Women's health reports (New Rochelle, N.Y.)最新文献

Objective: To ascertain the impact of marginal sinus on the risk of antepartum, intrapartum, and postpartum hemorrhage in women with a low-positioned placenta.

Data sources: PubMed, Scopus, EMBASE, and the Cochrane Library databases (1980-2024).

Study selection: Systematic reviews and quantitative primary research studies reporting a diagnosis of low-positioned placenta with the presence or absence of marginal sinus. Outcome measures: antepartum, intrapartum, and postpartum hemorrhage.

Data extraction and synthesis: Of the 8140 articles screened for eligibility, 171 were sought for full-text review, and 6 were included for analysis. The systematic review comprises six cohort studies, two prospective and four retrospective, for a total of 621 women with a low-positioned placenta. Five studies assessed the impact of marginal sinus on antenatal hemorrhage, two examined its influence on intrapartum hemorrhage, and one study also evaluated postpartum hemorrhage.

Conclusions: The studies displayed adequate representativeness of exposed individuals. Limitations included retrospective design with a small sample size, different gestational ages at diagnosis of low-positioned placenta, and substantial heterogeneity in outcomes.

Abstract: Among the five studies examining the relationship between marginal sinus and antepartum bleeding, a significant association was reported in four, while one found no such link. The only two studies examining the relationship between marginal sinus and intrapartum hemorrhage reported no association. Additionally, one of these studies identified lower rates of postpartum bleeding in women with normally located placental tissue and a marginal sinus reaching the internal os, compared with women with low-positioned placental tissue. The risk of bleeding in women with a low-positioned placenta and marginal sinus is still poorly evaluated. The evidence from the included studies lacked consistency and conclusive findings, highlighting the need for further research to elucidate this association and inform clinical management effectively. Additionally, studies failed to address the significance of marginal sinus in diagnosing and managing low-positioned placenta.

Introduction: Childhood trauma (CT) is associated with chronic widespread pain and high rates of pain sensitization, which are typical of fibromyalgia (FM), and with FM itself. The present investigation was twofold: it analyzed the prevalence of single types and cumulative types of CT in a Spanish sample of women diagnosed with FM with depressive symptoms.

Methods: A reanalysis of data gathered at baseline for a randomized clinical trial of treatment methods for depression in 104 women with FM and depressive symptoms was conducted using the reanalysis data of the self-reported Childhood Trauma Questionnaire Short Form before treatment.

Results: This study included higher and lower thresholds for identifying CT. Prevalence varied according to the threshold used; lower thresholds highlighted emotional neglect (52%) as higher than all other single subscales, followed by emotional abuse (42%), sexual abuse (42%), physical neglect (30%), and physical abuse (27%). At higher thresholds, emotional abuse was the highest (37%), followed by sexual abuse (31%), physical neglect (30%), physical abuse (27%), and emotional neglect (26%).

Conclusions: This study's results show that CT assessment is a necessary component of intake protocols for patients with FM.

Background: This study aimed to identify the determinants of antenatal care (ANC) utilization among reproductive-aged women in Somaliland. Understanding these factors is crucial for improving maternal health. This study utilized data from the 2020 Somaliland Demographic Health Survey (SLDHS), which encompasses urban, rural, and nomadic residencies across six geographic zones in Somaliland.

Methods: This cross-sectional study included 2741 women aged 15-49 based on data from the SLDHS 2020. The primary outcome variable was ANC utilization, which was measured as a binary variable (utilization vs. nonutilization). Descriptive statistics and binary logistic regression analyses were conducted to identify the factors associated with ANC utilization.

Results: The study found that higher maternal education levels (adjusted odds ratios [OR] = 2.15, 95% confidence interval [CI]: 1.47-3.14), urban residence (adjusted OR = 1.36, 95% CI: 1.09-1.70), higher household wealth quintiles (adjusted OR = 3.45, 95% CI: 2.50-4.76), husband's education level (adjusted OR = 1.87, 95% CI: 1.36-2.56), and exposure to mass media (adjusted OR = 1.75, 95% CI: 1.32-2.31) were significantly associated with increased ANC utilization.

Conclusion: Education, economic status, and accessibility are the key determinants of ANC service uptake in Somaliland. These findings provide valuable insights for health planners and policymakers aiming to improve ANC utilization and maternal health outcomes in Somaliland.

Introduction: Self-injection (SI) for contraceptive use is recommended for its proven ability to empower women and overcome barriers to contraceptive access. The World Health Organization endorsed SI as a self-care approach in 2019. Despite the increase in Malawi's modern contraceptive prevalence rate from 38.1% in 2012 to 48.9% in 2020, it remains below the government's 60% target. Injectable contraceptives, including depot medroxyprogesterone acetate subcutaneous (DMPA-SC), introduced in 2018, are the most popular contraceptive method in Malawi, particularly among adolescents, representing 49.8% of the contraceptive method mix. However, utilization of SI remains limited, especially in rural areas where access challenges persist. This study explores the behavioral drivers influencing women's decision to use self-injectable contraception provided by community health surveillance assistants (CHSA) in rural Malawi.

Methods: Using the capability, opportunity, motivation-behavior model, the study analyzed drivers of DMPA-SC SI adoption among 60 women aged 15-45 years in two rural districts, Mulanje and Ntchisi. Data were collected through in-depth interviews on women's experiences with contraceptives, including SI.

Results: Women's capability was strengthened as CHSAs addressed initial hesitation through practical demonstrations. Opportunity improved through enhanced access, trust, and privacy. Motivation increased with counseling, reduced travel costs, and CHSAs' support, encouraging women to adopt self-injection confidently and consistently.

Discussion: Women's decisions to adopt SI were shaped by capability, motivation, and opportunity, with CHSAs playing a pivotal role. Future family planning programs should prioritize CHSAs' training and deployment to improve SI uptake, fostering autonomy and accessibility for rural women.

Background: Combined oral contraceptives (COCs) are essential for the well-being and reproductive health of millions of women globally. Despite their widespread use, concerns among clinicians persist about potential drug-drug interactions between antibiotics and COCs. This systematic review evaluates existing literature on the interaction between antibiotics and COC efficacy, offering guidance for clinicians in managing the use of contraception alongside antibiotics.

Materials and methods: Utilizing Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, a comprehensive literature search was conducted using PubMed, Clinical Trials.gov, Cochrane Library, and Google Scholar, focusing on studies published from 2000 to 2024. The search strategy was centered on peer-reviewed observational and experimental studies.

Results: Initial analysis of the databases resulted in 712 potential articles. Nine articles were chosen relative to specific inclusion and exclusion criteria. While most antibiotics did not compromise COC effectiveness, enzyme-inducing antibiotics, particularly rifampicin, significantly reduced COC efficacy.

Conclusion: Although common antibiotics pose minimal risk to COC effectiveness, clinicians should remain vigilant when prescribing enzyme-inducing antibiotics such as rifampicin. When these antibiotics are used, it is advisable to consider additional or alternative contraceptive methods to ensure continued pregnancy prevention.

Introduction: Well-woman exams (WWEs) are important preventive health care; however, many do not regularly receive these exams. Understanding barriers to timely care is important in improving health care delivery and health outcomes.

Methods: We conducted a panel survey of 1000 U.S. females 18-30 years of age. Barriers to gynecological care were assessed in four domains: financial, practical, procedural, and health care provider related. Differences between groups were assessed using t-test and analysis of variance, and logistic regression was used to examine the association between barriers and delayed care.

Results: Respondents were on an average 24.5 years old and the majority were White, non-Hispanic (63%). Respondents were categorized by WWE screening status: never screened (24%), delayed screening (>1 year) (30%), and on-time screening (46%). Those who had delayed WWE expressed higher practical, procedural, and provider barriers compared with those with on-time exams. After adjusting for other barrier types and sociodemographic characteristics, lack of insurance was associated with more than twice the odds of delayed WWE (odds ratio [OR]: 2.61 95% confidence interval [CI]: 1.41-4.92) and a one-point increase in the provider barriers mean scale was associated with nearly 60% increased odds (OR: 1.59; 95% CI: 1.16-2.17) of having delayed WWE.

Conclusions: The patient experience with the health care provider, along with insurance coverage, is significantly associated with delayed WWE. These results indicate that in the presence of insurance coverage, providers have a significant role in creating an environment that supports the timeliness of WWE in young adult patients.

Background: Vaginal self-collection offers an effective option for cervical cancer (CC) screening that can improve screening experiences and engagement.

Objective: This article presents data from a multi-center pilot study (n = 185) across the United States, evaluating experiences and preferences reported with an at-home self-collection device compared with clinician-collected screening using a speculum. The device is designed specifically for at-home self-collection and optimized for performance and usability, where collected samples are tested for high-risk human papillomavirus (hrHPV) using the Roche cobas HPV test. In an earlier report, self-collected samples using this device showed high agreement for hrHPV detection when compared with clinician-collection with a speculum and cervical brush.

Study design: Participants were screened with a self-collection device and a clinician-collection. They provided feedback about their experiences via usability and preference surveys.

Results: Significantly more participants reported pain (p < 0.001), discomfort (p < 0.001), embarrassment (p < 0.001), and nervousness (p < 0.001) during clinician-collection compared with self-collection. In contrast, being at-ease (p < 0.001) and in-control (p < 0.001) were reported significantly more during self-collection. Similar patterns held across demographic groups relevant to CC screening engagement and related risk (i.e., sexual orientation, menopause status, income, and prior HPV diagnosis). Almost all (94% [156/166]) felt confident using the at-home self-collection device if they knew the results would be equivalent to clinician-collection. The device demonstrated wide usability, with 96% (163/170) successfully self-collecting using only the device's provided instructions.

Conclusion: By improving screening experiences and accessibility, at-home self-collection can increase screening participation and accelerate progress toward eliminating CC as a public health concern in the United States.

Background: Urinary incontinence (UI) and associated lower urinary tract symptoms (LUTS) are well documented in older, multiparous women, with established risk factors such as menopause, neurological disorders, and diabetes mellitus. However, emerging evidence indicates that young, nulligravid women without these traditional risk factors may also be affected. This study explores the prevalence, risk factors, and impact of UI and LUTS in this population.

Methods: A cross-sectional study was conducted using an anonymous online questionnaire adapted from the International Consultation on Incontinence Questionnaire for Female Lower Urinary Tract Symptoms and the Lower Urinary Tract Symptoms Quality of Life. Participants were women aged 18-25 years who had never been pregnant.

Results: Approximately one-third of participants reported experiencing UI (urge, stress, or mixed incontinence), whereas 45.9% reported at least one LUTS without UI. Significant associations were identified between UI and increased body mass index (p = 0.007), smoking (p = 0.018), and recurrent urinary tract infection (p = 0.004). Toilet behaviors, such as delaying urination until bladder fullness, were also significantly associated with UI. Logistic regression analysis identified key predictive risk factors for UI: being overweight or obese (odds ratio [OR] = 1.88, confidence interval [CI] = 1.22-2.90), smoking (OR = 3.07, CI = 1.32-7.12), and delaying bladder emptying (OR = 2.99, CI = 1.63-5.47). Women with UI self-reported significant bother from symptoms, particularly those with overactive bladder (urge incontinence: 72.3%, urinary urgency: 53.6%, and nocturia: 55.4%). Quality of life was notably impacted, with 28.3% of participants with urge incontinence requiring daily pad use. Despite this, the majority (85.1%) did not seek medical care.

Conclusions: UI and LUTS are prevalent in young nulligravid women, with modifiable risk factors such as lifestyle habits and toilet behaviors playing a critical role. These findings highlight the need for community awareness programs and proactive patient education during clinical encounters, as affected women are unlikely to seek medical advice voluntarily.

Objective: This research seeks to establish comprehensive baseline data on the normal anatomical features of the uterus and ovaries in a cohort of healthy Indonesian subjects.

Methods: This research was a retrospective study employing 500 ultrasonography results from various gynecological examinations conducted between 2021 and 2024. The ultrasound record serves as a basis for diagnosis and the definition of inclusion criteria. A morphometric analysis will be performed on the uterus and ovaries of the subject.

Results: The study sample comprised 121 healthy women from reproductive age to menopause, examined using ultrasonography. Significant differences in uterine volume (p < 0.05) were observed between the 21-30 age group and the 31-40, 41-50, 51-60, and >60 age groups. Furthermore, differences in ovarian volume were observed between the right and left ovaries, as well as between women of reproductive age and those who are menopausal.

Conclusion: This study on ovarian and uterine volumes in Indonesian women offers significant insights into reproductive health, highlighting age-related changes and prospective improvements in diagnostic accuracy.

Objective: Patient-centered care is a core value of both Family Medicine and Obstetrics & Gynecology. We sought to know if patients prefer being offered a mirror to see their cervix and external genitalia during asymptomatic speculum exams (Mirror Pelvic Exam, MPE). Additionally, we explored clinicians' (medical assistants, residents, and faculty) opinions about offering patients a mirror during exams.

Methods: The patient portion was a cross-sectional mixed-methods survey of people presenting for cervical cancer screening at a residency-based Family Medicine Clinic. Patients took a presurvey, were offered a mirror to see their external genitalia and/or their cervix during the exam, and then took a post-survey. The clinician portion was a mixed-methods survey given at the initiation of the study and after the four-month patient survey period.

Results: While only half the patients (n = 22) accepted the use of a mirror, the majority preferred being offered and felt offering a mirror should be a routine part of the well-exam. Being offered a mirror did not bother anyone. Free responses further emphasized that patients preferred being offered the MPE. Over half of clinicians (n = 51) felt the MPE was a good idea, but only a third felt it would improve patient satisfaction. Some did not offer the MPE due to thinking patients would not want the option, lack of comfort with the MPE, or concerns about slowing down clinic flow.

Conclusion: Patients prefer being offered the MPE while clinicians did not have insight into patients' preferences. Our results suggest clinician perceptions about offering the MPE are a barrier to the MPE as a standard of care.