Journal of reproductive health and medicine最新文献

Background

The relationship between utilization of quality health services and positive health outcomes is well documented, however in low resource settings there is both a shortage of quality services and low utilization of existing services. We assessed women and men's understanding of quality in health facilities and their application of this understanding in selecting place of delivery.

Methods

Ten focus group discussions (FGD) were held between May and December 2011 (five with women and five with men). The groups had 6–11 respondents. FGDs were conducted, recorded, and transcribed in Swahili then translated into English. Transcripts were analyzed using NVivo 9 software. Conceptual framework confirmatory analysis was conducted to compare results from FGDs with pre-existing frameworks for understanding health center quality in low resource settings.

Results

High education and positive attitude of delivery staff, close proximity to the health facility, availability of providers, and modern equipment were cited as reasons for facility delivery. Expectations of complications and better care led to seeking care at higher-level institutions. The one aspect of quality that men focused on more than women was disrespectful care and health worker attitude. The choice to deliver in a hospital versus a primary care clinic or at home was not always the woman's – it was greatly influenced by providers, the husband and the mother-in-law.

Conclusions

These results suggest that quality improvement efforts should focus on both technical and nontechnical aspects of care and target not just women, but those who influence their choice of delivery location.

Trial registration

ISRCTN17107760.

A survey of private and public sector maternity care providers was carried out to understand their perspective on use of current guidelines advocating selective use of episiotomy. Nearly 90% of the providers were aware of guidelines on selective episiotomy use but significantly higher proportion (p = 0.03) of private practitioners (56.6%) advocated its use in all nullipara as compared to public sector doctors (23.3%). In actual practice, however, nearly 80% providers reported performing episiotomy in more than 75% nullipara with no difference between private and public sector doctors. Thus, awareness of current evidence was not reflected in clinical practice.

Systemic lupus erythematosus (SLE) is a chronic, multi-organ autoimmune disease that occurs predominantly among reproductive age women. When SLE is newly diagnosed during pregnancy or puerperium, it is known as new-onset SLE during pregnancy. Delayed or missed diagnosis of new-onset SLE during pregnancy due to similar clinical manifestation of SLE with normal physiological changes of pregnancy and lupus nephritis with preeclampsia have drawn attention toward this topic. Furthermore, new-onset SLE during pregnancy has major organ involvement with poor maternal and fetal outcomes. Knowledge and awareness of this complex disease allows physicians to more effectively address and less likely for patient to suffer from misdiagnosis and inappropriate treatment. This article will briefly review important issues in new-onset SLE during pregnancy and describes challenges to overcome its diagnosis.

Introduction

Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. Contraception plays a major role in women's health. Increased number of institutional deliveries allows us to offer family planning methods to couples. Postpartum intrauterine devices (PPIUCD) are the reversible long acting method. It does not interfere with breast feeding and can be provided before the woman leaves the hospital. This study of acceptance of postpartum intrauterine device was conducted in tertiary care hospital in India.

Aim and objectives

To find out the (1) acceptance of PPIUCD CU T 380 A, (2) retention rate of PPIUCD and (3) spontaneous expulsion rate at end of 6 months of delivery.

Material and methods

PPIUCD was inserted in 680 women either after vaginal delivery or during caesarian section. Data analysis was done at the end of 6 months.

Results

(1) Insertion of PPIUCD amongst Para 2 was highest 375 (55.14%). (2) Retention rate was 86.33%. (3) Spontaneous expulsion was found in 55 (8.54%) women. (4) Bleeding was the main symptom perceived by 249 (88.71%) women followed by long thread 73 (26.02%) and pain in lower abdomen 45 (15.90%). (5) Total 361 (61.29%) women were satisfied and were continuing the method.

Conclusion

Retention rate of PPIUCD was high. Spontaneous expulsion in intra-caesarian IUCD was less as fundal placement was assured at the time of insertion. Bleeding problems were the major complaint and the main reason for removal of PPIUCD.

This review article has comprehensively covered the benefits of uterine ligation simultaneous laparoscopic myomectomy in the views of operative time, operative blood loss, hospital stay, recurrent rate and symptoms relief in recent articles. The information has been derived from medical database such as SprinkerLink, DOAJ, CINAHL, EBSCO delivery system, PubMed-NCBI, Sciencedirect, HighWire, Web of Science and ProQuest. There were only 3 articles which met my research criteria. The positive result of combined operation was reduction of operative blood loss for all studies. But 2 articles showed the operative time in combined operation more than single procedure. One study had a better percentage of symptom relief in a group of combined operation and tendency to decline in recurrent rate. However other articles revealed no difference in recurrent rate and pregnancy rate in both groups. Nowadays we still need more information from further randomized controlled trial studies to prove the hypothesis of benefits and risks of this add-on procedure.

Uterine leiomyoma is a common uterine tumor. Because it is a benign uterine tumor, its variants are often underreported by histopathologists. Lipoleiomyoma (LL) is a very rare variant, currently increasingly reported due to increased awareness. Imaging studies can help to locate this tumor but it seldom helps in diagnosing the same. Most of such cases are incidentally/retrospectively reported on gross examination and histopathology after hysterectomy. We report a rare case of lipoleiomyoma occurring in a postmenopausal thin woman with deranged lipid profile.

Background/aims

Timed administration of endometrial scratching in natural cycles followed by IVF-ET reportedly yields improved clinical pregnancy in women. In the present study, we have examined the issue of endometrial transcriptomic response in natural cycles preceding to the intervention cycles of IVF-ET to explore the differences, if any, in transcript expression profiles between those who conceived and those who did not following endometrial scratching in IVF-ET.

Methods

Patients (n = 25) undergoing autologous IVF-ET cycles with history of failed IVF-ET/ICSI cycles underwent endometrial scratching and sampling during 12–18 day of untreated cycles preceding to intervention. Each patient was monitored for pregnancy outcome using the routine protocol. Each sample was subjected to whole genome expression array experiment (n = 20) followed by exploratory and differential display analysis.

Results

Endometrial whole genome transcriptomics of two groups (pregnancy positive, n = 10; pregnancy negative, n = 10) revealed that samples mutually clustered primarily based on pregnancy outcome. The secretory maturation of endometrium was seen to involve pathways related to oxidative phosphorylation, ubiquinone metabolism, cellular adhesion, skeletal and motor activities, and transcription and translation regulation. Additionally, genes related to neurogenesis and synaptogenesis, chemokines associated with cell adhesion, and developmental signalling were up-regulated in samples obtained from pregnancy-positive women. Further, patients with affected endometrial expression of genes involved in gynaecological neoplasm and transcriptional dysregulation in natural cycles did not conceive in IVF-ET.

Conclusion

Transcriptomic expressions in endometrium yielded information with predictive value of pregnancy outcome following endometrial scratching in women with history of repeated implantation failure upon IVF-ET.

Background

Blastocyst hatching is a prerequisite for successful implantation. Knowledge on this phenomenon is scarce in humans and the available information stems from studies on rodents. In hamsters, we earlier showed that embryo-derived cathepsin (Cat) proteases (Cat-L, -B and -P) are involved in blastocyst hatching and it is governed by a few molecular regulators. Here, we assessed the involvement of NF-κB signaling in blastocyst development and hatching.

Methods

Hamster embryos, recovered from super-ovulated hamsters, were cultured in the absence or presence of NF-κB inhibitors (BAY-11-7082 or JSH-23). Development through peri-hatching stages and hatching rates were scored. Embryonic mRNA and protein expressions analyzed for NF-κB and Cats (-L, -B, -P); their levels correlated with hatching rates; their cellular immuno-localizations were examined.

Results

Transcript and protein expression of NF-κB components (IKK, Rel-A and IκB-b) were observed in 8-cell embryos through hatched-blastocysts. The NF-κB inhibitors (BAY-11-7082 and JSH-23) inhibited blastocyst hatching in a dose-dependent manner; percentages being 37.8 ± 3% and 36.5 ± 2.8%, respectively; >90% hatching in untreated-controls. NF-κB inhibition lead to a peri-hatching inflated-state of blastocysts, in contrast to deflated-state observed with control blastocysts. Also, NF-κB signaling inhibition-mediated reduction in hatching rates were accompanied by significant reductions in transcript and protein levels of Cat-L, -B and -P.

Conclusion

We conclude that NF-κB signaling components are expressed during peri-hatching blastocyst development and that it is important for blastocyst hatching. Our results provide the first evidence for the involvement of NF-κB transcription-factor in mammalian blastocyst hatching phenomenon.