Therapeutic advances in reproductive health最新文献

Background: Uterine niches (isthmoceles) are myometrial defects commonly occurring after caesarean sections and may lead to abnormal uterine bleeding, pelvic pain and impaired fertility. Robotic-assisted surgical approaches have emerged as a minimally invasive option for their management, yet data on their efficacy remain limited.

Objective: To evaluate the efficacy of robotic-assisted laparoscopic repair of uterine niches in improving clinical symptoms and fertility outcomes.

Design: A retrospective observational study conducted at a tertiary university hospital.

Methods: All patients who underwent robotic-assisted laparoscopic repair of uterine niches between 2013 and 2023 were included. Preoperative assessments included transvaginal ultrasound and hysterosalpingo-ultrasonography to evaluate residual myometrial thickness (RMT) and niche morphology. The surgical procedure entailed isthmocele resection followed by double-layer myometrial suturing using the Da Vinci Robotic System®. Pre- and postoperative RMT measurements were compared to assess myometrial restoration. Symptom resolution and postoperative fertility outcomes were also evaluated.

Results: Fifty-one patients underwent robotic-assisted laparoscopic repair during the study period. The mean RMT significantly increased from 1.75 ± 1.4 mm preoperatively to 4.9 ± 3.4 mm postoperatively (p < 0.001). While niche diameter reduction was not statistically significant, the healing ratio demonstrated a significant improvement (p < 0.001). Among symptomatic patients with postoperative symptom assessment (n = 28), 20 (71.4%) reported complete or partial symptom resolution. Among patients desiring conception postoperatively (n = 36), 26 conceived; among pregnancies, 17/26 (65.4%) resulted in live birth, 1/26 (3.8%) was ongoing at last follow-up and 3/26 (11.5%) had an unknown outcome.

Conclusion: Robotic-assisted laparoscopic repair was associated with improvement in symptoms related to uterine niches. The technique significantly improves myometrial thickness and supports favourable reproductive outcomes. Further prospective studies are warranted to establish standardised treatment guidelines and assess long-term efficacy.

Trial registration: Not applicable.

Background: Modern contraceptives are effective in preventing unintended pregnancies, which may consequently reduce the risk of unsafe abortions. However, their use among adolescent girls and young women (AGYW) in Tanzania remains low. Despite various national strategies, the fertility rate in the Mara region remains high at 6.1.

Objectives: The first objective of this study was to determine the prevalence of modern contraceptive use among postpartum AGYW in rural Mara, Tanzania. The second objective was to identify factors influencing modern contraceptive use among postpartum AGYW.

Design: An analytical cross-sectional study was conducted to assess modern contraceptive use among postpartum AGYW in rural Mara, Tanzania.

Methods: A random multistage sampling technique was used to select 614 AGYW aged 15-24 years from rural Mara. Data were collected from January 5 to February 27, 2024, using a structured Swahili questionnaire. Analysis was performed using SPSS version 27.0, employing descriptive statistics, bivariate analysis to examine associations between categorical variables, and multivariate logistic regression to identify predictors of contraceptive use (p < 0.05).

Results: Modern contraceptive use was reported by 21.7% (95% CI: 18.5%-25.0%) of postpartum AGYW. Women who had primary education were 4.83 times more likely to use contraceptives than those with no or incomplete primary education (AOR = 4.83, 95% CI: 2.61-8.91, p = 0.001). Women in the middle and highest wealth categories had significantly higher odds of contraceptive use (AOR = 1.83; 95% CI: 1.72-4.72; p = 0.04), representing an 83% increase compared to those in the lowest wealth category. In contrast, participants with two to three children were 60% less likely to use contraceptives compared to those with one child (AOR = 0.40; 95% CI: 0.22-0.72; p = 0.002).

Conclusion: Modern contraceptive use among AGYW remains low. Education level, wealth status, and number of children significantly influence uptake, highlighting the need for targeted interventions to improve access and informed choice.

Background: Despite the severe, chronic nature of polycystic ovary syndrome (PCOS), relatively little is known about the lived experience of women with this condition, especially as they transition through menopause.

Objective: This mixed-methods study investigated the lived experience of women with PCOS before and after the menopause transition to understand their health literacy, barriers to healthcare management, and desired resources to improve their health and well-being.

Design: This was a convergent-parallel mixed-methods study.

Methods: Twenty-four participants completed semi-structured interviews and electronic surveys between April 2023 and August 2024. Qualitative data were analyzed using an inductive open-ended approach for thematic analysis.

Results: Participants, including 17 pre-menopausal (30.1 ± 4.8 years) and 7 post-menopausal (58.6 ± 6.0 years), self-reported clinical symptoms of PCOS (irregular cycles, hirsutism, and acne) and higher than average anxiety symptoms (pre-menopausal only). Both pre- and post-menopausal women were knowledgeable about the impact of PCOS on their fertility, and expressed low to moderate health literacy to successfully manage the PCOS-related symptoms. Few participants expressed understanding of long-term chronic disease risk. Pre-menopausal participants sought resources for managing symptoms but reported dissatisfaction with provider education and overall patient care. Post-menopausal participants did not view a PCOS diagnosis as a health concern following menopause and internalized PCOS-related health issues as something to be endured. Both pre- and post-menopausal women expressed desires for improved personalized care, life-stage-specific support groups, and better patient-facing resources.

Conclusion: Pre-menopausal and post-menopausal women with PCOS exhibit low health literacy about the potential impact of PCOS on metabolic health. Primary care providers should be trained in how to educate women with PCOS, with an emphasis on the impact of the disease beyond reproductive health and through the lifespan. In addition, creating patient-centered resources supporting women throughout the lifespan is needed.

Trial registration: This study was registered with ClinicalTrials.gov as NCT05769426.

Background: Adolescents in Africa are experiencing a significant epidemiological shift, characterised by earlier sexual debut and delayed marriage, leading to a longer period of sexual activity outside of marriage. In Chiredzi district, Zimbabwe, this often results in adolescent girls facing pregnancies without adequate access to tailored maternal health services.

Objectives: This study aimed to gather quantitative data from health workers on the availability, accessibility and quality of adolescent maternal health services in Chiredzi district.

Design: This study employed a quantitative, cross-sectional study.

Methods: An exploratory study was conducted at Chiredzi General Hospital's maternity ward, involving all 90 healthcare workers via census sampling. Participants completed a structured, pre-tested questionnaire uploaded to Kobo Collect. A pre-test was conducted on 10% (n = 9) of the sample size. Data analysis involved cross-tabulations and inferential statistics performed in Statistical Package for Social Sciences (SPSS).

Results: All 90 targeted health workers completed the questionnaire, offering valuable insights into the challenges faced by adolescent mothers at the hospital. Key findings revealed that over half (53.3%) of facilities lacked specific protocols for pregnant adolescents. A significant gender disparity in training was found, with 70% of female staff receiving adolescent service training compared to only 42% of male staff (p = 0.008). Furthermore, a high proportion of 'Not sure' responses (up to 50%) regarding available services indicated critical gaps in staff awareness and communication.

Conclusion: The study underscores the critical need for standardised adolescent-friendly protocols, mandatory and equitable staff training, and the implementation of mobile health services to improve care for adolescent mothers. Investment in these areas is essential to improve health outcomes.

Background: Globally, adolescent girls aged 15-19 years give birth to approximately 16 million children annually, accounting for 11% of all births. Low- and middle-income nations carry the burden of these births, with 95% happening in Africa, where maternal mortality rates continue to be high. In Sub-Saharan Africa, early marriages persist, with roughly half of women delivering before age 20.

Objectives: This scoping review aimed to map evidence on the accessibility and barriers to maternal health services for adolescent girls in Sub-Saharan Africa.

Eligibility criteria: Included studies were peer-reviewed articles published in English between 2014 and 2025, focusing on adolescent girls (10-19 years) and maternal health services in Sub-Saharan Africa.

Sources of evidence: Literature searches were conducted in PubMed, Scopus, Web of Science, Directory of Open Access Journals and Google Scholar.

Charting methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Scoping Review extension guidelines. Data were extracted using a pre-designed template and analysed thematically. Results were synthesized narratively and presented in tables.

Results: A total of 652 records were identified, with 26 articles included. Key findings indicate that financial constraints, stigma, geographical distance and restrictive policies are significant barriers to access. While most studies focused on accessibility, aspects of quality such as provider attitudes, adherence to guidelines and respectful care were less frequently and deeply explored, representing a significant evidence gap. Community-based programmes and youth-friendly services were identified as key facilitators. Unmarried adolescents and those with lower education levels faced compounded barriers.

Conclusion: Given their reproductive health vulnerabilities, maternal health services targeting adolescents should be prioritized in Sub-Saharan Africa. Interventions must address both access barriers and critically improve service quality, including provider training in adolescent-sensitive care, though the current evidence base on quality-specific interventions is limited. Further research is needed to develop standardized metrics for quality care in this population.

Background: Adolescents in sub-Saharan Africa shoulder a disproportionate burden of sexually transmitted infections (STIs), yet data for pregnant teenagers in these settings are sparse.

Objectives: The study estimated the prevalence of STI seropositivity and its associated factors, among pregnant adolescents at Mbarara Regional Referral Hospital (MRRH), Uganda.

Design: Hospital-based cross-sectional study.

Methods: Consecutive pregnant adolescents (10-19 years) attending the MRRH antenatal clinic or maternity ward between 1 July and 30 September 2024 were enrolled. A structured questionnaire captured socio-demographic, sexual-behavioural, obstetric, clinical and nutritional variables. Blood samples were tested for HIV (Determine™/STAT-PAK™), syphilis (Treponema pallidum haemagglutination assay) and Hepatitis B (HBsAg rapid test). The composite STI outcome was seropositivity for any infection: HIV, syphilis or HBsAg. Independent associations were examined with Firth-penalised logistic regression; adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported.

Results: Among 249 participants (median age 18 years, interquartile range 18-19), the overall prevalence of STI seropositivity was 12.1% (95% CI: 8.3-16.8). Prevalence by each STI was HIV 8.8%, syphilis 4.0% and HBV 0.4%. Multigravidae had higher odds of infection than primigravidae (aOR: 2.81, 95% CI: 1.01-7.84). Having ever used a non-barrier modern contraception tripled the odds of STI (aOR 3.04, 95% CI: 1.10-8.45), whereas marriage or cohabitation reduced risk by 63% (aOR 0.37, 95% CI: 0.14-0.96).

Conclusion: Nearly one in eight pregnant adolescents at MRRH were infected with HIV, syphilis or HBV, with these STIs more likely to be among multigravidae and former users of non-barrier contraception and less likely among married/cohabiting pregnant adolescents. These findings support integrating repeat HIV-syphilis testing, dual-method contraceptive counselling and targeted interventions for multigravidae into youth-friendly antenatal services to advance STI-elimination goals.

Background: Understanding women's intention to shift from short-acting methods to long-acting reversible contraceptive methods (LARCMs) in diverse settings, including socioeconomic, behavioural and multicultural contexts, is crucial for improving contraceptive utilization. While short-acting methods are widely used, shifting to LARCMs remains a challenge in resource-limited settings like Ethiopia. Previous studies in Ethiopia either lack theoretical framework or focus on intention spanning a year with theoretical incoherence.

Objective: Guided by the theory of planned behaviour, this study aims to assess the intention to shift from short- to long-acting methods in 6 months and identify associated factors among women attending public health facilities in Hossana Town, Central Ethiopia.

Design: A facility-based cross-sectional study was conducted in public health facilities of Hossana town, Central Ethiopia Region.

Methods: The 336 reproductive-age women who were using short-acting contraceptive methods were included. The data were collected through face-to-face interviews using a pre-tested structured questionnaire. A generalized linear model (GLM) with a Gamma distribution and log link function was applied to model the positively skewed intention scores. Adjusted exponentiated beta coefficients (Exp(β)) and their corresponding 95% confidence intervals were used to quantify associations and declared statistically significant at p-value < 0.05.

Results: The proportion of women who intended to shift from short-acting contraceptives to LARCMs was only 42.3%. In the multivariable GLM, primary education (Exp(β) = 1.10; 95% CI: 1.033-1.170), secondary education (Exp(β) = 1.15; 95% CI: 1.078-1.227), and tertiary education (Exp(β) = 1.19; 95% CI: 1.061-1.329) were significantly associated to shift from short- to LARCMs. Additionally, attitude (Exp(β) = 1.011; 95% CI: 1.007-1.015), subjective norm (Exp(β) = 1.007; 95% CI: 1.001-1.013), and perceived behavioural control (Exp(β) = 1.012; 95% CI: 1.004-1.020) were also positively and significantly associated with the intention to shift.

Conclusion: These findings suggest that enhancing educational access, improving service delivery through informed decision-making support, addressing social influences and strengthening psychosocial factors such as attitude and self-confidence could improve the intention for uptake of long-acting contraceptive methods.

Infertility is a complex condition influenced by genetic and biological factors. In men, it is often caused by abnormalities in chromosome number or structure, alterations in DNA structure, specific gene mutations, or missing segments of the Y chromosome. Recent studies have also highlighted the impact of epigenetic mechanisms-such as DNA methylation, histone modifications, and noncoding RNAs-on gene function and fertility. Abnormal methylation patterns, particularly in genes such as DNMT3A/B/L, H19, MEST, SOX30, and those involved in the piRNA pathway, have been linked to poor sperm production and reduced fertility. These epigenetic changes can lower sperm quality, impair embryo health, and decrease the chances of success with fertility treatments. The role of biological and epigenetic factors in female reproduction is more limited. This narrative review aims to examine well-established genetic and epigenetic mechanisms associated with infertility, with a focus on key molecular pathways and regulatory processes. A literature review was conducted to summarize the most relevant and recent publications addressing genetic and epigenetic mechanisms as contributing factors to human infertility.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of childbearing age, affecting 8%-13% globally, associated with hyperandrogenism, anovulation, insulin resistance, cardiovascular diseases, and psychological issues, contributing to infertility and long-term health risks.

Objective: To estimate the prevalence of PCOS and its association with infertility, hormonal disturbances, metabolic comorbidities, and lifestyle factors among reproductive-aged women in the Barak Valley region of Assam, Northeast India-an ethnically diverse and underserved area where genetic, lifestyle, and healthcare disparities may influence the prevalence and clinical presentation of PCOS.

Design: Case-control study.

Methods: A pre-validated questionnaire-based screening and multi-stage stratified random sampling method was applied among women aged 18-40 years based on Rotterdam criteria (2003) and NHMRC guidelines (2018). Clinical and biochemical hyperandrogenism, anthropometric, metabolic, hormonal, and ultrasonographic parameters were assessed.

Results: The prevalence of PCOS was 9.18% (n = 53), with higher occurrence among native Bengali women. Phenotypes A, B, C, and D were identified at 39.62%, 20.75%, 7.54%, and 32.07%, respectively. Clinical hyperandrogenism manifested as acne (49.05%), hirsutism (43.39%), and alopecia (28.3%), while biochemical hyperandrogenism was observed in 92.45% based on elevated free testosterone levels. Menstrual issues involved oligomenorrhea (45.28%), amenorrhea (30.18%), and dysmenorrhea (33.96%). Metabolic abnormalities such as type II diabetes (52.83%), overweight (30.18%), obesity (9.43%), and obstructive sleep apnea (37.73%) were frequent. Elevated BMI, waist-hip ratio, luteinizing hormone (LH), anti-Müllerian hormone, and LH/FSH (follicle-stimulating hormone) ratio were observed. Free testosterone correlated strongly with clinical symptoms. Urban women reported poorer dietary habits (61.36%). Family history of PCOS and anxiety were commonly associated factors.

Conclusion: PCOS in Barak Valley shows strong hormonal and metabolic abnormalities that may be influenced by lifestyle factors and underlying genetic predisposition. Early detection, targeted lifestyle changes, and regional awareness strategies are essential for improving reproductive and metabolic outcomes.