Therapeutic advances in reproductive health最新文献

Background: Short birth intervals (SBI), defined as intervals of less than 33 months between consecutive live births, are a significant public health concern because of their association with adverse maternal and child health outcomes. Somalia has some of the highest maternal and neonatal mortality rates globally, compounded by limited access to family planning services.

Objectives: This study aimed to provide a descriptive analysis of the prevalence and patterns of SBI among Somali women across regions, offering insight into maternal health policies.

Design: A descriptive cross-sectional study design was employed.

Methods: Data from 9288 women aged 15-49 years drawn from the Somali Demographic and Health Survey were analyzed. Descriptive statistics were used to examine the prevalence and distribution of SBI across regions and sociodemographic groups.

Results: The overall prevalence of SBI was 77%, with regional disparities ranging from 82% in Togdheer and Hiraan to 74% in the Middle Shabelle. Women with no formal education and those in lower wealth quintiles exhibited a higher SBI prevalence than their counterparts. Rural and nomadic populations reported a higher SBI prevalence than urban residents, reflecting potential barriers to accessing family planning services.

Conclusion: This study highlights the widespread prevalence of SBI in Somalia, with notable variations according to region, education, and economic status. These findings underscore the need for targeted interventions to address the geographic, educational, and economic barriers to family planning access.

Background: Birth preparedness and complication readiness (BPCR) is a strategy that promotes the timely use of skilled maternal and neonatal care among pregnant women. Positive pregnancy outcomes can be achieved by appropriate birth preparedness and emergency complication readiness planning.

Objective: To explore the perceptions, benefits, awareness, and barriers of BPCR among pregnant women and health professionals at the antenatal care (ANC) clinic in the Oromia Region, Ethiopia.

Design: An exploratory, phenomenological descriptive qualitative study conducted from March 20 to April 24, 2022.

Methods: Three focus group discussion (FGD) sessions were conducted with 36 purposefully selected pregnant women attending ANC clinics. Key informant in-depth interviews (KIIs) were held with nine health professionals in Arsi Zone, Oromia, Ethiopia, using an interview guide. The data were analyzed using an inductive thematic analysis approach.

Results: Among the FGD participants, 19 reside in urban areas and 17 in rural areas. The KII participants comprised six midwives, two health officers, and a nurse. The participants mentioned their perception of BPCR during pregnancy, childbirth, the postpartum period, obstetric danger signs, and barriers to BPCR. Different sources of information on BPCR were mentioned, including friends, neighbors, health professionals, and family. The study showed that the participants were unfamiliar with the major BPCR components. The health professionals planned to educate pregnant women during ANC visits to enhance the adequacy of their BPCR plans. Facilitating husband support, increasing health facility accessibility, economic empowerment, and transport access will enable pregnant women to develop adequate BPCR plans.

Conclusion: This study's findings indicated that most participants did not focus strongly on BPCR plans because of low awareness, lack of support from husbands, family, and the community, poor infrastructure, and improper handling by health professionals. To increase service utilization, husbands, families, and the community should be informed about the benefits of the BPCR plan for pregnant women.

Background: Preterm premature rupture of membranes (PPROM) is a significant risk factor for perinatal morbidity and mortality. It is the main cause of preterm birth and affects approximately 10% of all pregnancies. The occurrence of PPROM has recently increased significantly. However, there is limited data on the determinants of PROM in the study area.

Objective: To assess the determinants of PPROM, among pregnant women admitted to maternity wards of public hospitals in the Sidama Region.

Design: An institution-based, unmatched case-control study.

Methods: The study was conducted in public hospitals in the Sidama Region from March 1st to May 15th, 2023. The consecutive cases were recruited until the required sample size was reached, and controls were randomly selected. Face-to-face interviews were used to collect data from 69 cases and 207 controls. Binary logistic regression analysis was used to identify determinants of PPROM. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported to show the strength of the association. The significance of the association was declared at a p value <0.05. The goodness-of-fit model was checked by the Hosmer-Lemeshow test.

Results: A total of 69 cases and 207 controls were included in the study. Pregnancy-induced hypertension (AOR: 2.65; 95% CI: 1.12-6.27), a history of abortion (AOR: 3.1; 95% CI: 1.41-7.08), a history of abortion (AOR: 3.78; 95% CI: 1.75-8.15), a history of cesarean section (AOR: 2.57, 95% CI: 1.10-5.99), a mid-upper arm circumference <23 cm (AOR: 2.1; 95% CI: 1.02-4.54), a history of urinary tract infection (AOR: 2.42; 95% CI: 1.10-5.32), and a hemoglobin level <11 mg/dl (AOR: 2.68; 95% CI: 1.15-6.23) were determinants of PPROM.

Conclusion: Past obstetric history, nutritional status, and risks in the index pregnancy have an association with PPROM. Therefore, strategies to reduce the occurrence of PPROM should target women in rural areas and emphasize the early identification and treatment of urinary tract infections, anemia, and pregnancy-induced hypertension.

Background: Preventing unintended pregnancies among reproductive-aged women with HIV (WWH) is crucial in combating mother-to-child transmission (MTCT) of HIV. We assessed the utilization of modern contraceptives and related factors among WWH attending the antiretroviral therapy (ART) clinic at a faith-based tertiary hospital in northern Uganda.

Objectives: To determine the proportion of and factors associated with the utilization of modern contraceptives among WWH of reproductive age attending the ART clinic in St. Mary's Hospital Lacor.

Design: This cross-sectional study was conducted at the HIV clinic within St. Mary's Hospital Lacor, from February to May 2023.

Methods: Between February and May 2023, we conducted a cross-sectional study among randomly selected WWH of reproductive age attending the ART clinic at a faith-based health facility, St. Mary's Hospital Lacor in Gulu city, northern Uganda. Quantitative data were collected using semi-structured questionnaires and analyzed using STATA version 16. Factors associated with the utilization of modern contraceptives were assessed using multivariable logistic regression. p < 0.05 was considered statistically significant.

Results: Of the 385 enrolled participants, 94 (24.4%) reported current modern contraceptive use, and 58 (15.1%) were using natural methods. Being referred to another facility to access modern contraceptives (adjusted odds ratio (aOR): 2.60, 95% confidence interval (CI): 1.31-5.17, p < 0.01), prior use of modern contraceptive (aOR: 32.47, 95% CI: 3.56-300.94, p < 0.01), and age (aOR: 0.92, 95% CI: 0.87-0.98, p < 0.01) were all statistically associated with uptake of modern contraceptives.

Conclusion: Only about one in every four WWH was currently using modern methods of contraceptives. There is a need to provide regular counseling to WWH on modern contraceptive methods to create awareness of the vital connection between modern contraceptive use and MTCT, as well as strengthen referral of clients opting to use modern contraceptives to facilities providing these services.

Background: Infertility affects around 17.5% of reproductive-aged individuals worldwide, posing significant personal and public health challenges. Although Medically Assisted Reproduction and Assisted Reproductive Technology (ART; e.g., in vitro fertilization) have advanced outcomes, many couples fail to conceive due to unaddressed pelvic, uterine, or systemic factors.

Objectives: We aim to (1) define the current usage of Restorative Reproduction Medicine (RRM) in clinical practice, (2) compare RRM outcomes with conventional ART, and (3) propose an integrated model of RRM plus ART for optimal fertility care.

Design: A systematic review following PRISMA guidelines was conducted (INPLASY registration no. INPLASY2024110069).

Data sources and methods: We searched PubMed, Scopus, and Web of Science (January 1995-October 2024), combining terms such as "restorative reproductive medicine," "intrauterine adhesions," "myomas," "polyps," "hydrosalpinx," "endometritis," "BMI," "thyroid dysfunction," "microbiome," and "assisted reproductive technology." Inclusion criteria: studies on uterine/systemic factors affecting infertility, focusing on surgical/pharmacological RRM interventions and ART limitations. Exclusion criteria: male-only infertility, case reports, narrative reviews, non-English publications. Quality assessment employed the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool. We also briefly noted potential publication bias due to language and study-type restrictions.

Results: From >25,000 initial titles, 3 sequential screenings yielded 145 key articles addressing uterine (septum, myomas, polyps, adhesions) and systemic (body mass index (BMI) extremes, thyroid dysfunction, microbiome imbalance) factors. Surgical corrections (e.g., hysteroscopic removal of polyps/myomas, salpingectomy for hydrosalpinx) significantly improved natural conception and ART success (⩾20%-40% increase in clinical pregnancy). Chronic endometritis treatment, endometrial microbiome modulation, and BMI/thyroid optimization further improved pregnancy rates by 15%-20%. Comparisons of RRM versus ART alone indicated that RRM often lowers overall cost and may reduce miscarriage, while ART offers immediate embryo transfer. Combining RRM to correct pathologies prior to ART can boost implantation and live birth rates (⩾40%-70% improvement in some studies).

Conclusion: Restorative Reproductive Medicine comprehensively addresses pelvic and systemic abnormalities, thereby enhancing fertility outcomes and complementing ART. A proposed integrated model-RRM diagnostics/interventions followed by ART if needed-maximizes success, reduces time/cost, and emphasizes holistic reproductive health. Further multicenter trials are warranted to standardize protocols and fully realize RRM's potential in modern fertility care.

Background: Adverse birth outcomes associated with grand multiparity are more ambiguous than those linked to multiparity. The primary literature on this issue reveals inconsistent findings across various studies. A paucity of data is evident in systematic reviews and meta-analyses that assess adverse birth outcomes specifically for African grand multiparas.

Objectives: To address the pooled adverse birth outcomes and their associated factors among African grand multiparas.

Design: Systematic review and meta-analysis.

Data sources and methods: Studies were systematically searched from April 20, 2024, to June 15, 2024, using Scopus, Web of Science, PubMed, Science Direct, African Journal Online, and the Wiley Online Library. The Joanna Briggs Institute tool was used for a quality assessment of each primary study. Data were extracted using Excel and analyzed with Stata 11 software. A random-effects model was employed to calculate the pooled estimates. The paper employs appropriate statistical techniques to assess publication bias and heterogeneity, such as the symmetry of the funnel plot, Egger's test, and Cochran's Q test. The study addresses a critical public health issue in Africa, contributing valuable data that could inform policy and healthcare practices aimed at reducing adverse birth outcomes among grand multiparas. A subgroup analysis was performed based on the publication years.

Results: The pooled prevalence of adverse birth outcomes among African grand multiparas was 24.97%; 95% CI: 19.97-31.99. Pregnancy-related complications (AOR: 3.17; 95% CI: 2.35-4.28), a history of home births (AOR: 3.30; 95% CI: 1.70-6.40), and rural residence (AOR: 4.12; 95% CI: 3.12-5.44) were significantly associated with adverse birth outcomes among African grand multiparas.

Conclusion: Overall, the pooled prevalence of adverse birth outcomes among grand multiparas was comparably high. Variables such as rural residence, previous pregnancy-related complications, and a history of home births were significantly associated with adverse birth outcomes. Strengthening institutional births, providing high-quality prenatal care, and early pregnancy follow-ups are recommended to reduce adverse birth outcomes in grand multiparous women. In addition, improving the availability of comprehensive contraceptive options for rural-residing African grand multiparous women is essential.

Prospero registration: CRD42024569768.

Fertility preservation (FP) includes all the methods to preserve germ cells, reproductive tissues, or embryos for the future reproduction of patients at risk of infertility. Cryopreservation is an essential step of FP, storing the specimens in subzero temperatures to suppress cellular metabolism and restore cryopreserved specimens for future use. Although oocyte cryopreservation (OC) and embryo cryopreservation (EC) are two accepted methods of FP in women, ovarian tissue cryopreservation (OTC) is a novel method that is favorable in patients who are not appropriate candidates for OC and EC, and those who suffer from irritating menopause symptoms caused by estradiol deficiency. OTC has shown promising results in restoring fertility and the endocrine function of ovaries. Slow freezing and vitrification are two well-established methods for cryopreservation of biological specimens. Despite recent developments in the vitrification of ovarian tissue and comparable results to slow freezing, we lack a standard protocol for ovarian tissue vitrification, and slow freezing is still the preferred method in most centers. Under an acceptable medical condition and desirability, transplantation of cryopreserved tissue is performed either in orthotopic sites (orthotopic transplantation, OT) such as the original site of the ovaries and uterus, or heterotopic sites (heterotopic transplantation, HT) like abdominal wall, forearm, and peritoneal lining. Although both sites of transplantation are associated with endocrine function recovery, OT better restores fertility. This review will focus on OTC and its types, ovarian tissue transplantation, and efficacy in clinical practice.

Background: The rising rate of cesarean sections (CSs) has become a global concern due to its implications for maternal and neonatal health. The World Health Organization recommends that CS rates should not exceed 10-15% at the population level. However, many countries report rates well above this threshold.

Objectives: To evaluate CS rates using the Robson Ten Group Classification System (TGCS) and identify the major contributing groups to develop targeted strategies for reducing unnecessary cesarean deliveries.

Design: A retrospective clinical audit based on standardized classification and descriptive analysis.

Methods: This retrospective audit was conducted using hospital delivery records from January 1st to December 31st, 2022, at the Department of Obstetrics and Gynecology, Holy Family Hospital, Karachi, Pakistan. All CSs were categorized into 10 groups using the Robson classification system. Descriptive statistics were used to determine group size, CS rate within each group, relative contribution to the overall CS rate, and absolute group contribution.

Results: A total of 1464 deliveries occurred during the study period, including 507 CSs. Of these, 48.8% were elective and 51.2% were emergency CS. The major contributors to the CS rate were group 5 (51.9%), group 2 (18.5%), and group 10 (14.4%). The leading indications for cesarean delivery were previous CS (32.3%), non-progress of labor (21.15%), and cephalopelvic disproportion (16.92%).

Conclusion: Targeted strategies such as promoting vaginal birth after cesarean, implementing standardized labor monitoring protocols, and strengthening antenatal counseling can help reduce unnecessary CS while maintaining maternal and neonatal safety.

Background: Preeclampsia is a leading cause of maternal morbidity and mortality. Various predictive methods exist, but none are without flaws. Risk factors vary in different women and at different gestational ages; hence, investigating non-modifiable factors, such as ABO and Rhesus blood groups, may aid prediction and early detection of preeclampsia.

Objectives: This study aimed to evaluate the association between maternal ABO blood groups and preeclampsia.

Design: This was a prospective cohort study.

Methods: This study included singleton, normotensive, Rhesus-positive primigravidae with different ABO blood groups at <20 weeks of gestation. The primary outcome was the incidence of preeclampsia in mothers with Rhesus (D)-positive ABO blood groups (O, A, B and AB), while the secondary outcomes were the overall preeclampsia incidence and the odds ratio for preeclampsia between blood group O and non-O (A, B and AB) participants.

Results: A total of 264 participants were enrolled, with 244 followed up until delivery. Eighteen participants developed preeclampsia with an incidence of 7.4% (95% confidence interval: 3.9-10.7). Most participants had blood group O (57.0%), followed by A (29.5%), B (12.7%) and AB (0.8%). The mean gestational age at preeclampsia onset was 37.8 ± 2 weeks. Blood group AB had the highest incidence of preeclampsia (50%), followed by B (16.1%), O (5.8%) and A (5.6%). Among 105 participants with non-O blood groups, 10 developed preeclampsia (p = 0.265). The adjusted odds ratio for the non-O blood group who developed preeclampsia was 1.65.

Conclusion: Maternal ABO blood group was not significantly associated with preeclampsia incidence. However, blood group AB exhibited the highest preeclampsia incidence compared with the other blood groups.