Pub Date : 2024-03-28DOI: 10.1101/2024.03.28.24304995
Maria Marchante, Ferran Barrachina, Sabrina Piechota, Marta Fernandez-Gonzalez, Alexa Giovannini, Trozalla Smith, Simone Kats, Bruna Paulsen, Eva Gonzalez, Virginia Calvente, Ana Silvan, Baruch Abittan, Joshua Klein, Peter Klatsky, Daniel Ordonez, Christian C Kramme
Objective: To evaluate how minimal controlled ovarian stimulation (COS) for in vitro maturation (IVM) affects subjects' oocyte retrieval experiences compared to conventional COS, considering side effects Design: Retrospective Survey Study Setting: Clinical in vitro fertilization (IVF) treatment centers in Spain and the United States. Subjects: Data were collected from subjects undergoing minimal COS (n=110; 600-800 IU FSH) for IVM and conventional COS for egg donation (n=48; 2000-3000 IU FSH) from April 2022 to November 2023. In the same period, a pairwise comparison of subjects (n=13) undergoing both minimal COS for IVM and conventional COS for oocyte cryopreservation was conducted. Intervention/Exposure: Minimal and conventional controlled ovarian stimulation. Main Outcome Measures: The most common side effects suffered during ovarian stimulation and after OPU, satisfaction level, and the likelihood of recommending or repeating minimal or conventional COS. Statistical analysis included Mann Whitney, Wilcoxon, Chi-square, and McNemar tests, with a significance level set at p<0.05. Results: During minimal COS, most subjects did not experience breast swelling (86%), pelvic or abdominal pain (76%), nausea or vomiting (96%), and bleeding (96%). After oocyte pick-up, the majority (75%) reported no pelvic or abdominal pain. The most common side effect was abdominal swelling (52%). Compared to conventional COS cycles, minimal COS subjects reported significantly less post-retrieval pain, with 33% experiencing no pain (vs. 6%; p=0.0011) and with a reduced severe level of pain (5% vs.19%; p=0.0097), leading to fewer subjects requiring pain medication (25% vs. 54%; p=0.0003). Additionally, 85% of women were very satisfied with minimal stimulation and would recommend or repeat the treatment. In the comparison in which each donor underwent both minimal and conventional COS treatments, women indicated more side effects with the conventional stimulation, presenting a significantly overall higher level of pain (p=0.0078). Conclusion: Reducing the hormonal dose for ovarian stimulation has a beneficial effect on subjects, suggesting the combination of minimal COS with IVM techniques is a well-tolerated alternative for women who cannot or do not wish to undergo conventional controlled ovarian hyperstimulation.
目的：评估体外成熟（IVM）的最小控制性卵巢刺激（COS）与传统 COS 相比对受试者取卵体验的影响考虑到副作用，评估用于体外成熟（IVM）的最小控制性卵巢刺激（COS）与传统 COS 相比如何影响受试者的卵母细胞获取经验：回顾性调查研究研究对象： 西班牙和美国的临床体外受精（IVF）治疗中心：从2022年4月至2023年11月，对接受最小COS（n=110；600-800 IU FSH）体外受精和常规COS捐卵（n=48；2000-3000 IU FSH）的受试者收集数据。同期，对同时接受最小COS进行IVM和常规COS进行卵母细胞冷冻保存的受试者（n=13）进行了配对比较。干预/暴露：最小控制卵巢刺激和常规控制卵巢刺激：卵巢刺激过程中和 OPU 后最常见的副作用、满意度以及推荐或重复最小或常规 COS 的可能性。统计分析包括曼-惠特尼检验、Wilcoxon 检验、Chi-square 检验和 McNemar 检验，显著性水平设定为 p<0.05：在最小 COS 过程中，大多数受试者没有出现乳房胀痛（86%）、盆腔或腹痛（76%）、恶心或呕吐（96%）和出血（96%）。取卵后，大多数受试者（75%）没有出现盆腔或腹部疼痛。最常见的副作用是腹部肿胀（52%）。与传统的 COS 周期相比，最小 COS 受试者报告的取卵后疼痛明显减少，33% 的受试者没有疼痛感（对 6%；P=0.0011），剧烈疼痛程度降低（5% 对 19%；P=0.0097），需要服用止痛药的受试者减少（25% 对 54%；P=0.0003）。此外，85% 的女性对最小刺激非常满意，并愿意推荐或重复这种治疗方法。在每个供体同时接受最小刺激和传统 COS 治疗的对比中，妇女表示传统刺激的副作用更大，疼痛程度明显更高（P=0.0078）：结论：减少卵巢刺激的激素剂量对受试者有好处，这表明将最小COS与IVM技术相结合，对于不能或不愿接受常规控制性卵巢过度刺激的妇女来说，是一种耐受性良好的替代方法。
{"title":"Donor side effects experienced under minimal controlled ovarian stimulation (COS) with in vitro maturation (IVM) versus conventional COS for in vitro fertilization (IVF) treatment","authors":"Maria Marchante, Ferran Barrachina, Sabrina Piechota, Marta Fernandez-Gonzalez, Alexa Giovannini, Trozalla Smith, Simone Kats, Bruna Paulsen, Eva Gonzalez, Virginia Calvente, Ana Silvan, Baruch Abittan, Joshua Klein, Peter Klatsky, Daniel Ordonez, Christian C Kramme","doi":"10.1101/2024.03.28.24304995","DOIUrl":"https://doi.org/10.1101/2024.03.28.24304995","url":null,"abstract":"Objective: To evaluate how minimal controlled ovarian stimulation (COS) for in vitro maturation (IVM) affects subjects' oocyte retrieval experiences compared to conventional COS, considering side effects\u0000Design: Retrospective Survey Study\u0000Setting: Clinical in vitro fertilization (IVF) treatment centers in Spain and the United States.\u0000Subjects: Data were collected from subjects undergoing minimal COS (n=110; 600-800 IU FSH) for IVM and conventional COS for egg donation (n=48; 2000-3000 IU FSH) from April 2022 to November 2023. In the same period, a pairwise comparison of subjects (n=13) undergoing both minimal COS for IVM and conventional COS for oocyte cryopreservation was conducted. Intervention/Exposure: Minimal and conventional controlled ovarian stimulation.\u0000Main Outcome Measures: The most common side effects suffered during ovarian stimulation and after OPU, satisfaction level, and the likelihood of recommending or repeating minimal or conventional COS. Statistical analysis included Mann Whitney, Wilcoxon, Chi-square, and McNemar tests, with a significance level set at p<0.05.\u0000Results: During minimal COS, most subjects did not experience breast swelling (86%), pelvic or abdominal pain (76%), nausea or vomiting (96%), and bleeding (96%). After oocyte pick-up, the majority (75%) reported no pelvic or abdominal pain. The most common side effect was abdominal swelling (52%). Compared to conventional COS cycles, minimal COS subjects reported significantly less post-retrieval pain, with 33% experiencing no pain (vs. 6%; p=0.0011) and with a reduced severe level of pain (5% vs.19%; p=0.0097), leading to fewer subjects requiring pain medication (25% vs. 54%; p=0.0003). Additionally, 85% of women were very satisfied with minimal stimulation and would recommend or repeat the treatment. In the comparison in which each donor underwent both minimal and conventional COS treatments, women indicated more side effects with the conventional stimulation, presenting a significantly overall higher level of pain (p=0.0078).\u0000Conclusion: Reducing the hormonal dose for ovarian stimulation has a beneficial effect on subjects, suggesting the combination of minimal COS with IVM techniques is a well-tolerated alternative for women who cannot or do not wish to undergo conventional controlled ovarian hyperstimulation.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140322247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1101/2024.03.25.24304838
Anna Galle, Silke D'hauwers, Helga Berghman, Nele Vaerewijck, Emanuelle Pessa Valente, Ilaria Mariani, Arianna Bomben, Stefano delle Vedove, Marzia Lazzerini
Objectives To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time. Design A cross-sectional observational study. Setting Data of the IMAgiNE EURO study in Belgium. Participants Women giving birth in a Belgian facility from March 1, 2020, to May 1, 2023, responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources, and organizational changes related to COVID 19. Primary and secondary outcome measures Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann Kendall test. Results 897 women were included in the analysis, 67%(n=601) with spontaneous vaginal birth, 13.3%(n=119) with instrumental vaginal birth and 19.7%(n=177) with cesarean section. We found high QMNC scores but also specific gaps in all domains of QMNC. On provision of care, 21.0%(n=166) of women who experienced labor and 14.7%(n=26) of women with a cesarean reported inadequate pain relief; 64.7%(n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1%(n=279) reported unclear communication, 32.9%(n=295) reported that they were not involved in choices,11.5%(n=104) stated not being treated with dignity and 8.1%(n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). The multivariable analyses showed significantly lower QMNC scores for women with an instrumental vaginal birth. Over time there was a significant increase in QMNC score for experience of care and key organizational changes due to COVID-19. Conclusions and relevance Although overall QMNC scores were high, findings also suggest gaps in QMNC. Underlying causes of these gaps should be explored to design appropriate interventions and policies.
{"title":"Quality of Care at childbirth during the COVID-19 pandemic: findings of the IMAgiNE EURO study in Belgium","authors":"Anna Galle, Silke D'hauwers, Helga Berghman, Nele Vaerewijck, Emanuelle Pessa Valente, Ilaria Mariani, Arianna Bomben, Stefano delle Vedove, Marzia Lazzerini","doi":"10.1101/2024.03.25.24304838","DOIUrl":"https://doi.org/10.1101/2024.03.25.24304838","url":null,"abstract":"Objectives\u0000To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time.\u0000Design\u0000A cross-sectional observational study.\u0000Setting\u0000Data of the IMAgiNE EURO study in Belgium. Participants\u0000Women giving birth in a Belgian facility from March 1, 2020, to May 1, 2023, responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources, and organizational changes related to COVID 19. Primary and secondary outcome measures Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann Kendall test.\u0000Results\u0000897 women were included in the analysis, 67%(n=601) with spontaneous vaginal birth, 13.3%(n=119) with instrumental vaginal birth and 19.7%(n=177) with cesarean section. We found high QMNC scores but also specific gaps in all domains of QMNC. On provision of care, 21.0%(n=166) of women who experienced labor and 14.7%(n=26) of women with a cesarean reported inadequate pain relief; 64.7%(n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1%(n=279) reported unclear communication, 32.9%(n=295) reported that they were not involved in choices,11.5%(n=104) stated not being treated with dignity and 8.1%(n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). The multivariable analyses showed significantly lower QMNC scores for women with an instrumental vaginal birth. Over time there was a significant increase in QMNC score for experience of care and key organizational changes due to COVID-19. Conclusions and relevance\u0000Although overall QMNC scores were high, findings also suggest gaps in QMNC. Underlying causes of these gaps should be explored to design appropriate interventions and policies.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"158 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140301052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1101/2024.03.26.24304584
Shannon REGO, Olaide ASHIMI BALOGUN, Kirsten EMANUEL, Rachael OVERCASH, Juan M GONZALEZ, Gregory A DENOMME, Jennifer M HOSKOVEC, Haley KING, Ashley L WILSON, Julia WYNN, Kenneth J. Moise
Abstract Objective: To evaluate the accuracy of NGS based quantitative cfDNA analysis for fetal antigen genotyping in alloimmunized pregnancies undergoing clinical testing across the US practices. Timely identification of the fetal red blood cell antigen genotype for the antigen to which the pregnant person is alloimmunized is vital for determining fetal risk for HDFN and guiding management. Presently in the US, recommended care is to determine fetal antigen genotype with reproductive partner testing and/or amniocentesis. This approach has many limitations, including availability of reproductive partner testing, risk of nonpaternity, and low uptake of invasive testing such as amniocentesis. These barriers to obtaining fetal antigen genotype information lead to pregnancies not at risk for HDFN undergoing burdensome monitoring and, in some cases, unnecessary intervention. PCR based qualitative cfDNA analysis for fetal antigen genotyping is available in Europe however it is offered at later gestational ages, may require a repeat sample, has a higher frequency of inconclusive results for individuals of non-European ancestry, and has logistical challenges related to shipping and insurance coverage for patients in the US. The availability of a NGS based quantitative cfDNA analysis for fetal antigen genotyping in the US that is robust for diverse populations and is available as early as 10 weeks presents an opportunity to assess performance. Methods: Patients with alloimmunized pregnancies undergoing clinical fetal antigen cfDNA analysis were recruited to the study along with the neonates resulting from the pregnancies. Neonatal buccal swabs were sent to an outside laboratory, blinded to the fetal cfDNA testing results, for antigen genotyping and the results were compared. Concordance was reported for the fetal antigen cfDNA analysis for antigens to which the pregnant person was alloimmunized as well as for all antigens for which the pregnant person was genotype negative. Results: We observed complete concordance between the fetal antigen cfDNA analysis result and neonatal genotypes for the 206 calls made on antigens to which the pregnant person was alloimmunized, for 100% sensitivity, specificity, PPV, and NPV across a racial and ethnically diverse cohort. Concordance was 99.8% for all antigens to which the pregnant person was genotype negative. Conclusion: This study demonstrates that cfDNA analysis for determining fetal antigen genotype is more accurate than real-life use of the current recommendations, ie., partner testing and amniocentesis, in a diverse US population. In addition, this noninvasive approach reduces barriers to obtaining timely, accurate information about fetal antigen genotype. These results support the routine implementation of fetal antigen cfDNA analysis to guide care of alloimmunized pregnancies in the US.
{"title":"Cell-free DNA analysis for the determination of fetal red blood cell antigen genotype in alloimmunized pregnancies.","authors":"Shannon REGO, Olaide ASHIMI BALOGUN, Kirsten EMANUEL, Rachael OVERCASH, Juan M GONZALEZ, Gregory A DENOMME, Jennifer M HOSKOVEC, Haley KING, Ashley L WILSON, Julia WYNN, Kenneth J. Moise","doi":"10.1101/2024.03.26.24304584","DOIUrl":"https://doi.org/10.1101/2024.03.26.24304584","url":null,"abstract":"Abstract\u0000Objective: To evaluate the accuracy of NGS based quantitative cfDNA analysis for fetal antigen genotyping in alloimmunized pregnancies undergoing clinical testing across the US practices. Timely identification of the fetal red blood cell antigen genotype for the antigen to which the pregnant person is alloimmunized is vital for determining fetal risk for HDFN and guiding management. Presently in the US, recommended care is to determine fetal antigen genotype with reproductive partner testing and/or amniocentesis. This approach has many limitations, including availability of reproductive partner testing, risk of nonpaternity, and low uptake of invasive testing such as amniocentesis. These barriers to obtaining fetal antigen genotype information lead to pregnancies not at risk for HDFN undergoing burdensome monitoring and, in some cases, unnecessary intervention. PCR based qualitative cfDNA analysis for fetal antigen genotyping is available in Europe however it is offered at later gestational ages, may require a repeat sample, has a higher frequency of inconclusive results for individuals of non-European ancestry, and has logistical challenges related to shipping and insurance coverage for patients in the US. The availability of a NGS based quantitative cfDNA analysis for fetal antigen genotyping in the US that is robust for diverse populations and is available as early as 10 weeks presents an opportunity to assess performance. Methods: Patients with alloimmunized pregnancies undergoing clinical fetal antigen cfDNA analysis were recruited to the study along with the neonates resulting from the pregnancies. Neonatal buccal swabs were sent to an outside laboratory, blinded to the fetal cfDNA testing results, for antigen genotyping and the results were compared. Concordance was reported for the fetal antigen cfDNA analysis for antigens to which the pregnant person was alloimmunized as well as for all antigens for which the pregnant person was genotype negative. Results: We observed complete concordance between the fetal antigen cfDNA analysis result and neonatal genotypes for the 206 calls made on antigens to which the pregnant person was alloimmunized, for 100% sensitivity, specificity, PPV, and NPV across a racial and ethnically diverse cohort. Concordance was 99.8% for all antigens to which the pregnant person was genotype negative. Conclusion: This study demonstrates that cfDNA analysis for determining fetal antigen genotype is more accurate than real-life use of the current recommendations, ie., partner testing and amniocentesis, in a diverse US population. In addition, this noninvasive approach reduces barriers to obtaining timely, accurate information about fetal antigen genotype. These results support the routine implementation of fetal antigen cfDNA analysis to guide care of alloimmunized pregnancies in the US.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140316881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.1101/2024.03.19.24304557
Megan M Lydon, Joaquim Vilanculos, Carter Crew, Américo Barata, Emily Keyes
Pandemic-related health service adaptations raised concerns about provision of quality, respectful maternity care globally. Despite this, little research has focused on the experiences of those using intrapartum care during this time. This study aimed to elevate the voices and document the experiences of birthing people in Nampula Province, Mozambique during the COVID-19 pandemic. We conducted a longitudinal qualitative study from March-August 2021 and present an analysis of the 17 follow-up in-depth interviews conducted with participants who had a vaginal live birth. Interviews explored participants’ experience of labor and delivery care. They were conducted in Makua and Portuguese, audio-recorded, transcribed and translated. We applied thematic content analysis. Overall, participants did not express major concerns about COVID-19 or related service adaptations when describing their experiences of intrapartum care. Some noted its negative effects on elements of respectful care such as restricting birth companions. Overcrowding became more concerning due to the threat of infection. While unclear if affected by the pandemic, all participants who gave birth at a health facility reported experiencing at least one form of mistreatment, some recounting threats of cesarean delivery. Most explained that they and their newborns received care without their consent, especially regarding enemas and episiotomies. At the same time, respondents described a range of intrapartum experiences that included both respectful and disrespectful care. Most recalled positive verbal communication with their providers and many described receiving continuous attentive care. Participants explained that their satisfaction with childbirth services was tied to their birth outcome and their experience of respectful care. The findings indicate that steadfast commitments to quality care are critical to ensure families benefit from high-quality, respectful care at all times. The ramifications of the COVID-19 pandemic were limited but nonetheless signal a need for tighter connections between maternal health and emergency preparedness stakeholders.
{"title":"“She helped from the first minute to the last” – experiences of respectful maternal and newborn care during the COVID-19 pandemic in Nampula Province, Mozambique","authors":"Megan M Lydon, Joaquim Vilanculos, Carter Crew, Américo Barata, Emily Keyes","doi":"10.1101/2024.03.19.24304557","DOIUrl":"https://doi.org/10.1101/2024.03.19.24304557","url":null,"abstract":"Pandemic-related health service adaptations raised concerns about provision of quality, respectful maternity care globally. Despite this, little research has focused on the experiences of those using intrapartum care during this time. This study aimed to elevate the voices and document the experiences of birthing people in Nampula Province, Mozambique during the COVID-19 pandemic. We conducted a longitudinal qualitative study from March-August 2021 and present an analysis of the 17 follow-up in-depth interviews conducted with participants who had a vaginal live birth. Interviews explored participants’ experience of labor and delivery care. They were conducted in Makua and Portuguese, audio-recorded, transcribed and translated. We applied thematic content analysis. Overall, participants did not express major concerns about COVID-19 or related service adaptations when describing their experiences of intrapartum care. Some noted its negative effects on elements of respectful care such as restricting birth companions. Overcrowding became more concerning due to the threat of infection. While unclear if affected by the pandemic, all participants who gave birth at a health facility reported experiencing at least one form of mistreatment, some recounting threats of cesarean delivery. Most explained that they and their newborns received care without their consent, especially regarding enemas and episiotomies. At the same time, respondents described a range of intrapartum experiences that included both respectful and disrespectful care. Most recalled positive verbal communication with their providers and many described receiving continuous attentive care. Participants explained that their satisfaction with childbirth services was tied to their birth outcome and their experience of respectful care. The findings indicate that steadfast commitments to quality care are critical to ensure families benefit from high-quality, respectful care at all times. The ramifications of the COVID-19 pandemic were limited but nonetheless signal a need for tighter connections between maternal health and emergency preparedness stakeholders.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140202458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-18DOI: 10.1101/2024.03.17.24304434
Jonathan Mwiindi, Rigoberto Delgado, Lee Revere, Beth Wangigi, Edward Muguthu, Priscilla Busingye
Synopsis Post-operative quality of care for emergency C-section cases, measured by length of stay in Ugandan rural hospitals, is impacted by case management. Background The study examined the relationship between payer type, and quality of care among mothers who deliver through emergency cesarean section in rural Ugandan hospitals. Methods We analyzed retrospective, de-identified patient data from three rural private-not-for-profit hospitals in Uganda. Two groups were included in the study, a self-payer patient group and a group fully sponsored by an international funding organization. The data was analyzed using hierarchical linear regression models comparing length of stay against payer type, and controlling for patient age, education level, parity, and indication for C-section. Length of stay (LOS) was assumed to represent a realistic proxy variable for patient quality of care. Results The self-pay group had statistically significant longer postoperative LOS (surgery to clinical discharge), and longer aggregate LOS, or admission to clinical discharge, compared to the sponsored group. Payer type was not significant in the admission-to-decision LOS, but payer type was highly significant for aggregate LOS (p < .001). Conclusion Case management in rural Ugandan hospitals influences quality of post-operative care for patients undergoing emergency C-sections. Expanding surgical funding, combined with effective case management approaches, is likely to increase quality of surgical care as measured by length of stay.
{"title":"The relationship between payer type and quality of care for women undergoing emergency cesarean section at three hospitals in rural Uganda.","authors":"Jonathan Mwiindi, Rigoberto Delgado, Lee Revere, Beth Wangigi, Edward Muguthu, Priscilla Busingye","doi":"10.1101/2024.03.17.24304434","DOIUrl":"https://doi.org/10.1101/2024.03.17.24304434","url":null,"abstract":"Synopsis Post-operative quality of care for emergency C-section cases, measured by length of stay in Ugandan rural hospitals, is impacted by case management.\u0000Background\u0000The study examined the relationship between payer type, and quality of care among mothers who deliver through emergency cesarean section in rural Ugandan hospitals.\u0000Methods We analyzed retrospective, de-identified patient data from three rural private-not-for-profit hospitals in Uganda. Two groups were included in the study, a self-payer patient group and a group fully sponsored by an international funding organization. The data was analyzed using hierarchical linear regression models comparing length of stay against payer type, and controlling for patient age, education level, parity, and indication for C-section. Length of stay (LOS) was assumed to represent a realistic proxy variable for patient quality of care. Results\u0000The self-pay group had statistically significant longer postoperative LOS (surgery to clinical discharge), and longer aggregate LOS, or admission to clinical discharge, compared to the sponsored group. Payer type was not significant in the admission-to-decision LOS, but payer type was highly significant for aggregate LOS (p < .001).\u0000Conclusion Case management in rural Ugandan hospitals influences quality of post-operative care for patients undergoing emergency C-sections. Expanding surgical funding, combined with effective case management approaches, is likely to increase quality of surgical care as measured by length of stay.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140168181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.1101/2024.03.14.24304282
An Coosemans, Jolien Ceusters, Chiara Landolfo, Thaïs Baert, Wouter Froyman, Ruben Heremans, Gitte Thirion, Sandra Claes, Julie Oosterlynck, Roxanne Wouters, Ann Vankerckhoven, Francesca Moro, Floriana Mascilini, Adam Neumann, Anne-Sophie Van Rompuy, Dominique Schols, Jaak Billen, Toon Van Gorp, Ignace Vergote, Tom Bourne, Caroline Van Holsbeke, Valentina Chiappa, Giovanni Scambia, Antonia Testa, Daniela Fischerova, Dirk Timmerman, Ben Van Calster
Background: The ADNEX model (Assessment of Different NEoplasias in the adnexa) is the best performing model to predict the risk of malignancy (binary) and type of malignancy (multiclass) in ovarian tumors. The immune system plays a role in the onset and progression of ovarian cancer. Preliminary research has suggested that immune-related biomarkers can help in the discrimination of ovarian tumors. We aimed to assess which proteins have the most additional diagnostic value in addition to ADNEX' clinical and ultrasound predictors. Materials and methods: In this exploratory diagnostic study, 1086 patients with an adnexal mass scheduled for surgery were consecutively enrolled at five oncology centers and one non-oncology center in Belgium, Italy, Czech Republic and United Kingdom between 2015 and 2019. The quantification of 33 serum proteins was carried out preoperatively, using multiplex high throughput immunoassays (Luminex) and electrochemiluminescence immuno-assay (ECLIA). Logistic regression analysis was performed for ADNEX' clinical and ultrasound predictors alone (age, maximum diameter of lesion, proportion of solid tissue, presence of >10 cyst locules, number of papillary projections, acoustic shadows and ascites) and after adding proteins. We reported the AUC for benign vs malignant, Polytomous Discrimination Index (PDI; a multiclass AUC) and pairwise AUCs for pairs of tumor types. AUCs were corrected for optimism using bootstrapping. Results: After applying exclusion criteria, 932/1086 patients were eligible for analysis (474 benign, 135 borderline, 84 stage I primary invasive cancer, 208 stage II-IV primary invasive cancer, 31 secondary metastatic invasive tumors). ADNEX predictors alone had an AUC of 0.909 (95% CI 0.894-0.929) to discriminate benign from malignant tumors, and a PDI of 0.532 (0.510-0.589). HE4 yielded the highest increase in AUC (+0.026), followed by CA125 (+0.017). CA125 yielded the highest increase in PDI (+0.049), followed by HE4 (+0.036). Whereas CA125 mainly improved pairwise AUCs between different types of invasive tumors (increases between 0.020-0.165 over ADNEX alone), HE4 mainly improved pairwise AUCs for benign tumors versus stage I (+0.022) and benign tumors versus stage II-IV ovarian cancers (+0.028). CA72.4 might be useful to distinguishing secondary metastatic tumors from benign, borderline, and stage I tumors. CA15.3 might be useful to discriminate borderline tumors from stage I and stage II-IV tumors. Distinguishing stage I and borderline tumors (AUCs ≤ 0.72) and stage I and secondary metastatic tumors (AUCs ≤ 0.76) remained difficult after adding proteins. Conclusions: CA125 had the highest added value over clinical and ultrasound predictors to distinguish between the five tumor types, followed by HE4. In addition, CA72.4 and CA15.3 may further improve discrimination but findings for these proteins should be confirmed. The immune-related proteins were in general not able to discriminate the groups.
{"title":"Added value of serum proteins to clinical and ultrasound information in predicting the risk of malignancy in ovarian tumors","authors":"An Coosemans, Jolien Ceusters, Chiara Landolfo, Thaïs Baert, Wouter Froyman, Ruben Heremans, Gitte Thirion, Sandra Claes, Julie Oosterlynck, Roxanne Wouters, Ann Vankerckhoven, Francesca Moro, Floriana Mascilini, Adam Neumann, Anne-Sophie Van Rompuy, Dominique Schols, Jaak Billen, Toon Van Gorp, Ignace Vergote, Tom Bourne, Caroline Van Holsbeke, Valentina Chiappa, Giovanni Scambia, Antonia Testa, Daniela Fischerova, Dirk Timmerman, Ben Van Calster","doi":"10.1101/2024.03.14.24304282","DOIUrl":"https://doi.org/10.1101/2024.03.14.24304282","url":null,"abstract":"Background: The ADNEX model (Assessment of Different NEoplasias in the adnexa) is the best performing model to predict the risk of malignancy (binary) and type of malignancy (multiclass) in ovarian tumors. The immune system plays a role in the onset and progression of ovarian cancer. Preliminary research has suggested that immune-related biomarkers can help in the discrimination of ovarian tumors. We aimed to assess which proteins have the most additional diagnostic value in addition to ADNEX' clinical and ultrasound predictors. Materials and methods: In this exploratory diagnostic study, 1086 patients with an adnexal mass scheduled for surgery were consecutively enrolled at five oncology centers and one non-oncology center in Belgium, Italy, Czech Republic and United Kingdom between 2015 and 2019. The quantification of 33 serum proteins was carried out preoperatively, using multiplex high throughput immunoassays (Luminex) and electrochemiluminescence immuno-assay (ECLIA). Logistic regression analysis was performed for ADNEX' clinical and ultrasound predictors alone (age, maximum diameter of lesion, proportion of solid tissue, presence of >10 cyst locules, number of papillary projections, acoustic shadows and ascites) and after adding proteins. We reported the AUC for benign vs malignant, Polytomous Discrimination Index (PDI; a multiclass AUC) and pairwise AUCs for pairs of tumor types. AUCs were corrected for optimism using bootstrapping.\u0000Results: After applying exclusion criteria, 932/1086 patients were eligible for analysis (474 benign, 135 borderline, 84 stage I primary invasive cancer, 208 stage II-IV primary invasive cancer, 31 secondary metastatic invasive tumors). ADNEX predictors alone had an AUC of 0.909 (95% CI 0.894-0.929) to discriminate benign from malignant tumors, and a PDI of 0.532 (0.510-0.589). HE4 yielded the highest increase in AUC (+0.026), followed by CA125 (+0.017). CA125 yielded the highest increase in PDI (+0.049), followed by HE4 (+0.036). Whereas CA125 mainly improved pairwise AUCs between different types of invasive tumors (increases between 0.020-0.165 over ADNEX alone), HE4 mainly improved pairwise AUCs for benign tumors versus stage I (+0.022) and benign tumors versus stage II-IV ovarian cancers (+0.028). CA72.4 might be useful to distinguishing secondary metastatic tumors from benign, borderline, and stage I tumors. CA15.3 might be useful to discriminate borderline tumors from stage I and stage II-IV tumors. Distinguishing stage I and borderline tumors (AUCs ≤ 0.72) and stage I and secondary metastatic tumors (AUCs ≤ 0.76) remained difficult after adding proteins. Conclusions: CA125 had the highest added value over clinical and ultrasound predictors to distinguish between the five tumor types, followed by HE4. In addition, CA72.4 and CA15.3 may further improve discrimination but findings for these proteins should be confirmed. The immune-related proteins were in general not able to discriminate the groups.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140152074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.1101/2024.03.13.24304247
Zahinoor Ismail, Jasper F.E. Crockford, Dylan X Guan, Gillian Einstein, Clive Ballard, Bryon Creese, Anne Corbett, Ellie Pickering, Adam Bloomfield, Pamela Roach, Eric E Smith
Background Recent evidence suggests the experience of menopausal symptoms (i.e., perimenopausal symptoms) may be associated with cognitive and behavioural changes. We investigated these two relationships in a sample of post-menopausal females. Design Cross-sectional observational study. Setting Participant data was collected from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging (CAN-PROTECT) study. Participants 896 post-menopausal female participants. Methods Menopausal symptom burden was operationalized by summing the total number of recalled perimenopausal symptoms experienced. Cognitive function was measured using the Everyday Cognition (ECog-II) Scale, with higher scores reflecting greater severity. Mild Behavioral Impairment (MBI) was measured using the Mild Behavioral Impairment Checklist (MBI-C), with higher scores reflecting greater severity. A negative-binomial regression model examined the relationship between menopausal symptom burden and cognitive function, while a zero-inflated negative binomial regression model examined the relationship between menopausal symptom burden and MBI symptoms. Models adjusted for age, years of education, age of menopausal onset, type of menopause, and hormone therapy (HT). Age of menopausal onset and use of HT in the two associations were investigated with moderation analyses. Results Greater menopausal symptom burden was associated with higher ECog-II total scores (b [95% confidence interval (CI)] = 5.37 [2.85, 7.97]) and higher MBI-C total scores (b [95% CI] = 6.09 [2.50, 9.80]). Use of HT did not significantly associate with ECog-II total scores (b [95% CI] = -10.98 [-25.33, 6.35]), however, HT was significantly associated with lower MBI-C total scores (b [95% CI] = -26.90 [-43.35, -5.67]). Conclusions Menopausal symptom burden is associated with poorer cognitive function and more MBI symptoms in mid- to late life. HT may help mitigate symptoms of MBI. These findings suggest the experience of menopause may indicate susceptibility to cognitive and behavioural changes, both markers of dementia.
{"title":"Menopausal symptom burden as a predictor of mid- to late-life cognitive function and mild behavioral impairment symptoms: A CAN-PROTECT study.","authors":"Zahinoor Ismail, Jasper F.E. Crockford, Dylan X Guan, Gillian Einstein, Clive Ballard, Bryon Creese, Anne Corbett, Ellie Pickering, Adam Bloomfield, Pamela Roach, Eric E Smith","doi":"10.1101/2024.03.13.24304247","DOIUrl":"https://doi.org/10.1101/2024.03.13.24304247","url":null,"abstract":"Background Recent evidence suggests the experience of menopausal symptoms (i.e., perimenopausal symptoms) may be associated with cognitive and behavioural changes. We investigated these two relationships in a sample of post-menopausal females. Design Cross-sectional observational study. Setting Participant data was collected from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging (CAN-PROTECT) study. Participants 896 post-menopausal female participants. Methods Menopausal symptom burden was operationalized by summing the total number of recalled perimenopausal symptoms experienced. Cognitive function was measured using the Everyday Cognition (ECog-II) Scale, with higher scores reflecting greater severity. Mild Behavioral Impairment (MBI) was measured using the Mild Behavioral Impairment Checklist (MBI-C), with higher scores reflecting greater severity. A negative-binomial regression model examined the relationship between menopausal symptom burden and cognitive function, while a zero-inflated negative binomial regression model examined the relationship between menopausal symptom burden and MBI symptoms. Models adjusted for age, years of education, age of menopausal onset, type of menopause, and hormone therapy (HT). Age of menopausal onset and use of HT in the two associations were investigated with moderation analyses. Results Greater menopausal symptom burden was associated with higher ECog-II total scores (b [95% confidence interval (CI)] = 5.37 [2.85, 7.97]) and higher MBI-C total scores (b [95% CI] = 6.09 [2.50, 9.80]). Use of HT did not significantly associate with ECog-II total scores (b [95% CI] = -10.98 [-25.33, 6.35]), however, HT was significantly associated with lower MBI-C total scores (b [95% CI] = -26.90 [-43.35, -5.67]). Conclusions Menopausal symptom burden is associated with poorer cognitive function and more MBI symptoms in mid- to late life. HT may help mitigate symptoms of MBI. These findings suggest the experience of menopause may indicate susceptibility to cognitive and behavioural changes, both markers of dementia.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140152102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-13DOI: 10.1101/2024.03.11.24304083
Chemtai Mungo, Aparna Ghosh Kachoria, Everlyn Adoyo, Graham Zulu, Supreet Kaur Goraya, Jackton Omoto, Cirilus Osongo, Renée M Ferrari
Background: Women in low- and middle-income countries (LMICs) bear a disproportionate burden of global incidence and deaths from cervical cancer, despite being a preventable disease. Prevention efforts in LMICs are hindered in part by lack of access to cervical precancer treatment, due to weak health infrastructure and a lack of adequate human resources to deliver current provider-administered precancer treatments. Innovative strategies are urgently needed to close the cervical precancer treatment gap in LMICs, including the use of self-administered topical therapies for which efficacy evidence is available from high-income settings. We investigated African womens perceptions and perceived acceptability of these therapies for cervical precancer treatment. Methods: Between November 2022 and April 2023, we conducted five focus group discussions (FGDs) with women ages 25-65 years undergoing cervical cancer screening or precancer treatment in Kisumu, Kenya. The FGDs explored womens experiences with screening and precancer treatment, their acceptability of topical therapies for precancer treatment, and perceived barriers and facilitators to uptake. The FGDs were moderated by local qualitative research assistants, conducted in local languages, transcribed, coded, and analyzed using qualitative description using NVIVO software. Results: Twenty-nine women participated, with a mean age of 35.4 years (SD 6.5). All had undergone cervical cancer screening, and 25 (83%) had a history of precancer treatment with ablation or excision. Multiple themes were identified related to womens perceptions of topical therapies. Participants were highly receptive of topical treatments, with many favoring the option of self-administration compared to provider-administration of such therapies. Self-administration of topical therapies was felt to help address challenges associated with current treatment methods, including difficulty in access, pain with procedures, cost, and lack of privacy with pelvic exams. Participants had a preference for topical therapies that are used less frequently compared to those used daily. Conclusions: Among Kenyan women with a history of cervical precancer treatment, self-administered topical therapies for precancer are acceptable and have the potential to address barriers, including access, privacy, and cost, that hinder precancer treatment in LMICs. If supported by efficacy studies in LMICs, self-administered topical therapies offer a scalable approach to closing the precancer treatment gap in LMICs.
{"title":"ARVs is for HIV and cream is for HPV or precancer: Womens Perceptions and Perceived Acceptability of Self-Administered Topical Therapies for Cervical Precancer Treatment: A Qualitative Study from Kenya","authors":"Chemtai Mungo, Aparna Ghosh Kachoria, Everlyn Adoyo, Graham Zulu, Supreet Kaur Goraya, Jackton Omoto, Cirilus Osongo, Renée M Ferrari","doi":"10.1101/2024.03.11.24304083","DOIUrl":"https://doi.org/10.1101/2024.03.11.24304083","url":null,"abstract":"Background: Women in low- and middle-income countries (LMICs) bear a disproportionate burden of global incidence and deaths from cervical cancer, despite being a preventable disease. Prevention efforts in LMICs are hindered in part by lack of access to cervical precancer treatment, due to weak health infrastructure and a lack of adequate human resources to deliver current provider-administered precancer treatments. Innovative strategies are urgently needed to close the cervical precancer treatment gap in LMICs, including the use of self-administered topical therapies for which efficacy evidence is available from high-income settings. We investigated African womens perceptions and perceived acceptability of these therapies for cervical precancer treatment. Methods: Between November 2022 and April 2023, we conducted five focus group discussions (FGDs) with women ages 25-65 years undergoing cervical cancer screening or precancer treatment in Kisumu, Kenya. The FGDs explored womens experiences with screening and precancer treatment, their acceptability of topical therapies for precancer treatment, and perceived barriers and facilitators to uptake. The FGDs were moderated by local qualitative research assistants, conducted in local languages, transcribed, coded, and analyzed using qualitative description using NVIVO software.\u0000Results: Twenty-nine women participated, with a mean age of 35.4 years (SD 6.5). All had undergone cervical cancer screening, and 25 (83%) had a history of precancer treatment with ablation or excision. Multiple themes were identified related to womens perceptions of topical therapies. Participants were highly receptive of topical treatments, with many favoring the option of self-administration compared to provider-administration of such therapies. Self-administration of topical therapies was felt to help address challenges associated with current treatment methods, including difficulty in access, pain with procedures, cost, and lack of privacy with pelvic exams. Participants had a preference for topical therapies that are used less frequently compared to those used daily. Conclusions: Among Kenyan women with a history of cervical precancer treatment, self-administered topical therapies for precancer are acceptable and have the potential to address barriers, including access, privacy, and cost, that hinder precancer treatment in LMICs. If supported by efficacy studies in LMICs, self-administered topical therapies offer a scalable approach to closing the precancer treatment gap in LMICs.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"112 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140128076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.1101/2024.03.05.24303824
Susan Nasab, Ethan Gough, Elisabeth Nylander, Mostafa Borahay, James Segars, Valerie Baker, Xiaobin Wang, Katherine Cameron
Objective: To examine the association between uterine fibroids and the development of hypertensive disorders in pregnancy. Data sources: Cochrane, Embase, PubMed, MEDLINE, Scopus, and Web of Science databases were searched from inception through April 2023. Study Selection and Synthesis: Cohort, case-control, or case series studies including uterine fibroid status and hypertensive disorders of pregnancy status were included. The comparison group was pregnant women without uterine fibroids. Inverse-variance weighted random effects models were used to pool RR and OR estimates separately. Age and BMI were explored as potential sources of heterogeneity using inverse-variance weighted meta-regression. Main Outcomes: Hypertensive disorders of pregnancy (HDP) defined as gestational hypertension, pre-eclampsia, eclampsia, superimposed preeclampsia, or hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Results: A total of 17 studies were included (Total N=1,374,395 participants, N=64,968 with uterine fibroids). Thirteen studies were retrospective cohorts and four were case-control studies. Women with uterine fibroids had a significantly higher risk of hypertensive disorders in pregnancy compared to women without uterine fibroids with RR 1.74 (95% CI 1.33-2.27, p<0.01), and OR 2.87 (95% CI 1.38-5.97, p<0.01), in cohort studies and case-control studies, respectively. In meta-regression analyses, age did not significantly change the positive association between uterine fibroids and hypertensive disorders in pregnancy. Conclusion: Uterine fibroids were associated with an increased risk of hypertensive disorders of pregnancy when all available literature was synthesized, including when shared risk factors are examined in meta-regression analyses. Relevance: If confirmed in future studies, investigations into the mechanisms of this association are needed as this finding potentially has implications for risk stratification and monitoring for hypertensive disorders of pregnancy in this population. Key Words: Uterine fibroids, Leiomyoma, Preeclampsia, hypertensive disorders in pregnancy.
目的研究子宫肌瘤与妊娠期高血压疾病之间的关系。数据来源：检索了从开始到 2023 年 4 月的 Cochrane、Embase、PubMed、MEDLINE、Scopus 和 Web of Science 数据库。研究选择与综合：包括子宫肌瘤状态和妊娠期高血压疾病状态的队列、病例对照或病例系列研究。对比组为无子宫肌瘤的孕妇。采用逆方差加权随机效应模型分别汇总 RR 和 OR 估计值。使用逆方差加权元回归法探讨了年龄和体重指数作为异质性的潜在来源：妊娠高血压疾病（HDP）定义为妊娠高血压、子痫前期、子痫、叠加子痫前期或溶血、肝酶升高和血小板低（HELLP）综合征。结果：共纳入17项研究（总人数=1,374,395人，其中64,968人患有子宫肌瘤）。其中 13 项为回顾性队列研究，4 项为病例对照研究。在队列研究和病例对照研究中，与无子宫肌瘤的妇女相比，有子宫肌瘤的妇女患妊娠期高血压疾病的风险明显更高，分别为 RR 1.74（95% CI 1.33-2.27，p<0.01）和 OR 2.87（95% CI 1.38-5.97，p<0.01）。在元回归分析中，年龄并没有显著改变子宫肌瘤与妊娠期高血压疾病之间的正相关关系：结论：综合所有现有文献，包括在元回归分析中研究共同风险因素时，子宫肌瘤与妊娠期高血压疾病的风险增加有关。相关性：如果在今后的研究中得到证实，需要对这种关联的机制进行调查，因为这一发现可能会对这一人群的妊娠高血压疾病的风险分层和监测产生影响。关键字子宫肌瘤、子宫肌瘤、子痫前期、妊娠高血压疾病。
{"title":"Uterine Fibroids and Hypertensive Disorders in Pregnancy: A Systematic Review and Meta-Analysis","authors":"Susan Nasab, Ethan Gough, Elisabeth Nylander, Mostafa Borahay, James Segars, Valerie Baker, Xiaobin Wang, Katherine Cameron","doi":"10.1101/2024.03.05.24303824","DOIUrl":"https://doi.org/10.1101/2024.03.05.24303824","url":null,"abstract":"Objective: To examine the association between uterine fibroids and the development of hypertensive disorders in pregnancy. Data sources: Cochrane, Embase, PubMed, MEDLINE, Scopus, and Web of Science databases were searched from inception through April 2023. Study Selection and Synthesis: Cohort, case-control, or case series studies including uterine fibroid status and hypertensive disorders of pregnancy status were included. The comparison group was pregnant women without uterine fibroids. Inverse-variance weighted random effects models were used to pool RR and OR estimates separately. Age and BMI were explored as potential sources of heterogeneity using inverse-variance weighted meta-regression.\u0000Main Outcomes: Hypertensive disorders of pregnancy (HDP) defined as gestational hypertension, pre-eclampsia, eclampsia, superimposed preeclampsia, or hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Results: A total of 17 studies were included (Total N=1,374,395 participants, N=64,968 with uterine fibroids). Thirteen studies were retrospective cohorts and four were case-control studies. Women with uterine fibroids had a significantly higher risk of hypertensive disorders in pregnancy compared to women without uterine fibroids with RR 1.74 (95% CI 1.33-2.27, p<0.01), and OR 2.87 (95% CI 1.38-5.97, p<0.01), in cohort studies and case-control studies, respectively. In meta-regression analyses, age did not significantly change the positive association between uterine fibroids and hypertensive disorders in pregnancy.\u0000Conclusion: Uterine fibroids were associated with an increased risk of hypertensive disorders of pregnancy when all available literature was synthesized, including when shared risk factors are examined in meta-regression analyses. Relevance: If confirmed in future studies, investigations into the mechanisms of this association are needed as this finding potentially has implications for risk stratification and monitoring for hypertensive disorders of pregnancy in this population. Key Words: Uterine fibroids, Leiomyoma, Preeclampsia, hypertensive disorders in pregnancy.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140054560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Childbirth at advanced maternal age (AMA) is increasing among women, and some studies have shown adverse outcomes. There is a need to map evidence on the subject to harness findings and identify research gaps for further studies. This scoping review aims to examine pertinent studies on AMA and its impact on pregnancy outcomes. Methods The Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) chart is employed for systematic data extraction. This review draws from Google Scholar, the Cochrane Library, Medline (via PubMed), and Embase (via OVID). For inclusion in this scoping review, articles must thoroughly examine and elucidate the effects, impacts, and relationships between advanced maternal age and pregnancy outcomes. A crucial prerequisite is that the articles undergo a peer-review process to ensure the reliability and credibility of the presented information. For this review, advanced maternal age is defined explicitly as women aged ≥35. However, studies focusing on women aged ≥40 are also considered, mainly if they are high quality. In terms of research methodology, both primary and secondary research will be eligible, encompassing systematic reviews and meta-analyses. This broad inclusion aims to capture a comprehensive overview of the existing literature on the subject. Furthermore, articles must be presented in the English language to facilitate a standardized and accessible analysis. This criterion ensures that language barriers do not impede the review's ability to synthesize relevant information effectively. Results There are significant associations between advanced maternal age and poor pregnancy outcomes, even when adjusted for confounders. Conclusions The adverse pregnancy outcome due to maternal age alone may be due to placental dysfunction resulting from a relative deficiency in maternal cardiovascular adaptations to pregnancy, and this provides a window for further studies
背景高龄产妇（AMA）越来越多，一些研究显示会产生不良后果。有必要对相关证据进行梳理，以利用研究结果并确定进一步研究的空白点。本范围综述旨在研究有关高龄产妇及其对妊娠结局影响的相关研究。方法采用系统性综述和荟萃分析首选报告项目（PRISMA）表进行系统性数据提取。本综述从 Google Scholar、Cochrane 图书馆、Medline（通过 PubMed）和 Embase（通过 OVID）中提取数据。要纳入本次范围界定综述，文章必须深入研究并阐明高龄产妇与妊娠结局之间的作用、影响和关系。一个重要的前提条件是这些文章必须经过同行评审，以确保所提供信息的可靠性和可信度。在本综述中，高龄产妇明确定义为年龄≥35 岁的女性。不过，以年龄≥40 岁的女性为重点的研究也在考虑之列，主要是质量较高的研究。在研究方法方面，初级研究和二级研究均符合条件，包括系统综述和荟萃分析。这种广泛的收录方式旨在对该主题的现有文献进行全面概述。此外，文章必须用英语撰写，以便于进行标准化的分析。结果即使对混杂因素进行调整，高龄产妇与不良妊娠结局之间仍存在显著关联。结论仅由高龄产妇引起的不良妊娠结局可能是由于产妇心血管对妊娠的适应性相对不足导致胎盘功能障碍所致，这为进一步研究提供了窗口。
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