Therapeutic advances in reproductive health最新文献

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).

Background: Antenatal care is essential for reducing maternal and neonatal mortality, particularly in low-income regions. However, the adequacy of the care provided is crucial for achieving maternal health goals. Maternal mortality rates in Uganda are still among the highest globally. Thus, evaluating the adequacy of antenatal care (ANC) services, especially in high-risk regions is imperative.

Objective: To determine the prevalence of adequate ANC and associated factors in Eastern Uganda.

Design: A multicenter quantitative cross-sectional study was conducted at four healthcare facilities in Eastern Uganda from July to August 2022.

Methods: We included immediate postpartum mothers who had given birth within 48 h with a record of their ANC information on a card or book. Adequate ANC was measured by a composite index of 10 core components per WHO guidelines on ANC for a positive pregnancy experience. Data were collected using a structured questionnaire designed with Kobo Toolbox and analyzed using Stata 15.0. Bivariable and multivariable logistic regression analyses assessed factors associated with receiving adequate ANC. Statistical significance was determined by a p value <0.05.

Results: We recruited 1104 postnatal mothers, most aged 20-34 years (n = 805, 72.9%). Only 5.9% received adequate ANC, with most mothers receiving an average of 6.9 (±2.0) of the 10 assessed ANC components. Receiving adequate ANC was associated with urban residency (AOR: 2.3; 95% CI: 1.16-4.38, p = 0.017), age between 20 and 34 years (AOR: 3.5; 95% CI: 1.07-11.30, p = 0.038), current or previous complications (AOR: 1.8; 95% CI: 1.02-3.29, p = 0.043), and delivery at a general hospital (AOR: 4.8; 95% CI: 2.60-8.83, p < 0.001).

Conclusion: There is a critical gap in providing adequate ANC in Eastern Uganda, especially for rural and younger mothers. Policy efforts should focus on expanding access, enhancing maternal education, and strengthening healthcare infrastructure to meet the recommended ANC standards.

Background: Menstruation is a universal and normal phenomenon during the reproductive age of females; adolescence is an essential period where females are preparing and adjusting themselves to manage their menstrual bleeding safely and cleanly. Menstrual hygiene management (MHM) is an issue that is insufficiently acknowledged and has not received adequate attention among visually impaired adolescent girls (VIAGs).

Objectives: The purpose of this study was to determine the knowledge and practice of MHM and associated factors among VIAGs of selected institutions in Rwanda.

Design: This study consisted of a cross-sectional study design using a quantitative approach.

Methods: A cross-sectional study was conducted in April and May 2021 on 92 VIAGs. They were recruited from educational institutions in two Provinces in Rwanda. Voluntary participation and confidentiality were assured. Socioeconomic and demographic data, menstruation, and menstrual hygiene questionnaires were used to obtain the required information. Statistical Packages for the Social Sciences (SPSS) for Windows version 25 was used. Descriptive statistics, Chi-square test, and logistic regressions were used for data analysis.

Results: The study reached 92 respondents. The majority of the respondents, 67.4% had a poor level of menstruation and menstrual hygiene knowledge while only 32.6% had a good level of menstruation and menstrual hygiene knowledge. Also, it is confirmed that the majority of respondents, 52.1% had a good level of practice, while 47.8% had a poor level of menstrual hygiene practice. The multivariable analysis revealed that factors associated with the menstrual hygiene practice were as follows: the mother's education (odds ratio (OR): 5.979; 95% CI: [1.700-21.032]; p value: 0.005) and level of knowledge of menstruation and menstrual hygiene (OR: 0.132; 95% CI: [0.028-0.622]; p value: 0.010).

Conclusion: The knowledge and practice of MHM among VIAGs were poor. Recommendations included the need for mothers to assist their daughters in improving learning and practice of menstrual hygiene, as well as the integration of MHM into school curricula. Further research is suggested to better understand MHM among Rwandan adolescent girls, both visually impaired and non-blind.

The ideal morphology of the sperm cell was initially described based on the characteristics of sperm able to migrate through the endocervical canal assuming these had the best fertilization potential. Sperm morphology assessment has moved over the years toward stricter criteria based on the findings from studies that underline its value in successful reproductive outcomes. While treatment options are clear for some conditions related to abnormal sperm morphology, the value of sperm morphology in assisted reproduction requires further investigation. The objective of this review is to offer care providers updated guidance for choosing appropriate treatment strategies based on sperm morphology assessment and morphological deviations. Issues to be considered for a reliable determination and interpretation of sperm morphology using the current thresholds and criteria are discussed. In addition, key knowledge on morphological abnormalities relevant to the clinical care of infertile patients, distinguishing between monomorphic and polymorphic forms as well as the isolated or non-isolated occurrence of teratozoospermia in semen is presented. Furthermore, the impact of impaired morphology on assisted reproductive technique outcomes is summarized in light of the latest research.

Background: Maternal and child mortality rates remain a serious public health challenge in Ethiopia. Short interpregnancy intervals are known to negatively impact perinatal and child health; therefore, improving this practice is a key strategy to reduce mortality and adverse outcomes.

Objective: This study aimed to evaluate the extent of short intervals between pregnancies and the factors associated with them among women who gave birth at public hospitals in the North Wollo Zone of northeastern Ethiopia in 2023.

Design: A facility-based cross-sectional study was conducted in the North Wollo Zone of northeastern Ethiopia in 2023.

Methods: This study was conducted on mothers who delivered at public hospitals in the North Wollo Zone of northeastern Ethiopia. The study participants were selected using a systematic random sampling technique between February 1, 2023, and April 1, 2023. Data were collected through an interviewer-administered questionnaire using the Kobo Collect tool and analyzed using SPSS version 27.0. Bivariable and multivariable analyses were performed to determine the relationship between the outcome and predictor variables. A p value of less than 0.05 was considered significant in the multivariable analysis.

Results: The study found that 51.5% of participants had short interpregnancy intervals. Several independent factors were associated with a short birth interval, including the status of the last pregnancy (adjusted odds ratio (AOR): 9.51; 95% CI: 3.932-23.0028), educational status of the woman (AOR: 4.545; 95% CI: 1.208-17.108), and use of modern contraceptives in previous pregnancies (AOR: 6.460, 95% CI: 3.882-23.008).

Conclusion: Despite the efforts made through public health interventions in Ethiopia, the prevalence of short interpregnancy intervals in this study was high. Therefore, increasing the utilization of modern contraceptives and promoting health education at both health facilities and community levels could contribute to addressing this issue.

Uterine fibroids, known as leiomyomas, are non-cancerous tumors in women. Uterine fibroids disproportionately affect African American women, as they are more common and severe. Uterine fibroids are the leading cause of hysterectomy in African American women. Over 80% of African American women will receive a uterine fibroids diagnosis before 50. Myomectomies (removal of uterine fibroids) and hysterectomies (removal of the uterus) are more prevalent in African American women due to more significant symptoms. Socioeconomic status, including education and income, influences access to healthcare, with some treatments directly affected by insurance coverage and the cost of the procedure. This review aimed to characterize the socioeconomic disparities and inequities regarding uterine fibroids awareness, perceptions, and treatment and to understand how socioeconomic status impacts knowledge and treatment of uterine fibroids. Recognition of the treatment barriers and decisions due to socioeconomic status is a critical step in ensuring equitable treatment options for women diagnosed with uterine fibroids. A narrative literature review was conducted using PubMed, MedLine, and Google Scholar. A total of 98 articles were returned. After adjusting for the exclusion criteria, 10 articles were included in this review. The review demonstrated the disparities in treatment options based on race and socioeconomic status. Low-income women were more likely to receive more invasive treatment, which resulted in more time off work and increased medical bills. In addition, women in lower-income brackets frequented the emergency department at an increased level. This review underscored the need for additional research to learn about the role of socioeconomic status in uterine fibroid awareness and treatment.