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Effectiveness of Different Algorithms and Cut-off Value in Preeclampsia First Trimester Screening 不同算法和截断值在子痫前期筛查中的有效性
IF 3.2 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2022-04-08 DOI: 10.1155/2022/6414857
Piotr Tousty, B. Czuba, D. Borowski, Magda Fraszczyk-Tousty, Sylwia Dzidek, E. Kwiatkowska, A. Cymbaluk-Płoska, A. Torbé, S. Kwiatkowski
Results For the cut-off point >1 : 150, 86 women at an increased risk of eo-PE using algorithm 1 were identified. Of these 86 patients, 83 (96%) were identified using algorithm 2, 62 (72%) using algorithm 3, and 60 (69%) using algorithm 4. In addition, it was demonstrated that between 21% and 29% of women at a low risk of eo-PE could be given acetylsalicylic acid if a screening test was used that did not account for PlGF. Conclusions In order to provide the highest level of health care to pregnant women, it is extremely important that full screening for eo-PE should be ensured. The cheapest algorithm based only on MAP and UtPI resulted in our patients being unnecessarily exposed to complications.
结果对于截断点bb1:15 0,使用算法1确定了86名eo-PE风险增加的女性。在这86例患者中,83例(96%)采用算法2,62例(72%)采用算法3,60例(69%)采用算法4。此外,研究表明,如果使用不考虑PlGF的筛查试验,21%至29%的低风险eo-PE妇女可以给予乙酰水杨酸。结论为了向孕妇提供最高水平的医疗保健,确保eo-PE的全面筛查至关重要。仅基于MAP和UtPI的最便宜的算法导致我们的患者不必要地暴露于并发症。
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引用次数: 1
Storytelling in Pregnancy and Childbirth: An Integrative Review of the Literature. 妊娠和分娩中的故事叙述:文献综述。
IF 3.2 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1155/2022/8483777
Zahra Mahdavi, Leila Amiri-Farahani, Sally Pezaro

Methods: An integrative review of the literature was conducted, including peer-reviewed articles published between 2001 and 2022. The following databases were used to search for relevant studies: PubMed, CINAHL, PsycINFO, Web of Science, Ovid, Google Scholar, ScienceDirect, Cochrane Library, Magiran, Irandoc, and SID. A process of thematic synthesis was used to make sense of the data extracted.

Results: Whilst 21 studies were retrieved, only 12 were relevant and thus met the inclusion criteria set. Two themes were identified from our thematic synthesis: (1) effects of childbirth storytelling on the storyteller and (2) effects of childbirth storytelling on the listener of the story. Subthemes included "reducing fear of childbirth," "transferring information and raising awareness in line with community culture," and "adjusting expectations."

Conclusion: The use of storytelling can be used as an effective method in educational interventions during pregnancy and childbirth. Due to limited high-quality intervention studies in this field, future studies could usefully be more robustly designed and incorporate digital storytelling methods to inform future directions.

方法:对2001年至2022年间发表的同行评议文章进行综合文献综述。使用以下数据库检索相关研究:PubMed、CINAHL、PsycINFO、Web of Science、Ovid、Google Scholar、ScienceDirect、Cochrane Library、Magiran、Irandoc和SID。一个专题综合过程被用来理解所提取的数据。结果:在检索到的21项研究中,只有12项是相关的,因此符合纳入标准。从我们的主题综合中确定了两个主题:(1)分娩讲故事对讲故事者的影响;(2)分娩讲故事对故事听者的影响。分主题包括“减少对分娩的恐惧”、“根据社区文化传递信息和提高意识”以及“调整期望”。结论:讲故事是一种有效的孕产期教育干预手段。由于该领域的高质量干预研究有限,未来的研究可以更有力地设计,并纳入数字叙事方法,以指导未来的方向。
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引用次数: 1
Red Light Mitigates the Deteriorating Placental Extracellular Matrix in Late Onset of Preeclampsia and Improves the Trophoblast Behavior. 红光减轻晚发型子痫前期胎盘细胞外基质恶化并改善滋养细胞行为。
IF 3.2 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1155/2022/3922368
Jakara Griffin, John G Krolikowski, Kenisha Kounga, Janine Struve, Agnes Keszler, Brian Lindemer, Michelle Bordas, Grant Broeckel, Nicole L Lohr, Dorothee Weihrauch

Preeclampsia is a serious pregnancy disorder which in extreme cases may lead to maternal and fetal injury or death. Preexisting conditions which increase oxidative stress, e.g., hypertension and diabetes, increase the mother's risk to develop preeclampsia. Previously, we established that when the extracellular matrix is exposed to oxidative stress, trophoblast function is impaired, and this may lead to improper placentation. We investigated how the oxidative ECM present in preeclampsia alters the behavior of first trimester extravillous trophoblasts. We demonstrate elevated levels of advanced glycation end products (AGE) and lipid oxidation end product 4-hydroxynonenal in preeclamptic ECM (28%, and 32% increase vs control, respectively) accompanied with 35% and 82% more 3-chlorotyrosine and 3-nitrotyrosine vs control, respectively. Furthermore, we hypothesized that 670 nm phototherapy, which has antioxidant properties, reverses the observed trophoblast dysfunction as depicted in the improved migration and reduction in apoptosis. Since NO is critical for placentation, we examined eNOS activity in preeclamptic placentas compared to healthy ones and found no differences; however, 670 nm light treatment triggered enhanced NO availability presumably by using alternative NO sources. Light exposure decreased apoptosis and restored trophoblast migration to levels in trophoblasts cultured on preeclamptic ECM. Moreover, 670 nm irradiation restored expression of Transforming Growth Factor (TGFβ) and Placental Growth Factor (PLGF) to levels observed in trophoblasts cultured on healthy placental ECM. We conclude the application of 670 nm light can successfully mitigate the damaged placental microenvironment of late onset preeclampsia as depicted by the restored trophoblast behavior.

子痫前期是一种严重的妊娠障碍,在极端情况下可能导致母婴损伤或死亡。先前存在的增加氧化应激的疾病,如高血压和糖尿病,会增加母亲患先兆子痫的风险。先前,我们证实当细胞外基质暴露于氧化应激时,滋养细胞功能受损,这可能导致胎盘不正确。我们研究了存在于子痫前期的氧化性ECM如何改变妊娠早期上皮外滋养细胞的行为。我们发现,在子痫前期ECM中,晚期糖基化终产物(AGE)和脂质氧化终产物4-羟基壬烯醛水平升高(分别比对照组增加28%和32%),3-氯酪氨酸和3-硝基酪氨酸分别比对照组增加35%和82%。此外,我们假设具有抗氧化特性的670 nm光疗可以逆转观察到的滋养细胞功能障碍,如改善迁移和减少细胞凋亡。由于NO对胎盘至关重要,我们检测了子痫前期胎盘与健康胎盘的eNOS活性,未发现差异;然而,670 nm光处理可能通过使用替代NO源而增强了NO可用性。光照减少了子痫前期ECM培养的滋养细胞的凋亡,并使滋养细胞迁移恢复到原来的水平。此外,670 nm辐照使转化生长因子(tgf - β)和胎盘生长因子(PLGF)的表达恢复到健康胎盘ECM上培养的滋养细胞的水平。我们得出结论,通过恢复滋养细胞行为,应用670 nm光可以成功减轻晚发型子痫前期胎盘微环境的破坏。
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引用次数: 0
Clinical Presentation as a Predictor of the Response to Methotrexate Therapy in Patients with Ectopic Pregnancy. 临床表现作为异位妊娠患者甲氨蝶呤治疗反应的预测因子。
IF 3.2 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1155/2022/5778321
Sarah Almutairy, Lateefa Othman Aldakhil

Purpose: Ectopic pregnancy can be fatal if not diagnosed and timely treated. There is an increase in ectopic pregnancy rate which attributes in part to fertility medications and procedures and early diagnosis. Methotrexate, a folic acid antagonist, is widely used in the medical treatment of ectopic pregnancy. Many studies examined the safety and success rate of methotrexate looking into factors affecting the success rate, if the patient may present with symptoms such as abdominal pain, and some consider this as impeding rupture and it might affect the success of medical treatment. This study evaluates the success rate of methotrexate treatment outcomes in regard to presentation and looks into other factors that can help choosing a single or multiple dose modality.

Methods: This is a retrospective review of 154 cases of ectopic pregnancy treated with methotrexate from January 2011 to December 2020 at King Khalid University Hospital (KKUH). Demographic data, clinical presentation, treatment progress, and outcome and failure rate were collected and analyzed. Student's t-test was used for statistical analysis of associations in SPSS.

Results: 154 patients were treated with MTX; of those patients, 25 received more than one dose. The difference between the responses to MTX treatment in symptomatic and asymptomatic individuals was not significant (p = 0.267). 131 (85%) had successful treatment. There were no associations between patient BMI, ectopic mass size, or ectopic mass site, the presence or absence of pelvic fluid on ultrasound at diagnosis, and the treatment success rate. There was a significant decline in the treatment success rate with increasing β-hCG levels on the presentation day (p = 0.035) and on day 4 (p value <0.001) of treatment.

Conclusion: MTX treatment can be used to manage symptomatic patients with ectopic pregnancy. The success rate in symptomatic patients is not different from that in asymptomatic patients. β - hCG levels > 5000 IU/L. Pretreatment and on day 4 posttreatment is associated with higher failure rate.

目的:异位妊娠如不及时诊断和治疗可致死性。异位妊娠率的增加部分归因于生育药物和程序以及早期诊断。甲氨蝶呤是一种叶酸拮抗剂,广泛用于异位妊娠的医学治疗。许多研究检查了甲氨蝶呤的安全性和成功率,寻找影响成功率的因素,如果患者可能出现腹痛等症状,一些研究认为这是阻碍破裂的,可能会影响医疗的成功。本研究评估了甲氨蝶呤治疗结果的成功率,并探讨了其他有助于选择单剂量或多剂量方式的因素。方法:回顾性分析2011年1月至2020年12月在哈立德国王大学医院(KKUH)接受甲氨蝶呤治疗的154例异位妊娠。收集和分析人口统计学资料、临床表现、治疗进展、结果和失败率。在SPSS软件中使用学生t检验进行相关性的统计分析。结果:154例患者接受甲氨蝶呤治疗;在这些患者中,有25人接受了一次以上的剂量。有症状和无症状个体对MTX治疗的反应差异无统计学意义(p = 0.267)。131例(85%)治疗成功。患者BMI、异位肿块大小、异位肿块位置、诊断时超声检查盆腔液是否存在与治疗成功率之间没有关联。出现当天和第4天β-hCG水平升高,治疗成功率显著下降(p = 0.035) (p值)。结论:MTX治疗可用于治疗有症状的异位妊娠患者。有症状患者的成功率与无症状患者的成功率无明显差异。β - hCG水平> 5000 IU/L。治疗前和治疗后第4天的失败率较高。
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引用次数: 0
Ectopic Pregnancy in Tigray, Ethiopia: A Cross-Sectional Survey of Prevalence, Management Outcomes, and Associated Factors. 埃塞俄比亚提格雷的异位妊娠:患病率、管理结果和相关因素的横断面调查。
IF 3.2 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2021-11-30 eCollection Date: 2021-01-01 DOI: 10.1155/2021/4443117
Elsa Tesfa Berhe, Kalayu Kiros, Merhawit Gebremeskel Hagos, Hailay Abrha Gesesew, Paul R Ward, Teferi Gebru Gebremeskel

Background: Ectopic pregnancy is a neglected and challenging gynecologic problem in developing countries including Ethiopia.

Objective: The present study is aimed at assessing the prevalence of ectopic pregnancy, its management outcomes, and factors associated with management outcomes in Tigray, North Ethiopia.

Methods: We employed a four-year retrospective cross-sectional study from September 2015 to August 2019. We extracted data about all pregnant mothers who were admitted and managed for EPs in Axum, Tigray. Ectopic pregnancy and its outcomes (favorable and unfavorable) were the dependent variables, and age, residence, ethnicity, religion, parity, history of abortion, history of EP, pelvic infections, history of surgical procedures, and use contraceptives were the independent variables. We employed descriptive statistics and bivariate and multivariate logistic regression analyses using SPSS. Ethical clearance was obtained from Axum University, Tigray, Ethiopia.

Results: The overall prevalence of ectopic pregnancy was 0.52% of total deliveries, which equates to 1 : 193 deliveries. Surgery for ectopic pregnancy accounts for 7.6% of all gynecological surgeries. Most participants were in the age group 26-30 years and lived in rural areas. Among the different EP implantation sites, most cases (92.4%) occurred in the fallopian tube, followed by 5.1% in the ovary and 2.5% in abdominal EPs. Surgical management (laparotomy) was undertaken for all the 79 women diagnosed with EPs, including laparotomy (100%), salpingo-oophorectomy (17.7%), salpingectomy (73.9%), oophorectomy (3.4%), cornual resection (2.5%), and removal of concepts tissue 2.5. The record reports that intraoperative procedure was correctly managed for 47 (59.5%) women but the condition of EP procedure was ruptured for about two-thirds (63.3%) of the women. Thirty (38%) patients had developed some complications after surgery including anemia (hemoglobin < 10.5) (n = 12), fever (n = 10), wound infection (n = 2), and pneumonia (n = 2). Women who were from urban (AOR = 11.2, 95% CI: 2.65-47.2) and who had normal hemoglobin at presentation (AOR = 9.94, 95% CI: 2.03-48.7) were associated with favorable maternal outcomes.

Conclusions: More than one-third of women with ectopic pregnancies had an unfavorable maternal outcome, which was higher among rural residents and anemic mothers. Women living in rural areas and anemia during pregnancy should seek special attention in the management of EPs. We also recommend improving the data management of hospitals in Ethiopia.

背景:在包括埃塞俄比亚在内的发展中国家,异位妊娠是一个被忽视且具有挑战性的妇科问题。目的:本研究旨在评估埃塞俄比亚北部提格雷地区异位妊娠的患病率、其管理结果以及与管理结果相关的因素。方法:我们从2015年9月至2019年8月进行了一项为期四年的回顾性横断面研究。我们提取了提格雷阿克苏姆所有因EPs入院并接受治疗的孕妇的数据。异位妊娠及其结局(有利和不利)为因变量,年龄、居住地、种族、宗教、胎次、流产史、EP史、盆腔感染、手术史和使用避孕药为自变量。我们采用描述性统计和双变量和多变量logistic回归分析使用SPSS。获得了埃塞俄比亚提格雷阿克苏姆大学的伦理许可。结果:宫外孕总发生率为0.52%,为1.193例。异位妊娠手术占全部妇科手术的7.6%。大多数参与者年龄在26-30岁之间,居住在农村地区。在不同的EP着床部位中,以输卵管着床最多(92.4%),其次为卵巢5.1%,腹部EP 2.5%。79例确诊为EPs的女性均采用开腹手术治疗,包括开腹手术(100%)、输卵管-卵巢切除术(17.7%)、输卵管切除术(73.9%)、卵巢切除术(3.4%)、角切除(2.5%)和子宫组织切除术(2.5%)。记录报告47例(59.5%)妇女术中处理正确,但约三分之二(63.3%)妇女的EP手术条件破裂。30例(38%)患者术后出现并发症,包括贫血(血红蛋白< 10.5)(n = 12)、发热(n = 10)、伤口感染(n = 2)和肺炎(n = 2)。来自城市的妇女(AOR = 11.2, 95% CI: 2.65-47.2)和就诊时血红蛋白正常的妇女(AOR = 9.94, 95% CI: 2.03-48.7)与良好的孕产结局相关。结论:超过三分之一的异位妊娠妇女发生不良结局,其中农村居民和贫血母亲发生率较高。生活在农村地区和怀孕期间贫血的妇女应在EPs的管理中寻求特别关注。我们还建议改善埃塞俄比亚医院的数据管理。
{"title":"Ectopic Pregnancy in Tigray, Ethiopia: A Cross-Sectional Survey of Prevalence, Management Outcomes, and Associated Factors.","authors":"Elsa Tesfa Berhe,&nbsp;Kalayu Kiros,&nbsp;Merhawit Gebremeskel Hagos,&nbsp;Hailay Abrha Gesesew,&nbsp;Paul R Ward,&nbsp;Teferi Gebru Gebremeskel","doi":"10.1155/2021/4443117","DOIUrl":"https://doi.org/10.1155/2021/4443117","url":null,"abstract":"<p><strong>Background: </strong>Ectopic pregnancy is a neglected and challenging gynecologic problem in developing countries including Ethiopia.</p><p><strong>Objective: </strong>The present study is aimed at assessing the prevalence of ectopic pregnancy, its management outcomes, and factors associated with management outcomes in Tigray, North Ethiopia.</p><p><strong>Methods: </strong>We employed a four-year retrospective cross-sectional study from September 2015 to August 2019. We extracted data about all pregnant mothers who were admitted and managed for EPs in Axum, Tigray. Ectopic pregnancy and its outcomes (favorable and unfavorable) were the dependent variables, and age, residence, ethnicity, religion, parity, history of abortion, history of EP, pelvic infections, history of surgical procedures, and use contraceptives were the independent variables. We employed descriptive statistics and bivariate and multivariate logistic regression analyses using SPSS. Ethical clearance was obtained from Axum University, Tigray, Ethiopia.</p><p><strong>Results: </strong>The overall prevalence of ectopic pregnancy was 0.52% of total deliveries, which equates to 1 : 193 deliveries. Surgery for ectopic pregnancy accounts for 7.6% of all gynecological surgeries. Most participants were in the age group 26-30 years and lived in rural areas. Among the different EP implantation sites, most cases (92.4%) occurred in the fallopian tube, followed by 5.1% in the ovary and 2.5% in abdominal EPs. Surgical management (laparotomy) was undertaken for all the 79 women diagnosed with EPs, including laparotomy (100%), salpingo-oophorectomy (17.7%), salpingectomy (73.9%), oophorectomy (3.4%), cornual resection (2.5%), and removal of concepts tissue 2.5. The record reports that intraoperative procedure was correctly managed for 47 (59.5%) women but the condition of EP procedure was ruptured for about two-thirds (63.3%) of the women. Thirty (38%) patients had developed some complications after surgery including anemia (hemoglobin < 10.5) (<i>n</i> = 12), fever (<i>n</i> = 10), wound infection (<i>n</i> = 2), and pneumonia (<i>n</i> = 2). Women who were from urban (AOR = 11.2, 95% CI: 2.65-47.2) and who had normal hemoglobin at presentation (AOR = 9.94, 95% CI: 2.03-48.7) were associated with favorable maternal outcomes.</p><p><strong>Conclusions: </strong>More than one-third of women with ectopic pregnancies had an unfavorable maternal outcome, which was higher among rural residents and anemic mothers. Women living in rural areas and anemia during pregnancy should seek special attention in the management of EPs. We also recommend improving the data management of hospitals in Ethiopia.</p>","PeriodicalId":47062,"journal":{"name":"Journal of Pregnancy","volume":"2021 ","pages":"4443117"},"PeriodicalIF":3.2,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8651379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39709820","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: 6
Histological Changes Observed in Placentas Exposed to Medication-Assisted Treatment. 在药物辅助治疗下观察到胎盘的组织学变化。
IF 3.2 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2021-10-07 eCollection Date: 2021-01-01 DOI: 10.1155/2021/2175026
Cara Staszewski, Kimberly M Herrera, Elizabeth Kertowidjojo, Victoria Ly, Nicole Iovino, Diana Garretto, Cynthia Kaplan, Malini D Persad, David J Garry
Introduction To compare the effects of medication-assisted treatment on the placenta in pregnant women with opioid use disorder and uncomplicated pregnancies. Methods This is a case-controlled study of pregnant women utilizing medication-assisted treatment, buprenorphine or methadone, which were matched to healthy uncomplicated controls by gestational age. Placental evaluations and neonatal outcomes were evaluated. Data analysis performed standard statistics and relative risk analysis with a p < 0.05 considered significant. Results There were 143 women who met the inclusion criteria: 103 utilizing MAT, 41 buprenorphine and 62 methadone, and 40 uncomplicated matched healthy controls. The incidence of delayed villous maturation was 36% in the medication-assisted group compared with 10% in controls (RR 3.6: 95% CI 1.37-9.43; p < 0.01). The placental weight was greater (541 ± 117 g versus 491 ± 117 g; p = 0.02), and the fetoplacental weight ratio was lower (5.70 ± 1.1 versus 7.13 ± 1.4; p < 0.01) in the medication-exposed pregnancies compared with controls. The mean birth weight of the MAT newborns was significantly lower than that of the healthy controls (3018 ± 536 g versus 3380 ± 492 g; p < 0.01). When evaluating the subgroups of the MAT newborns, the birth weight of the methadone-exposed newborns (2886 ± 514 g) was significantly lower than that of the buprenorphine-exposed newborns (3218 ± 512 g; p < 0.01). Conclusion Medication-exposed pregnancies have a greater incidence of delayed villous maturation, a larger placental size, and a decreased fetoplacental weight ratio compared to the healthy controls. Larger long-term follow-up studies to evaluate outcomes with the presence of delayed villous maturation are needed.
前言:比较药物辅助治疗对阿片类药物使用障碍和无并发症妊娠孕妇胎盘的影响。方法:这是一项病例对照研究,孕妇使用药物辅助治疗,丁丙诺啡或美沙酮,这是匹配健康无并发症对照孕龄。评估胎盘评估和新生儿结局。资料分析采用标准统计和相对风险分析,p < 0.05为显著性。结果:143名妇女符合纳入标准:使用MAT的103名,丁丙诺啡的41名,美沙酮的62名,对照者40名。药物辅助组的绒毛成熟延迟发生率为36%,而对照组为10% (RR 3.6: 95% CI 1.37-9.43;P < 0.01)。胎盘重量较大(541±117 g vs 491±117 g);P = 0.02),胎胎盘重比较低(5.70±1.1∶7.13±1.4;P < 0.01)。MAT组新生儿的平均出生体重显著低于健康对照组(3018±536 g vs 3380±492 g);P < 0.01)。对MAT新生儿亚组进行评价时,美沙酮暴露组新生儿出生体重(2886±514 g)显著低于丁丙诺啡暴露组新生儿出生体重(3218±512 g);P < 0.01)。结论:与健康对照组相比,药物暴露妊娠的绒毛成熟延迟发生率更高,胎盘尺寸更大,胎胎盘重量比下降。需要更大规模的长期随访研究来评估绒毛成熟延迟的结果。
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引用次数: 5
High Maternal Neonatal Mortality and Morbidity in Pregnancy with Eisenmenger Syndrome. 艾森曼格综合征孕妇新生儿死亡率和发病率高。
IF 3.2 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2021-09-27 eCollection Date: 2021-01-01 DOI: 10.1155/2021/3248850
Erry Gumilar Dachlan, Amirah, Nareswari Cininta, Rizky Pranadyan, Alisia Yuana Putri, Yudi Her Oktaviono, Muhammad Ilham Aldika Akbar

Objectives: This study is aimed at evaluating the maternal and perinatal characteristics and pregnancy outcomes of ES. Material and Methods. This is a retrospective cohort study of pregnancy with Eisenmenger syndrome (ES) in Dr. Soetomo Hospital from January 2018 to December 2019. Total sampling size was obtained. We collected all baseline maternal-perinatal characteristic data, cardiac status, and pregnancy outcomes as primary outcomes. The maternal death cases were also evaluated, and we compared characteristics based on defect size (< or >3 cm).

Results: During study periods, we collected 18 cases with ES from a total of 152 pregnancies with heart disease. The underlying heart disease type includes atrial septal defect (ASD), ventricle septal defect (VSD), and patent ductus arteriosus (PDA). All cases suffered pulmonary hypertension (PH), 3 cases moderate, and 15 cases as severe. 94% of cases fall into heart failure (DC FC NYHA III-IV) during treatment. The majority of cases are delivered by cesarean section (88.9%). Pregnancy complications found include preterm birth (78%), low birthweight (94%), intrauterine growth restriction (55%), oligohydramnios (16%), severe preeclampsia (33%), and placenta previa (5.5%). Large defect group has an older maternal ages (30.18 ± 4.60 vs. 24.15 ± 2.75; p = 0.002), higher clinical sign (100 vs. 40%, p = 0.003), and higher preterm delivery rate (100% vs. 69%, p = 0.047) compared to small defect groups. The R to L or bidirectional shunt is significantly higher at the large defect group (13 vs. 5 cases, p = 0.006, 95% confidence interval: -1.156 to -0.228). There were seven maternal death cases caused by shock cardiogenic.

Conclusions: Pregnancy with ES is still associated with very high maternal neonatal mortality and morbidity. The larger defect size is correlated with clinical performances and pregnancy outcomes. Effective preconception counseling is the best strategy to reduce the risk of maternal and neonatal death in ES women.

研究目的本研究旨在评估 ES 的母体和围产期特征以及妊娠结局。材料与方法。本研究是一项回顾性队列研究,研究对象为2018年1月至2019年12月期间在Dr. Soetomo医院妊娠的艾森曼格综合征(ES)孕妇。获得了总抽样规模。我们收集了所有孕产妇-围产期特征基线数据、心脏状态和妊娠结局作为主要结果。我们还对产妇死亡病例进行了评估,并根据缺陷大小(<或>3厘米)对特征进行了比较:在研究期间,我们从总共 152 例患有心脏病的孕妇中收集了 18 例 ES 患者。基础心脏病类型包括房间隔缺损(ASD)、室间隔缺损(VSD)和动脉导管未闭(PDA)。所有病例均患有肺动脉高压(PH),其中 3 例为中度,15 例为重度。94%的病例在治疗期间陷入心力衰竭(DC FC NYHA III-IV)。大多数病例采用剖腹产(88.9%)。妊娠并发症包括早产(78%)、低出生体重(94%)、宫内生长受限(55%)、少血畸形(16%)、重度子痫前期(33%)和前置胎盘(5.5%)。与小缺陷组相比,大缺陷组产妇年龄较大(30.18 ± 4.60 vs. 24.15 ± 2.75;P = 0.002),临床征象较多(100 vs. 40%,P = 0.003),早产率较高(100% vs. 69%,P = 0.047)。大缺损组的 R 到 L 或双向分流率明显更高(13 例对 5 例,P = 0.006,95% 置信区间:-1.156 到 -0.228)。有 7 例产妇死于心源性休克:结论:妊娠合并 ES 的产妇新生儿死亡率和发病率仍然很高。结论:妊娠合并 ES 的孕产妇死亡率和新生儿发病率仍然很高,缺陷越大与临床表现和妊娠结局越相关。有效的孕前咨询是降低 ES 孕妇和新生儿死亡风险的最佳策略。
{"title":"High Maternal Neonatal Mortality and Morbidity in Pregnancy with Eisenmenger Syndrome.","authors":"Erry Gumilar Dachlan, Amirah, Nareswari Cininta, Rizky Pranadyan, Alisia Yuana Putri, Yudi Her Oktaviono, Muhammad Ilham Aldika Akbar","doi":"10.1155/2021/3248850","DOIUrl":"10.1155/2021/3248850","url":null,"abstract":"<p><strong>Objectives: </strong>This study is aimed at evaluating the maternal and perinatal characteristics and pregnancy outcomes of ES. <i>Material and Methods</i>. This is a retrospective cohort study of pregnancy with Eisenmenger syndrome (ES) in Dr. Soetomo Hospital from January 2018 to December 2019. Total sampling size was obtained. We collected all baseline maternal-perinatal characteristic data, cardiac status, and pregnancy outcomes as primary outcomes. The maternal death cases were also evaluated, and we compared characteristics based on defect size (< or >3 cm).</p><p><strong>Results: </strong>During study periods, we collected 18 cases with ES from a total of 152 pregnancies with heart disease. The underlying heart disease type includes atrial septal defect (ASD), ventricle septal defect (VSD), and patent ductus arteriosus (PDA). All cases suffered pulmonary hypertension (PH), 3 cases moderate, and 15 cases as severe. 94% of cases fall into heart failure (DC FC NYHA III-IV) during treatment. The majority of cases are delivered by cesarean section (88.9%). Pregnancy complications found include preterm birth (78%), low birthweight (94%), intrauterine growth restriction (55%), oligohydramnios (16%), severe preeclampsia (33%), and placenta previa (5.5%). Large defect group has an older maternal ages (30.18 ± 4.60 vs. 24.15 ± 2.75; <i>p</i> = 0.002), higher clinical sign (100 vs. 40%, <i>p</i> = 0.003), and higher preterm delivery rate (100% vs. 69%, <i>p</i> = 0.047) compared to small defect groups. The R to L or bidirectional shunt is significantly higher at the large defect group (13 vs. 5 cases, <i>p</i> = 0.006, 95% confidence interval: -1.156 to -0.228). There were seven maternal death cases caused by shock cardiogenic.</p><p><strong>Conclusions: </strong>Pregnancy with ES is still associated with very high maternal neonatal mortality and morbidity. The larger defect size is correlated with clinical performances and pregnancy outcomes. Effective preconception counseling is the best strategy to reduce the risk of maternal and neonatal death in ES women.</p>","PeriodicalId":47062,"journal":{"name":"Journal of Pregnancy","volume":"2021 ","pages":"3248850"},"PeriodicalIF":3.2,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39491946","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: 0
Oxidative Stress Induced Damage and Early Senescence in Preterm Placenta. 氧化应激诱导的早产儿胎盘损伤和早期衰老。
IF 3.2 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2021-06-24 eCollection Date: 2021-01-01 DOI: 10.1155/2021/9923761
Yudianto Budi Saroyo, Noroyono Wibowo, Rima Irwinda, Ani Retno Prijanti, Evy Yunihastuti, Saptawati Bardosono, Sofie Rifayani Krisnadi, Putri Indah Permata, Stephanie Wijaya, Victor Prana Andika Santawi

Introduction: Senescent cells have been demonstrated to release High Mobility Group Box 1 (HMGB1) which induces labor through an inflammatory pathway. This research is aimed at demonstrating whether telomere shortening, proinflammatory HMGB1, and oxidative damage marker 8-OHdG play a role in the placenta of preterm birth in comparison to term birth.

Method: A cross-sectional study on 67 full thickness of the placenta obtained from mothers with term and preterm birth. Mothers with clinical signs of infection (fever > 38°C, leukocytosis > 18000/μL, or abnormal vaginal discharge) and other pregnancy complications were excluded. Real-time polymerase chain reaction was performed to measure T/S ratio and ELISA quantification to measure the amount of HMGB1 and 8-OHdG.

Result: A total of 34 placentas from preterm and 33 placentas from term birth were examined. Maternal characteristics were comparable between the two groups. There were no statistical difference of T/S ratio (p = 0.181), HMGB1 (p = 0.119), and 8-OHdG (p = 0.144) between the preterm and term groups. HMGB1 was moderately correlated with 8-OHdG (r = 0.314). Telomere T/S ratio of the placenta did not differ between preterm and term labor despite difference in gestational age, suggesting earlier shortening in the preterm group. It is possible that critical telomere length has been achieved in both term and preterm placenta that warrants labor through senescence process. The result of our study also showed that HMGB1 was not correlated to telomere length, due to the fact that HMGB1 is not upregulated until the critical length of telomere for senescence is exhibited.

Conclusion: Similar telomere length might be exhibited due to early telomere shortening in preterm birth that mimics the term placenta. The relationship between placental telomere shortening and HMGB1 release remains to be uncovered. Further research is needed to discover the factors leading to early telomere shortening in the placenta of preterm birth.

衰老细胞已被证明可以释放高迁移率组框1 (HMGB1),通过炎症途径诱导分娩。本研究旨在证明端粒缩短、促炎HMGB1和氧化损伤标志物8-OHdG是否与足月分娩相比在早产胎盘中起作用。方法:对足月和早产母亲的67个全层胎盘进行横断面研究。排除有感染临床症状(发热> 38℃、白细胞计数> 18000/μL、阴道分泌物异常)及其他妊娠并发症的产妇。实时聚合酶链反应测定T/S比,ELISA定量测定HMGB1和8-OHdG的量。结果:共检查早产儿胎盘34例,足月胎盘33例。两组产妇的特征具有可比性。两组间T/S比(p = 0.181)、HMGB1 (p = 0.119)、8-OHdG (p = 0.144)差异均无统计学意义。HMGB1与8-OHdG呈正相关(r = 0.314)。尽管胎龄不同,胎盘端粒T/S比值在早产组和足月产程之间没有差异,提示早产组胎盘端粒缩短较早。这是可能的临界端粒长度已达到足月和早产胎盘,保证劳动通过衰老过程。我们的研究结果还表明,HMGB1与端粒长度无关,因为HMGB1在端粒达到衰老的临界长度后才上调。结论:类似的端粒长度可能是由于早期端粒缩短的早产,模仿胎盘。胎盘端粒缩短与HMGB1释放之间的关系尚不清楚。早产胎盘早期端粒缩短的相关因素有待进一步研究。
{"title":"Oxidative Stress Induced Damage and Early Senescence in Preterm Placenta.","authors":"Yudianto Budi Saroyo,&nbsp;Noroyono Wibowo,&nbsp;Rima Irwinda,&nbsp;Ani Retno Prijanti,&nbsp;Evy Yunihastuti,&nbsp;Saptawati Bardosono,&nbsp;Sofie Rifayani Krisnadi,&nbsp;Putri Indah Permata,&nbsp;Stephanie Wijaya,&nbsp;Victor Prana Andika Santawi","doi":"10.1155/2021/9923761","DOIUrl":"https://doi.org/10.1155/2021/9923761","url":null,"abstract":"<p><strong>Introduction: </strong>Senescent cells have been demonstrated to release High Mobility Group Box 1 (HMGB1) which induces labor through an inflammatory pathway. This research is aimed at demonstrating whether telomere shortening, proinflammatory HMGB1, and oxidative damage marker 8-OHdG play a role in the placenta of preterm birth in comparison to term birth.</p><p><strong>Method: </strong>A cross-sectional study on 67 full thickness of the placenta obtained from mothers with term and preterm birth. Mothers with clinical signs of infection (fever > 38°C, leukocytosis > 18000/<i>μ</i>L, or abnormal vaginal discharge) and other pregnancy complications were excluded. Real-time polymerase chain reaction was performed to measure T/S ratio and ELISA quantification to measure the amount of HMGB1 and 8-OHdG.</p><p><strong>Result: </strong>A total of 34 placentas from preterm and 33 placentas from term birth were examined. Maternal characteristics were comparable between the two groups. There were no statistical difference of T/S ratio (<i>p</i> = 0.181), HMGB1 (<i>p</i> = 0.119), and 8-OHdG (<i>p</i> = 0.144) between the preterm and term groups. HMGB1 was moderately correlated with 8-OHdG (<i>r</i> = 0.314). Telomere T/S ratio of the placenta did not differ between preterm and term labor despite difference in gestational age, suggesting earlier shortening in the preterm group. It is possible that critical telomere length has been achieved in both term and preterm placenta that warrants labor through senescence process. The result of our study also showed that HMGB1 was not correlated to telomere length, due to the fact that HMGB1 is not upregulated until the critical length of telomere for senescence is exhibited.</p><p><strong>Conclusion: </strong>Similar telomere length might be exhibited due to early telomere shortening in preterm birth that mimics the term placenta. The relationship between placental telomere shortening and HMGB1 release remains to be uncovered. Further research is needed to discover the factors leading to early telomere shortening in the placenta of preterm birth.</p>","PeriodicalId":47062,"journal":{"name":"Journal of Pregnancy","volume":"2021 ","pages":"9923761"},"PeriodicalIF":3.2,"publicationDate":"2021-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8249137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39181849","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: 9
Determinants of Preeclampsia among Women Attending Delivery Services in Public Hospitals of Central Tigray, Northern Ethiopia: A Case-Control Study. 埃塞俄比亚北部提格雷中部公立医院分娩妇女子痫前期的决定因素:一项病例对照研究
IF 3.2 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2021-06-01 eCollection Date: 2021-01-01 DOI: 10.1155/2021/4654828
Teklehaimanot Gereziher Haile, Nega Assefa, Tadesse Alemayehu, Teklewoini Mariye, Gebreamlak Gebremedhn Geberemeskel, Degena Bahrey, Guesh Mebrahtom, Biniyam Demisse, Hailemikael Gebrekidan, Tamirat Getachew

Background: Preeclampsia occurs in up to 5% of all pregnancies, in 10% of first pregnancies, and 20-25% of women with a history of chronic hypertension.

Objective: This study aims to assess the determinants of preeclampsia among women attending delivery services in public hospitals of central Tigray, Ethiopia.

Methods: Hospital-based unmatched case-control study design was conducted. Women diagnosed with preeclampsia were cases, and women who had no preeclampsia were controls admitted to the same hospitals. A systematic sampling technique was used to select study participants for both cases and controls. The data were entered in EPI data 3.1 statistical software and, then, exported to SPSS Version 22 for cleaning and analysis.

Results: Family history of hypertension (AOR: 2.60; 95% CI: 1.15, 5.92), family history of preeclampsia (AOR: 5.24; 95% CI: 1.85, 14.80), history of diabetes mellitus (AOR: 4.31; 95% CI: 1.66, 11.21), anemia (AOR: 3.23; 95% CI: 1.18, 8.86), history of preeclampsia on prior pregnancy (AOR: 5.55; 95% CI: 1.80, 17.10), primigravida (AOR: 5.41; 95% CI: 2.85, 10.29), drinking alcohol during pregnancy (AOR: 4.06; 95% CI: 2.20, 7.52), and vegetable intake during pregnancy (AOR: 0.39; 95% CI: 0.21, 0.74) were significantly associated with preeclampsia.

Conclusion: This study concludes that a family history of hypertension and preeclampsia; a history of diabetes mellitus and anemia; and a history of preeclampsia on prior pregnancy, primigravida, and drinking alcohol were found to be risk factors for preeclampsia. However, vegetable intake was found to be a protective factor for the development of preeclampsia.

背景:高达5%的妊娠、10%的首次妊娠和20-25%有慢性高血压病史的妇女发生先兆子痫。目的:本研究旨在评估在埃塞俄比亚提格雷中部公立医院接受分娩服务的妇女子痫前期的决定因素。方法:采用基于医院的不匹配病例对照研究设计。诊断为子痫前期的妇女是病例,没有子痫前期的妇女是同一家医院的对照组。采用系统的抽样技术来选择病例和对照组的研究参与者。将数据输入EPI数据3.1统计软件,导出到SPSS Version 22进行清洗分析。结果:有高血压家族史(AOR: 2.60;95% CI: 1.15, 5.92),先兆子痫家族史(AOR: 5.24;95% CI: 1.85, 14.80),糖尿病史(AOR: 4.31;95% CI: 1.66, 11.21),贫血(AOR: 3.23;95% CI: 1.18, 8.86),妊娠前期子痫史(AOR: 5.55;95% CI: 1.80, 17.10),原始性(AOR: 5.41;95% CI: 2.85, 10.29),怀孕期间饮酒(AOR: 4.06;95% CI: 2.20, 7.52)和孕期蔬菜摄入量(AOR: 0.39;95% CI: 0.21, 0.74)与先兆子痫显著相关。结论:本研究得出高血压和子痫前期家族史;有糖尿病和贫血病史;怀孕前有子痫前期病史、初孕和饮酒是子痫前期的危险因素。然而,蔬菜摄入量被发现是子痫前期发展的一个保护因素。
{"title":"Determinants of Preeclampsia among Women Attending Delivery Services in Public Hospitals of Central Tigray, Northern Ethiopia: A Case-Control Study.","authors":"Teklehaimanot Gereziher Haile,&nbsp;Nega Assefa,&nbsp;Tadesse Alemayehu,&nbsp;Teklewoini Mariye,&nbsp;Gebreamlak Gebremedhn Geberemeskel,&nbsp;Degena Bahrey,&nbsp;Guesh Mebrahtom,&nbsp;Biniyam Demisse,&nbsp;Hailemikael Gebrekidan,&nbsp;Tamirat Getachew","doi":"10.1155/2021/4654828","DOIUrl":"https://doi.org/10.1155/2021/4654828","url":null,"abstract":"<p><strong>Background: </strong>Preeclampsia occurs in up to 5% of all pregnancies, in 10% of first pregnancies, and 20-25% of women with a history of chronic hypertension.</p><p><strong>Objective: </strong>This study aims to assess the determinants of preeclampsia among women attending delivery services in public hospitals of central Tigray, Ethiopia.</p><p><strong>Methods: </strong>Hospital-based unmatched case-control study design was conducted. Women diagnosed with preeclampsia were cases, and women who had no preeclampsia were controls admitted to the same hospitals. A systematic sampling technique was used to select study participants for both cases and controls. The data were entered in EPI data 3.1 statistical software and, then, exported to SPSS Version 22 for cleaning and analysis.</p><p><strong>Results: </strong>Family history of hypertension (AOR: 2.60; 95% CI: 1.15, 5.92), family history of preeclampsia (AOR: 5.24; 95% CI: 1.85, 14.80), history of diabetes mellitus (AOR: 4.31; 95% CI: 1.66, 11.21), anemia (AOR: 3.23; 95% CI: 1.18, 8.86), history of preeclampsia on prior pregnancy (AOR: 5.55; 95% CI: 1.80, 17.10), primigravida (AOR: 5.41; 95% CI: 2.85, 10.29), drinking alcohol during pregnancy (AOR: 4.06; 95% CI: 2.20, 7.52), and vegetable intake during pregnancy (AOR: 0.39; 95% CI: 0.21, 0.74) were significantly associated with preeclampsia.</p><p><strong>Conclusion: </strong>This study concludes that a family history of hypertension and preeclampsia; a history of diabetes mellitus and anemia; and a history of preeclampsia on prior pregnancy, primigravida, and drinking alcohol were found to be risk factors for preeclampsia. However, vegetable intake was found to be a protective factor for the development of preeclampsia.</p>","PeriodicalId":47062,"journal":{"name":"Journal of Pregnancy","volume":"2021 ","pages":"4654828"},"PeriodicalIF":3.2,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39023018","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: 7
Cost-Effectiveness of Contraceptive Use in Indonesia after the Implementation of the National Health Insurance System. 国家健康保险制度实施后印度尼西亚避孕药具使用的成本效益。
IF 3.2 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2021-05-08 eCollection Date: 2021-01-01 DOI: 10.1155/2021/3453291
Auliya A Suwantika, Neily Zakiyah, Irma M Puspitasari, Rizky Abdulah

Since 2014, Indonesia has initiated to implement a national health insurance system, which included both of short- (SARC) and long-acting reversible contraceptive (LARC) into the benefit package. The aim of this study was to analyze the cost-effectiveness of contraceptive use in Indonesia after the implementation of the national health insurance in 2014-2017. A decision tree model was developed to analyze the cost-effectiveness of contraceptive use in Indonesia in 2014-2017 by comparing two strategies of pregnancy prevention: contraceptive and non-contraceptive. For contraceptive strategy, we took into account SARC and LARC. In a comparison with non-contraceptive, we calculated that the incremental cost-effectiveness ratio (ICER) of SARC would be $5.18, $4.80 and $3.76 per pregnancy averted for injection, condom, and pill, respectively. For LARC, we calculated that the ICER would be $1.67 and $0.84 for implant and intrauterine device (IUD), respectively, compared with non-contraceptive. In general, the cost-effectiveness value of LARC ($1.25) was much better than SARC ($4.58). The cost of contraceptive was considered to be the most influential parameter affecting both the ICER of SARC and LARC. In conclusion, the use of LARC in Indonesia was considered to be more cost-effective than SARC since the implementation of national health insurance system. In particular, IUD yielded the greatest cost-effectiveness value, compared with other methods.

自2014年以来,印度尼西亚开始实施国家健康保险制度,将短期(SARC)和长效可逆避孕(LARC)纳入一揽子福利。本研究的目的是分析2014-2017年实施国家健康保险后印度尼西亚使用避孕药具的成本效益。通过比较避孕和非避孕两种避孕策略,建立决策树模型,分析2014-2017年印度尼西亚避孕措施使用的成本效益。在避孕策略方面,我们考虑了SARC和LARC。在与非避孕方法的比较中,我们计算出SARC的增量成本-效果比(ICER)将分别为5.18美元、4.80美元和3.76美元,分别用于注射、避孕套和避孕药。对于LARC,我们计算出与非避孕相比,植入物和宫内节育器(IUD)的ICER分别为1.67美元和0.84美元。总体而言,LARC的成本效益值(1.25美元)远优于SARC(4.58美元)。避孕费用被认为是影响SARC和LARC的ICER的最重要参数。综上所述,自实施国家健康保险制度以来,印度尼西亚使用LARC被认为比SARC更具成本效益。其中宫内节育器与其他方法相比具有最大的成本效益价值。
{"title":"Cost-Effectiveness of Contraceptive Use in Indonesia after the Implementation of the National Health Insurance System.","authors":"Auliya A Suwantika,&nbsp;Neily Zakiyah,&nbsp;Irma M Puspitasari,&nbsp;Rizky Abdulah","doi":"10.1155/2021/3453291","DOIUrl":"https://doi.org/10.1155/2021/3453291","url":null,"abstract":"<p><p>Since 2014, Indonesia has initiated to implement a national health insurance system, which included both of short- (SARC) and long-acting reversible contraceptive (LARC) into the benefit package. The aim of this study was to analyze the cost-effectiveness of contraceptive use in Indonesia after the implementation of the national health insurance in 2014-2017. A decision tree model was developed to analyze the cost-effectiveness of contraceptive use in Indonesia in 2014-2017 by comparing two strategies of pregnancy prevention: contraceptive and non-contraceptive. For contraceptive strategy, we took into account SARC and LARC. In a comparison with non-contraceptive, we calculated that the incremental cost-effectiveness ratio (ICER) of SARC would be $5.18, $4.80 and $3.76 per pregnancy averted for injection, condom, and pill, respectively. For LARC, we calculated that the ICER would be $1.67 and $0.84 for implant and intrauterine device (IUD), respectively, compared with non-contraceptive. In general, the cost-effectiveness value of LARC ($1.25) was much better than SARC ($4.58). The cost of contraceptive was considered to be the most influential parameter affecting both the ICER of SARC and LARC. In conclusion, the use of LARC in Indonesia was considered to be more cost-effective than SARC since the implementation of national health insurance system. In particular, IUD yielded the greatest cost-effectiveness value, compared with other methods.</p>","PeriodicalId":47062,"journal":{"name":"Journal of Pregnancy","volume":"2021 ","pages":"3453291"},"PeriodicalIF":3.2,"publicationDate":"2021-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39026948","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: 0
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Journal of Pregnancy
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