Therapeutic advances in reproductive health最新文献

Background: Septate uterus is a congenital uterine malformation associated with adverse reproductive and obstetrical outcomes. Hysteroscopic septum resection (HSC) with/without balloon stent placement is a treatment option for reconstituting to a normal uterine cavity; however, procedure safety and efficacy of office-based-ultrasound guided (US) HSC in patients undergoing fertility treatment is not thoroughly studied.

Objectives: (1) To assess the safety and efficacy of office-based US-guided HSC septoplasty; (2) compare the safety and effectiveness of adjuvant intrauterine-balloon-Cook stent (IUBS) and (3) to evaluate the reproductive outcomes after each method.

Design: Retrospective cohort study.

Methods: We conducted a retrospective cohort study (n = 90) of patients undergoing HSC at the CReATe Fertility Centre, Toronto, Canada between 2011-2022. The Congenital Uterine Malformation by Experts (CUME-2018) guideline's criteria were used for diagnosis and classification of malformation/septum size as 1-arcuate uterus <10 mm (52% (47/90)), 2-septum 10-19 mm (31% (28/90)), 3-septum 20-40 mm (7% (6/90)), and 4-complete septa (10% (9/90)). The main outcomes were the rate of procedure complications and the efficacy of septum removal. Secondary outcome measures were reproductive outcomes after septoplasty and the safety and effectiveness of adjuvant IUBS placement. T-test and chi-square test, McNemar test, and Cochran-Mantel-Haenszel test were used for stratified statistical analysis.

Results: Office-HSC under US guidance was performed in 82 patients (US group) and septoplasty with laparoscopic guidance in 8 patients laparoscopy (LSC) group. IUBS placement had 34% (28/82) of patients in the US group and 12.5% (1/8) in the LSC group. There were no intraoperative or postoperative complications (uterine perforations, excessive bleeding, or infections) in either group. The rate of repeated procedures, implantation, pregnancy, and live birth rates (LBR) were not different when comparing septoplasty with and without IUBS. However, for patients diagnosed with septum class-2, -3, and -4, septoplasty improved their pre-treatment-LBR from 21.6% (8/37) to 77.1% (27/35) post-treatment (p = 0.00005) and decreased pre-treatment miscarriage rate (MR) from 73% (27/37) to post-treatment 29% (7/24) (p = 0.0007) in both groups.

Conclusion: Hysteroscopic septum resection with transabdominal US guidance in the office setting is a safe and effective procedure in patients with infertility. Office hysteroscopy should be considered in the management of patients with uterine septum to improve LBR and reduce MR. The value of IUBS needs further evaluation in a larger sample-size study.

Background: High fertility and rapid population growth can threaten human development and increase risks to maternal and child health. The diffusion of the benefits of lower fertility requires readiness to plan, and willingness and ability to adopt and use family planning measures.

Objective: This assessment aimed to explore the readiness, willingness, and ability (RWA) among selected Ethiopian communities, and identify the facilitators and impediments of fertility transition.

Design: This exploratory phenomenological qualitative study collects data from purposefully selected community members and experts in Addis Ababa, Arbaminch, and Jigjiga.

Method: The analysis follows deductive coding and a thematic presentation of findings under the RWA domains. Readiness deals with four themes: (1) the rationalization of the value of children, (2) recognition of the burden of high-risk fertility, (3) readiness to define the ideal number of children, and (4) socio-cultural norms about family size. Willingness contains three themes: (1) the psychosocial legitimacy of contraceptives, (2) the religious legitimacy of contraceptives, and (3) women's power to cope with barriers to family planning. The ability domain contains (1) women's knowledge about contraception and (2) access to and utilization of contraceptives.

Results: The communities involved in this study recognized the burden of high-risk fertility behaviors (early-age fertility, and frequent and many births), but they prefer large family sizes. Consequently, they exhibit good family planning willingness and practice for birth spacing but not for birth limitation. Recognizing the socio-economic burden of high-risk fertility, accepting and using contraceptives for the health of mothers and children are possible facilitators of fertility transition. Conversely, the desire for high parity, husbands and religious disapproval of contraceptives, side effects of contraceptives, and limited access to method mix are possible impediments.

Conclusion: The RWA to space births are adequately diffused and adopted by the community, but birth limitation is not yet recognized. Beyond promoting birth spacing, Ethiopia's fertility transition requires a shift in societal values from large to small family size. Overcoming barriers to contraceptive use also requires tailored efforts to improve the availability of method mix and involve male and religious leaders.

Background: Globally, over 15 million preterm births (PTB) occur annually, with sub-Saharan Africa bearing a disproportionate burden. In Kenya, studies conducted between 2017 and 2021 at the hospital level show a PTB prevalence ranging from 15.9% to 20.2%. However, current PTB prevalence and associated factors remain underexplored despite their significant public health implications. Understanding the prevalence and factors associated with PTB is critical for effective interventions.

Objectives: This study aimed to determine the prevalence of PTB and also to identify individual- and community-level factors influencing PTB among women of reproductive age in Kenya.

Design: The study utilised a cross-sectional design, analysing data from the 2022 Kenya Demographic and Health Survey.

Methods: A sample of 7291 women aged 15-49 was analysed using weighted multilevel logistic regression in Stata 17.0. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) and a significance threshold of p < 0.05 were used to identify predictors of PTB.

Results: The prevalence of PTB was 7.14%. Women aged 25-34 (aOR = 0.67; 95% CI: 0.49-0.94) and 35+ (aOR = 0.86; 95% CI: 0.59-1.24) were less likely to experience PTB compared to younger women (15-24 years). Attending four or more antenatal care visits reduced PTB likelihood (aOR = 0.68; 95% CI: 0.53-0.88). Women in the richest wealth index had higher odds of PTB (aOR = 2.28; 95% CI: 1.39-3.74), while medium community literacy levels increased PTB risk (aOR = 1.56; 95% CI: 1.21-2.03).

Conclusion: This study highlights that individual- and community-level factors significantly influence PTB in Kenya. Addressing disparities in socio-demographic and obstetric factors through targeted, multipronged strategies is essential for reducing PTB rates and improving maternal and neonatal outcomes.

Background: In 2020 in sub-Saharan Africa, 25% of new human immunodeficiency virus (HIV) infections occurred among young women (15-24 years). In Uganda, the HIV prevalence is three times higher among young women at 2.9% compared to 0.8% among their male counterparts. HIV status disclosure is a gateway to preventive services.

Objectives: We set out to estimate the prevalence of HIV status disclosure to current male partners, and the predictors among the adolescent girls and young women living with HIV (AGYWLHIV) in a semi-rural northern Uganda.

Design: In a cross-sectional study design, a consecutive sample of the AGYWLHIV was recruited from six antiretroviral therapy clinics between November 2022 and April 2023.

Methods: Participants were administered an interviewer-guided questionnaire. They were asked whether they have ever disclosed their HIV status to their current male partners. They were also asked about their socio-demographics, sexual and reproductive health profiles, knowledge and perceptions of dual protection, and safer conception methods for AGYWLHIV. Percentages to estimate prevalence, Chi-square tests to assess associations, simple and multivariate modified Poisson regression to identify predictors at p < 0.05 and 95% confidence intervals (CI) were considered.

Results: Overall, 423 participants with a median age of 22 (IQR 4) years participated in the study. The prevalence of HIV status disclosure to the current male partners was found at 73.3% (95% CI 69.0-77.5). The predictors for HIV status disclosure were found to include the women's knowledge of their HIV status (APR 1.1 (95% CI 1.0-1.2), p 0.032), knowledge of their male partner's HIV status (APR 0.8 (95% CI 0.7-0.9), p 0.003), and the male partners' disclosure of their HIV status to the women (APR 0.7 (95% CI 0.5-0.9), p <0.016).

Conclusion: About three-fourths of the AGYWLHIV in semi-rural northern Uganda disclosed their HIV status to their male partners. The predictors of disclosure included the women's knowledge of their HIV status, knowledge of their male partner's HIV status, and the male partner's reciprocal disclosure of their HIV status. To enhance disclosure rates, post-test, and disclosure counseling for both individuals and couples is recommended as part of the routine HIV testing, treatment, and care programs.

Background: The placenta accreta spectrum (PAS) represents a significant risk factor for severe postpartum hemorrhage. Recent studies have demonstrated the safety of neuraxial anesthesia (NA) in cesarean delivery (CD) for patients with PAS.

Objectives: To evaluate the risk of severe peripartum hemorrhage in patients with PAS who underwent CD under NA.

Design: A multicenter retrospective cohort study.

Methods: This study analyzed 214 patients diagnosed with PAS. Logistic regression was used to identify factors increasing the risk of severe peripartum hemorrhage. A total of six machine learning (ML) algorithms were employed for model validation.

Results: The predictive model includes the following risk factors: age at delivery >33 years (p = 0.004), history of CD >1 (p = 0.020), preoperative HGB ⩽ 100 g/L (p = 0.013), placenta previa classification (p = 0.001), vascular lacunae within the placenta (p = 0.015), and labor duration (p = 0.026). The validation of ML algorithms revealed that the model achieved an accuracy ranging from 0.68 to 0.71, with an area under the receiver operating characteristic curve between 0.75 and 0.79. A nomogram list and web-based calculator were constructed for clinical implementation, and a risk stratification system was established based on model scores.

Conclusion: A prenatal risk assessment model was developed to estimate the likelihood of severe peripartum hemorrhage in PAS patients undergoing CD under NA. This model may provide preliminary support for clinicians in tailoring anesthetic management strategies for potentially high-risk cases, but further studies are needed to confirm its clinical utility.

Background: Placenta previa with antepartum hemorrhage (APH) is common and closely related to maternal and fetal morbidity and mortality. It is of the utmost importance to prepare for the possibility of APH using perinatal factors prior to delivery.

Objective: To develop and validate a nomogram predicting APH in women with placenta previa based on the perinatal factors.

Design: This was a retrospective and prospective cohort study of pregnant women with placenta previa.

Methods: The model was developed in the retrospective and validated in the prospective cohort study. Multivariate logistic regression was applied to discover independent variables and develop a nomogram to predict the possibility of APH. An Excel form computer interface was constructed to use the model.

Results: There are 1601 and 693 participants in the retrospective and prospective cohort study. Maternal age (odds ratio 0.950, 95% confidence interval 0.918-0.984), married (0.533, 0.309-0.920), parity (1.240, 1.024-1.502), threatened abortion (5.059, 3.648-7.014), and complete placenta previa (1.833, 95% CI 1.469-2.289) were independent variables for APH in placenta previa women. The area under the curve and concordance index were 0.828 and 0.676, respectively. The model was a good fit by the Hosmer-Lemeshow test (p = 0.352). The prospective validation proved the reliability of the prediction nomogram. The Excel form computer interface was practical.

Conclusion: A nomogram based on perinatal factors was developed and validated to predict APH in women with placenta previa. The reliable tool may thereafter offer important assistance for decision-making processes.

Background: Reproductive health technology has evolved significantly since the introduction of in vitro fertilization in 1978, enhancing the possibility of conceiving children at later stages in life. Despite these advancements, there remains a critical gap in fertility knowledge among young adults, as demonstrated by recent studies. This gap is compounded by the growing influence of social media on health information, where misinformation can distort public understanding of fertility-related issues. Addressing this knowledge deficit is essential for empowering individuals to make informed decisions about their reproductive futures.

Objectives: With the increasing prevalence of older individuals becoming parents and the growing reliance on Assisted Reproductive Technologies for conception, our study aimed to assess fertility knowledge among young adults.

Design: This study employed a survey-based approach using Amazon's crowd-sourcing marketing platform, Mechanical Turk (MTurk). Participants were asked to complete a 17-question survey that included a section on demographic information. The questionnaire explored various aspects of knowledge and perceptions regarding male and female fertility.

Methods: The survey was completed by 983 participants aged 18-30, recruited through MTurk. Individuals outside this age range were excluded from the study. Participants received a $0.50 incentive for their participation.

Results: Notably, a high percentage of respondents correctly identified the age range at which female fertility (70.4% of participants) declines, while fewer (56.4% of participants) demonstrated awareness of the age range at which male fertility declines. Furthermore, an overwhelming majority exhibited appropriate knowledge regarding the impact of lifestyle factors, such as obesity and smoking, on fertility. The findings suggest an encouragingly high level of awareness among participants regarding fundamental fertility concepts. Approximately 63% of participants reported social media as a source of this information.

Conclusion: This study yields promising insights into fertility knowledge among young adults. However, it underscores a notable deficiency in understanding male fertility, emphasizing the imperative for further educational initiatives in this domain. These results also highlight the crucial role of healthcare providers in maintaining an online presence to disseminate valuable, evidence-based knowledge. By doing so, healthcare professionals can empower individuals to make informed decisions regarding fertility.

Background: Chronic endometritis (CE), frequently asymptomatic, is associated with female infertility. Fallopian tube obstruction (FTO) is also one of the factors contributing to female infertility. More than 90% of cases of proximal FTO can be successfully treated after fallopian tubal recanalization (FTR) and the spontaneous pregnancy rate of treated women after FTR is only about 30%. Potential factors affecting the success rate of FTR remain unclear. We speculate that CE may be one of the reasons affecting the recanalization of the fallopian tubes.

Objectives: To identify the correlation between CE and FTO, as well as the influence of CE on pregnancy outcomes following FTR.

Design: Retrospective observational study.

Methods: We retrospectively analyzed 498 women of childbearing age who underwent laparoscopy and hysteroscopy surgery for infertility. Endometrial samples were collected during surgery for CD138 immunohistochemistry staining for the diagnosis of CE. Based on the results of the tubal patency test, they were divided into two groups: the fallopian tubal patency group and the proximal FTO group. The prevalence of CE was compared between these two groups. All women with FTO underwent FTR during the operation until successful treatment was achieved. Pregnancy outcomes were assessed after a 12-month follow-up period following the procedures. Logistic regression was used to analyze factors that might affect pregnancy after FTR.

Results: The prevalence of CE in women with tubal obstruction was 30.5%, which was significantly higher than that in the fallopian tubal patency group (10.75%), p < 0.001. After FTR, the prevalence of CE in non-pregnant women was 40.18%, which was higher than that in pregnant women (40.18% vs 13.11%), and the difference was significant (p < 0.001). Multiple regression analysis showed that CE was a significant risk factor for FTO (OR: 2.54, 95% CI: 1.368-4.717, p < 0.05). In addition, CE was identified as a risk factor for infertility after FTR (OR: 4.730, 95% CI: 2.012-11.122).

Conclusion: The presence of CE seems to decrease the likelihood of achieving spontaneous pregnancy following FTR. This observation underscores the clinical importance of early detection and treatment of CE, emphasizing the necessity for immediate intervention to prevent potential fertility complications.

Background: Chlamydia trachomatis (CT), a Gram-negative intracellular bacterium, is differentiated into three biovars associated with distinct clinical syndromes, ranging from trachoma, the world's cause of preventable blindness, to the most common sexually transmitted infection. This variability underscores CT's significant impact on public health, particularly in low-resource settings. In Kenya, where the demographic is predominantly younger, the burden of CT remains poorly understood and potentially underestimated.

Objectives: This study aimed to assess the prevalence of both sexually transmitted and ocular CT across various regions and populations within Kenya.

Eligibility criteria: Articles on CT population testing and laboratory detection, from 2014 to date, in English or Swahili only.

Sources of evidence: Electronic databases of PubMed and Google Scholar were used.

Design: A scoping review.

Charting methods: This study conducted a systematic scoping review, following Arksey and O'Malley's framework and adhering to PRISMA guidelines for scoping reviews (PRISMA-ScR).

Results: This study incorporates findings from 19 original studies on sexually transmitted CT and seven on ocular CT. CT prevalence for four identified populations: sexually active females 2%-13%, men who have sex with men 1.3%-51%, pregnant women 2.5%-14.9% and other population groups 2.8%-16.4%. By contrast, studies on ocular CT, all performed in rural settings, found prevalence surpassing the WHO's 10% threshold primarily amongst children and mothers.

Conclusion: The variability in CT prevalence across different demographics and geographical regions emphasizes the impact of socio-economic, environmental and diagnostic factors on disease transmission and detection. The insights gained here can serve as a foundation for evidence-based health policies and interventions aimed at mitigating the burden of CT in Kenya.

Background: Digital knowledge translation (KT) interventions play a crucial role in advancing adolescent sexual and reproductive health (ASRH). Despite the extensive literature on their effectiveness, there's a lack of synthesized evidence on the efficacy of digital KT tools for adolescent ASRH globally.

Objectives: This review aimed to systematically identify and map existing empirical evidence on digital KT tools targeting ASRH outcomes and identify research gaps.

Design: The review employed an evidence gap-map (EGM) approach following 2020 PRISMA reporting guidelines.

Data sources and methods: A comprehensive literature search was conducted across databases including Medline, EMBASE, Global Health, CINAHL, Scopus, and Cochrane. Covidence software was used for data management. EPPI-Mapper software was used to synthesize findings and develop a graphical EGM.

Results: The EGM comprises 68 studies: 59 experimental and 9 systematic reviews, predominantly from African (19 studies) and American regions (22 studies), with limited research from the Eastern Mediterranean and South East Asian regions. It examines digital KT tools' influence on sexual and reproductive health (SRH) outcomes, identifying research gaps. Websites are extensively studied for their impact on adolescent behavior, knowledge, attitude, and self-efficacy, yet research on their effects on ASRH and health services access is limited. Similarly, mobile apps and short message service (SMS)/text messages impact various aspects of SRH outcomes, but research on their effects on health services utilization is insufficient. Interventions like digital pamphlets and gaming lack exploration in health service access. OTT media and social media need further investigation. Mass media, including radio, television, and podcasts, are largely unexplored in adolescent SRH outcomes. Topics such as menstrual hygiene, abortion, and sexual and intimate partner violence also lack research.

Conclusion: The review underscores the dominance of certain KT tool interventions like SMS and websites. Despite advancements, research gaps persist in exploring diverse digital platforms on underrepresented outcomes globally. Future research should expand exploration across digital platforms and broaden the scope of outcome measures.

Trial registration: The protocol is registered with PROSPERO (CRD42022373970).