, Brazil, and Australia. To help elucidate how NOMAC/E2 clinical trial data translate into a real-world setting, this review describes the effectiveness and safety of NOMAC/E2 in prospective studies that include over 90,000 users (half of whom received NOMAC/E2), outlining its effects on risk of thrombosis, menstrual bleeding patterns, weight, mood, acne, bone health, and patient quality of life. Non-contraceptive benefits of NOMAC/E2 for women with endometriosis, dysmenorrhea, or pre-menstrual dysphoric disorder are also discussed. These data demonstrate that NOMAC/E2 has a long half-life and rapid absorption, is effective at preventing unwanted pregnancies, and exhibits a favorable safety profile in both clinical trials and real-world settings. Importantly, NOMAC/E2 is not associated with increased risk of venous thromboembolism, a major safety concern of healthcare professionals for women receiving hormonal contraceptives. This review highlights NOMAC/E2 as a differentiated option among COCs and could help inform oral contraceptive choice to ultimately improve patient management and outcomes in real-world settings.

Introduction

It is not well studied how fear of childbirth (FOC) influences the interpregnancy interval (IPI). Thus, we aimed to analyze the association between FOC and the length of the IPI.

Methods

All women having their first and second pregnancies during the study period (2004–2018) were gathered from the Finnish Medical Birth Register. A logistic regression model was used to assess the association between the FOC and subsequent length of the IPI. The length of the IPI was assessed separately for women with FOC in the first pregnancy, and for women who developed the FOC in the second pregnancy. IPIs with a length in the lower quartal were considered short IPIs, and length in the upper quartal as long IPIs. Adjusted odds ratios (aOR) with 95% CIs were compared between the groups.

Results

A total of 52 709 women with short IPI (<1.05 years), 105 604 women with normal IPI, and 52 889 women with long IPI (>2.57 years) were included. A total of 3606 women had FOC in the first pregnancy, and a total of 11 473 had their first FOC diagnosis in the second pregnancy. Women with FOC in the first pregnancy had lower odds for short IPI (aOR 0.88, CI 0.81–0.95) and higher odds for long IPI (aOR 1.30, CI 1.21–1.40). Women with the first FOC diagnosis in the second pregnancy had higher odds for long IPI (aOR 1.68, CI 1.61–1.75), When only vaginal deliveries in the first pregnancy were included, women with FOC in the second pregnancy had lower odds for long IPI (aOR 0.71, CI 0.66–0.75) and higher odds for long IPI (aOR 1.52, CI 1.41–1.62), when only cesarean section was included.

Conclusion

The main finding of this study was that women with FOC had notably higher odds for long IPI. The etiologic and background factors behind FOC should be better recognized and prevented, and FOC should not only be considered as a complicating factor for pregnancy and delivery but also a factor that strongly affects the desire of women to get pregnant again.

Introduction

During pregnancy, women experience metabolic changes that may induce insulin resistance, which can be traced to the blood glucose levels A number of factors may intervene in the metabolism of glucose in pregnant women; one of them is body composition. This factor is useful for studying metabolic diseases, for which the identification of the fat mass/muscle mass index (FMMMI) considered an especially relevant factor. Owing to their nature, techniques such as bioimpedance have been sparsely used for analysis during pregnancy.

Aim

This study aimed to identify the relationship between fat mass / muscle mass index and glucose metabolism in pregnant women.

Methods

This descriptive cross-sectional study included 231 women between the ages of 18 and 35 years and 24–28 weeks of gestation, who attended a state hospital for regular check-ups and exhibited risk factors for the development of gestational diabetes (GD) according to the Current Practice Guidelines in Primary Care. The participants underwent a physical examination, anthropometric measurements bio impedance were obtained, and oral glucose tolerance curves were constructed. FMMMI was calculated.

Results

The prevalence of gestational diabetes was observed to be 13.4%. Women with a GD diagnosis had a significantly higher FMMMI than in those with no GD (0.746 ± 0.168 vs 0.567 ± 0.167;p < 0.005). The assessment of the FMMMI tertiles revealed that GD prevalence was higher in tertile 3 than in tertiles 1 and 2 (tertile 1: 2.6%; tertile 2: 9.1%; tertile 3: 24%).

Conclusion

FMMMI is associated with glucose tolerance test response in pregnant women and a higher prevalence of GD.

Objective

To assess the association between witnessing domestic violence against the mother in childhood and intimate partner violence (IPV) in adulthood.

Study design

An analytical cross-sectional study was conducted using data from the 2019 Peruvian Demographic and Family Health Survey (ENDES). The independent variable was the condition of witnessing physical violence by the father against the mother during childhood. The dependent variable was IPV, defined by the presence of some subtype of violence (physical, psychological, and sexual) against the respondent in the last year by her husband or partner. To assess this association, generalized linear models of the Poisson Family with a logarithmic link function were performed to estimate crude and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95% CI).

Results

Data from 17,911 Peruvian women between 15 and 59 years of age were analyzed. Most women were between 30 and 49 years old (71.4%), were cohabiting (65.0%), and had secondary education (43.2%). The prevalence of IPV in the last year was 16.0%, and the history of witnessing domestic violence against the mother during childhood was 42.0%. In the regression models, those with the studied exposure showed a higher prevalence of experiencing an episode of IPV in the last year (any IPV [aPR: 1.69; 95% CI: 1.50–1.91]; physical IPV [aPR: 1.70; 95% CI: 1.43–2.02], psychological IPV [aPR: 1.64; 95% CI:1.42–1.88], and sexual IPV [aPR: 1.68; 95% CI: 1.22–2.32]).

Conclusions

Women with a history of domestic violence towards their mothers were likelier to have had IPV in the last year than women who did not report violence towards their mothers during childhood. Approximately two in ten Peruvian women reported having had IPV in the past year, and nearly half reported witnessing domestic violence against their mother as a child.

Soft tissue sarcomas accounts for 1–2% of adult malignancies. Undifferentiated pleomorphic sarcoma (UPS) is a rare subtype that lack immunohistochemical markers for a specific definition. About 18% of sarcomas are at a locally advanced stage, often requiring several cycles of chemotherapy and radiotherapy, in addition to surgery. For a young woman, this can mean delaying pregnancies with a high risk of therapy-induced ovarian damage. For this reason, proper counseling on fertility preservation plays a key role. In addition, all women of childbearing age with cancer, should be informed about the importance of planning a pregnancy to improve maternal and neonatal outcomes. We report a rare case of a 40-year-old woman with a UPS who, during CT scan after chemotherapy to decide on surgery, find out she was pregnant. After counseling, the patient decides to go ahead with the pregnancy.

Background

Increasing well qualified health professionals is a part of sustainable development goal to specially to decrease maternal mortality below 70 per 100,000 deaths. Contrarily, The Nursing and midwifery councils (NMC) expect that 36% of healthcare workers, especially midwives, are leaving their jobs due to high turnover rates and job unhappiness worldwide.

Methods

Studies were rigorously searched utilizing international databases from PubMed, Google Scholar, Cochrane Library, and Embase. Using the New Castle Ottawa scale for a cross-sectional study design, the quality of the articles that were searched was evaluated. The systemic review was conducted using the random effect approach, and statistical analysis was done using STATA version 17 software for the window. The Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guideline was followed for reporting results.

Results

A total of nine observational cross-sectional studies were included in this review. The pooled level of job satisfaction among midwives in Ethiopia was 52.2% (95% CI =41.7, 62.9). The pooled odds ratio showed that a significant positive association was found between midwives’ job satisfaction and studied variables. Male midwife (OR = 0.45; 95% CI: 0.04, 0.87), fair supervision (OR = 2.03; 95%CI: 1.58–1), workload (OR = 1.72; 95%CI: 1.102–2.43) and motivation (OR = 1.64; 95%CI: 1.02–2.25) were strongly associated with job satisfaction.

Conclusion

Evidence suggested that motivating employees, providing fair supervision, fair workloads, and fostering positive relationships with managers are all crucial tactics for retaining and enhancing the satisfaction of health professionals at health care facilities in Ethiopian.