BMC Women's Health最新文献

Introduction: IUDs are effective, reversible and safe methods of contraception. The mechanism of action of IUDs as a group is inducing endometrial atrophy, apoptosis, altering tubal motility; preventing sperm permeability, fertilization, and implantation. Complications of IUD include menstrual disturbance, pelvic pain, and increased risk of ectopic pregnancy with contraceptive failure, device expulsion, uterine perforation or transmural migration with misplacement of the device. Pregnancies and IUD migration are uncommon complications, occurring in 1 to 2 from 1,000 users. The clinical presentation of migrated IUDs depends on the final anatomic location at diagnosis. Migration can be asymptomatic and incidentally found while imaging for any other diagnosis or may have various acute clinical presentations.

Case presentation: We present the case of a 38-years-old Ethiopian woman with unusual migration of IUD to the infra-umbilical skin. She had infra-umbilical skin discoloration associated with intermittent itching for two months duration. On physical examination, there was diffuse violaceous patch over the infra-umbilical skin measuring 7 centimeters on its longest dimension and visible foreign body (IUD) with tiny sinus tract formation. Visible stem of copper-containing IUD was grasped by ring forceps and removed with gentle traction without complication during or following extraction. Removal of misplaced IUD with completely non-invasive manner makes this case special in addition to the unique site of migration to the infra-umbilical skin.

Conclusion and recommendation: To our knowledge, this is what likely to be the first reported case of IUD migration to the infra-umbilical skin which bestows a new finding to the existing literatures. Despite rare occurrence, possible IUD complications should be included in the informed consent process before insertion. Self-examination of the strings and vigilant evaluation at regular checkup is recommended for early detection of migrated IUDs.

Background: Recently, there have been an increasing number of reports on the association between inflammatory markers and the prognosis of malignant tumors. However, the current inflammatory indicators have limited accuracy. We aimed to develop a new scoring system for predicting endometrial cancer recurrence using inflammatory markers, tumor markers, and histological diagnoses.

Methods: Patients with primary, previously untreated, and suspected endometrial cancer who underwent surgery at the Nara Medical University Hospital between January 2007 and December 2020 were included and followed up until March 2024. Items were divided into positive and negative using scores based on cutoff values and placed into the new scoring system, the endometrial tumor-related (ETR) score.

Results: We found that positive postoperative histological examination of lymph node metastasis and myometrial invasion, high levels of carcinoembryonic antigen and D-dimer in preoperative blood tests, and a large difference in preoperative and postoperative white blood cell counts were significantly associated with recurrence. The sensitivity and specificity of recurrence prediction using the ETR score were not inferior to those using the International Federation of Gynecology and Obstetrics staging system, which is considered the best prognostic factor for survival.

Conclusions: The ETR score is a significant prognostic marker of recurrence in patients who have undergone staging surgery, with complete surgical tumor removal.

Background: Age-related cataract (ARC) is among the most common blinding eye disorders among the elderly. Prenatal nutrition may cause irreversible damage to the development of the ocular crystalline lens. Nevertheless, the potential association between prenatal malnutrition and age-related cataract has not been thoroughly examined. We investigated the prevalence of cataract at the age of 60 after prenatal exposure to Chinese famine (1959-1961) and particularly evaluated whether there was a disparity in this effect between men and women.

Methods: We utilized the health examination medical record system of a large-scale comprehensive hospital to screen individuals born in Chongqing, China and undergoing eye health examinations. Participants were categorized based on their year of birth into the famine-exposed group (1960) and the non-exposed group (1963), with their medical records at age 60 extracted from the database. Univariate and multivariate logistic regression analyses were conducted to investigate the association between famine exposure and the risk of developing ARC by age 60.

Results: The prevalence of ARC was significantly higher in the famine-exposed group (60.26%) compared to the non-exposed group (47.90%) (P < 0.001). After adjusting for diabetes history, body mass index (BMI), fasting blood glucose (FBG) level, and high-density lipoprotein (HDL) level using multivariate logistic regression analysis, the risk of ARC remained significantly higher in the famine-exposed group (OR:1.63; 95%CI:1.31-2.03). Subgroup analysis by sex indicated that women exposed to famine (OR: 1.77; 95% CI: 1.25-2.52) exhibited a higher risk of ARC compared to men (OR: 1.53; 95% CI: 1.16-2.03).

Conclusions: Prenatal exposure to famine might increase the risk of ARC among Chinese adults at age 60, and women exhibit a higher susceptibility than men.

Objective: This study aimed to analyse the correlation between the expression of cell proliferation-associated antigen (Ki-67), cell cycle protein-dependent kinase 4 (CDK4), epidermal growth factor receptor (EGFR), tumour-infiltrating lymphocytes (TILs) and circulating tumour DNA (ctDNA) with the outcome and prognosis of patients with breast cancer (BC) undergoing neoadjuvant chemotherapy (NACT).

Methods: We retrospectively analysed the clinicopathological data of 231 patients with BC who underwent preoperative NACT at XX Hospital between 1 January 2018 and 31 December 2021. Logistic regression models were used to analyse factors influencing NACT efficacy. The Cox risk regression model was used to analyse prognostic factors. The TILs were assessed on pre-treatment biopsies, and ctDNA levels were monitored during NACT. Propensity score matching and subgroup analyses were performed.

Results: After 4-6 cycles of chemotherapy, the response rate was 77.92% (180/231), with 58.87% (136/231) achieving pathological complete response (pCR). Multifactorial analysis showed that tumour, node and metastasis (TNM) stage II, EGFR positivity, low Ki-67 expression, CDK4 negativity, non-triple-negative subtypes and effective NACT results were associated with higher pCR rates. Higher TIL levels correlated with increased pCR rates (72.4% for high TILs vs 39.1% for low TILs, p < 0.001). The ctDNA levels decreased significantly in patients with pCR compared with patients without pCR during NACT (p < 0.001). After propensity score matching, the 3-year disease-free survival rate was significantly higher in the pCR group (88.9% vs 71.1%, p = 0.003). Subgroup analysis revealed varying pCR rates and predictive biomarkers across BC subtypes.

Conclusion: The TNM classification, EGFR, Ki-67, CDK4 expression, BC subtype and NACT results have predictive value for pCR in patients with BC. Lower TNM classification, lower Ki-67 expression and EGFR positivity are associated with better outcomes. High TIL levels and significant decreases in ctDNA during NACT correlate with improved response and prognosis. These findings highlight the potential for integrating traditional clinicopathological factors with novel biomarkers for personalised treatment strategies in BC.

Purpose: Previous studies have suggested a link between serum progesterone levels on the day of the HCG trigger in IVF cycles and oocyte and embryo quality. This study aims to explore this relationship more thoroughly.

Methods: This study included 496 infertility patients at Moloud Infertility Treatment Center, Zahedan, Iran. Statistical methods were used to assess factors such as oocyte maturation and embryo quality, fertilization rate, BMI, and gonadotropin dosage.

Results: While an initial progesterone cutoff of 1.2 ng/ml was used to perform fundamental analysis, a more accurate cutoff of 1.54 ng/ml was identified, beyond which the average number of M1 oocytes significantly declined. A strong relationship was found between higher progesterone levels and a greater number of retrieved oocytes (p = 0.004), with M1 oocytes showing a similar relation. Also, BMI was significantly related to the quality of eight-cell grade B embryos (p = 0.006). However, no significant correlations were found between progesterone levels and other factors, including patient age (p = 0.327), fertilization rate (p = 0.603), or embryo quality at other stages.

Conclusions: The findings demonstrate that elevated progesterone level, particularly beyond the identified cutoff of 1.54 ng/ml, is a valuable clinical indicator of suboptimal IVF outcomes due to its negative impact on oocyte maturation.

Background: Endometriosis, a condition that significantly impacts the quality of life for affected women, manifests with a spectrum of symptoms ranging from mild discomfort to severe pelvic pain, dysmenorrhea, dyspareunia, and infertility. A previous single-center study suggested an elevated prevalence of endometriosis in Jordan, prompting the need for larger studies to confirm these findings.

Methods: We conducted a cross-sectional study involving a sample of 866 women who underwent various laparoscopic procedures for different indications at the Department of Obstetrics and Gynecology at Jordan University Hospital and Al-Karak Governmental Hospital, two tertiary referral hospitals in Jordan between January 2015 and March 2023.

Results: Our study included 866 patients who underwent gynecological laparoscopic surgery between 2015 and 2023, with a mean age of 33.80 ± 7.7 years. Of these, 89 women were diagnosed with endometriosis, resulting in an overall prevalence of 10.3%. Diagnostic laparoscopy was the most common procedure, performed on 28.4% of patients. Infertility was the most common indication, observed in 34.5% of patients. Endometriosis was significantly more prevalent in patients with chronic pelvic pain (29.7%) and less prevalent in those seeking treatment for infertility (13.8%), ectopic pregnancy (1.1%), and family planning (0%). Endometriosis was significantly less prevalent in patients undergoing laparoscopic salpingectomy or salpingostomy (3.7%). Backstep-wise multivariate regression analysis suggested that endometriosis may be associated with higher age (OR 1.04, 95%CI 1.00 to 1.07, p = 0.027), lower BMI (OR 0.92, 95%CI 0.87 to 0.98, p = 0.007), lower number of parities (OR 0.72, 95%CI 0.6 to 0.86, p < 0.001), and fewer cesarean sections (OR 0.53, 95%CI 0.32 to 0.87, p = 0.013).

Conclusion: This is the most extensive Jordanian study assessing the prevalence of endometriosis in women undergoing gynecological laparoscopy. Our results suggest that the prevalence of endometriosis among Jordanian women remains high, albeit lower than previously reported. The study uncovered that age, BMI, parity number, and cesarean sections are predictors of endometriosis. Future research may explore causative reasons for the higher prevalence of endometriosis and the influence of other comorbidities, medications, and lifestyle factors.

Background: Research shows a decline in physical activity (PA) in women during the menopause transition (MT). Therefore, the purpose of this study was to explore experiences of the MT in Irish women and how it impacts motivators, facilitators, and barriers to PA engagement.

Methods: Twelve Irish women (age: 49 ± 4 years) who were in the MT participated in individual, online, semi-structured interviews. During each interview participants were asked about their experience of the MT and its influence on PA engagement to identify motivators, facilitators and barriers. All interviews were digitally recorded and transcribed verbatim, resulting in ≈ 72,610 words for descriptive and thematic analysis.

Results: The MT had a notable influence on PA engagement in Irish women. The main motivators to engage in PA throughout the MT included managing menopause symptoms, optimising future health, the opportunity for social engagement and rewards, as well as relatable role models. Many women discussed that menopause fraternities focused on community and collective experience, adapting and modifying PA, and medical supports were key factors that facilitated engagement in PA throughout this life stage. There were a multitude of barriers that women in midlife faced before they could engage in PA, such as perceived reduced capability, symptoms associated with the MT, the busyness of life and competing demands, as well as a lack of supportive environments.

Conclusion: The motivators, facilitators, and barriers to PA engagement throughout the MT are unique. These factors are important considerations for stakeholders when facilitating women to either continue or (re)introduce PA during this life stage.

Background: This study investigates acculturative stress and its impact on psychological distress among Mexican immigrant women in the United States, with a particular focus on contextual factors shaping these acculturative stress experiences. It also seeks to provide actionable insights to address Mexican immigrant women's mental health needs.

Methods: Using the data from a total of 257 Mexican immigrant women in the National Latino Asian American Survey (NLAAS), path analysis was conducted to examine the relationships between acculturative stress, psychological distress, and various contextual factors.

Results: Acculturative stress was found to significantly contribute to psychological distress among Mexican immigrant women. Key factors affecting acculturative stress include contentment with the decision to move to the United States, English language proficiency, experiences of racial discrimination, difficulties associated with visiting family abroad, religiosity, and age at immigration. Critical determinants of psychological distress in the studied cohort, according to the results, are familismo values and racial discrimination.

Conclusion: The results of this study underscore the need to consider contextual factors in understanding and addressing acculturative stress and psychological distress among Mexican immigrant women. Practical and policy implications include the necessity to develop culturally sensitive interventions, enhance educational opportunities, improve access to mental health services, and implement anti-discrimination policies. By adopting these strategies, mental health professionals and policymakers can foster resilience, wellbeing, and successful integration of Mexican immigrant women in the U.S. society.

Background: Globally, there has been an explosive rise in the cesarean section rate that exceeds the World Health Organization rate of 10-15% and in the past fifteen years the rates was doubled in some countries including Ethiopia. Therefore, it is essential to recognize the current magnitude and the factors that contribute to increasing cesarean section rates beyond the World Health Organization recommendations and specifically in the study areas.

Objective: This study aimed to assess the magnitude of cesarean sections and its associated factors among mothers who gave birth in public hospitals in East Wollega Zone, Oromia Ethiopia 2022.

Methods: A Facility-based cross-sectional study design supplemented by the qualitative study was conducted among 403 mothers, and an in-depth interview was held with purposefully selected 18 post-cesarean section mothers who gave birth at public hospitals. The study subject for quantitative data was selected by a systematic random sampling method. Face-to-face interviews and a chart review checklist were used for data collection. Data were entered into EPI Data Version 3.1 and analyzed by SPSS version 25 for quantitative data and thematic analysis for qualitative data. Bivariate and multivariable logistic regression was used to assess the association between dependent and independent variables. Variables that were statistically significant at bivariate logistic regression with a p-value < 0.25 were entered into the multivariable logistic regression. Statistical significance was declared at a p-value less than 0.005 RESULT: The finding of this study revealed that the magnitude of the cesarean section was 31.5% (95% CI: 27.4%-36.5%). Factors such as living in an urban area (AOR = 2.87, 95%CI (1.63,5.05)), a mother who attained college and above (AOR = 3.48, 95% CI (1.72, 7.06)), being a referred mother (AO R = 2.27, 95% CI (1.31, 3.94)), being induced labor (AOR = 4.83, 95% CI (1.93,12.06)) and lack of antenatal care follow up (AOR=7.84, 95% CI (4.26, 14.44)) were significantly associated with an increased likelihood of cesarean section.

Conclusion: and Recommendation The study indicates a high cesarean section rate that exceeds the World Health Organization recommendation 10-15%. Therefore, improving antenatal care, referral systems, and labor induction management needs concern to mitigate unnecessary cesarean deliveries.

Background: Adolescent girls and young women (AGYW) are disproportionately affected by HIV. Globally, in 2022, an estimated 4000 AGYW 15-24 were newly infected with HIV weekly, and nearly 78% of these infections occurred in sub-Saharan Africa. Oral Pre-Exposure Prophylaxis (PrEP) is a key HIV prevention option within an overall HIV combination prevention approach with an efficacy of over 90% when taken correctly. However, uptake of and adherence to PrEP remains low, particularly among AGYW. This scoping review aims to map available evidence on factors that limit PrEP use among AGYW in Eastern, Southern, and Western African countries to inform research, policy, and practice on delivery of PrEP. Our review identified factors that affect PrEP journey among AGYW along the HIV prevention cascade.

Methods: Guided by Arksey and O'Malley framework and using the PRISMA extension for scoping reviews, we searched the Web of Science, Global Health, and PubMed databases. Our review focused on oral PrEP, specifically papers reporting on barriers to PrEP experienced by AGYW, and peer-reviewed English-language articles published between 2012 and 2023.

Results: Of 1063 papers screened, 25 were included. Over half (60%) of the studies were qualitative; 72% were conducted in Kenya and South Africa. The barriers affecting motivation were, fear of side effects and pill burden, percieved low HIV risk, perceived stigma, PrEP use disapproval from parents and partners. PrEP access was limited by healthcare providers' stigma, isolated clinic setup, and lack of resources. Effective PrEP use was limited by a lack of parental or partner support, stigma, and lifestyle changes.

Conclusions: Adolescent girls and young women face multiple and often intersecting barriers to effective PrEP use with stigma being a factor cross-cutting all steps of the prevention cascade. Similarly, lack of social support, reflected through disapproval and judgmental attitudes and low HIV risk perception, also affected two steps of the prevention cascade. Our review identified gaps in available evidence, with most studies conducted in only two countries and few quantitative studies available. Improving PrEP uptake and adherence requires interventions that address barriers across the cascade, with a particular focus on stigma and social support.