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Hysteroscopic alterations in women with infertility or recurrent spontaneous abortion in case of normal transvaginal ultrasonography 经阴道超声检查正常的不孕症或复发性自然流产妇女的宫腔镜改变
Pub Date : 2023-05-12 DOI: 10.1097/GRH.0000000000000070
Ya-nan Zhang, Peng Liu, Dan Qi, Sheng-rui Zhao, Zi-jiang Chen, Ting Han, Lei Yan
Introduction: Whether hysteroscopy should routinely be conducted before embryo transfer remains uncertain especially when transvaginal ultrasonography (TVS) is normal. We aimed to investigate the hysteroscopic findings for patients with infertility or recurrent spontaneous abortion and with normal TVS. Methods: Patients who underwent TVS and hysteroscopy in the hospital from January 2014 to May 2019 were enrolled. Propensity score matching (1:1) was carried out for TVS positive and negative result groups. The positive results of hysteroscopy in the primary and secondary infertility patients were further compared. The prevalence rates of various diseases in different age groups were summarized and analyzed. Results: A total of 1532 individuals were enrolled in the study group and 19,118 cases in the control group. A total of 1495 cases with TVS positive results were matched using propensity score matching (1:1). The prevalence of uterine diseases in the TVS positive group was significantly higher than that in the TVS negative group (P<0.001).The prevalence of endometrial polyps and endometrial hyperplasia in patients with primary infertility was significantly higher than that with secondary infertility (P<0.001). The diagnostic sensitivity of TVS for major uterine cavity diseases, confirmed by hysteroscopy was relatively low (12.7%; 11.9%–13.6%). Conclusions: Hysteroscopy can detect a considerable number of uterine lesions even after normal TVS results. The sensitivity of TVS for the diagnosis of intrauterine lesions is relatively low. We suggest that hysteroscopy be recommended for patients with infertility or recurrent spontaneous abortion.
引言:在胚胎移植前是否应常规进行宫腔镜检查仍不确定,特别是当经阴道超声检查(TVS)正常时。我们的目的是探讨不孕症或复发性自然流产和TVS正常患者的宫腔镜表现。方法:选取2014年1月至2019年5月在该院接受TVS和宫腔镜检查的患者。TVS阳性和阴性结果组进行倾向得分匹配(1:1)。进一步比较原发性和继发性不孕症患者宫腔镜检查的阳性结果。总结并分析了不同年龄组各种疾病的患病率。结果:研究组共入组1532例,对照组入组19118例。采用倾向评分匹配(1:1)对1495例TVS阳性病例进行匹配。TVS阳性组子宫疾病患病率明显高于TVS阴性组(P<0.001)。原发性不孕症患者子宫内膜息肉和子宫内膜增生的发生率明显高于继发性不孕症患者(P<0.001)。TVS对宫腔镜确认的重大宫腔疾病的诊断敏感性较低(12.7%;11.9% - -13.6%)。结论:宫腔镜在TVS检查结果正常的情况下,仍能检出相当数量的子宫病变。TVS对宫内病变的诊断敏感性较低。我们建议对不孕症或反复自然流产的患者行宫腔镜检查。
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引用次数: 0
Use of autologous adipose-derived mesenchymal stem cells for ovarian rejuvenation in poor responder IVF patients: a phase 1 randomized placebo-controlled double-blind crossover study 自体脂肪间充质干细胞用于低反应IVF患者卵巢再生的1期随机安慰剂对照双盲交叉研究
Pub Date : 2023-04-13 DOI: 10.1097/GRH.0000000000000068
Mohamed Iqbal Cassim, T. Mohamed, J. Adam, C. Niesler, A. Chikandiwa
Background: Despite the application of various methods to augment ovarian responsiveness, the management of poor ovarian responders remains challenging and pregnancy rates following in vitro fertilization are poor. Advances in adult stem cell research and their clinical application has prompted interest in their use in assisted reproduction. We report the first double-blind, randomized, placebo-controlled clinical study using autologous human stromal vascular fraction (SVF) containing adipose-derived stem cells (ADSCs) for ovarian rejuvenation. Materials and methods: Thirty patients were recruited. Twenty-one had lower-than-expected reserves for their age and 9 had premature ovarian insufficiency. Patients were randomized into a placebo group (10) and an intervention group (20). SVF was obtained from adipose tissue following abdominal liposuction; the ADSC component was characterized using flow cytometry. Three equal insertions, adjusted based on ovarian volume, were performed at monthly intervals via an ultrasound-guided transvaginal needle puncture. The SVF was not cultured before transplantation. Those in the placebo group were then crossed over to the intervention group and received a single SVF (maximally concentrated) insertion (crossover group). Results: The median viable SVF cell number inserted per patient over 3 months, and the percentage of mesenchymal stem cells (MSC) thereof, was 1.6×106 and 13.2%, respectively. Resulting anti-Mullerian hormone (AMH) changes were variable over the treatment course with a notable placebo effect. Patients with premature ovarian insufficiency showed no change in AMH, both to intervention and placebo. Despite this, a temporary return of menses was noted in a third of patients while on treatment. Patients with low reserves for age showed an increase in AMH, although not statistically significant when compared to placebo. In the crossover group, insertions were limited to one intervention comprising all cells; here a significantly higher median of 3.4×106 SVF cells were injected containing an average of 16.9% MSCs. No significant change in AMH was noted. To date 12 patients have undergone ovarian stimulation and in vitro fertilization after stem cell therapy; of these 9 have had embryo transfers with a resulting pregnancy rate of 33%. There were also 2 spontaneous pregnancies. Conclusion: Although the application of SVF-derived ADSCs for ovarian rejuvenation remains experimental, the current study provides further support for the safety of this approach and presents encouraging results as to its efficacy in assisted reproduction.
背景:尽管应用了各种方法来增强卵巢反应性,但卵巢反应不良的管理仍然具有挑战性,体外受精后的妊娠率也很低。成人干细胞研究及其临床应用的进展促使人们对其在辅助生殖中的应用产生了兴趣。我们报道了第一项双盲、随机、安慰剂对照的临床研究,该研究使用含有脂肪来源干细胞(ADSCs)的自体人基质血管部分(SVF)进行卵巢再生。材料和方法:招募30名患者。21人的卵巢储备低于预期,9人患有卵巢早衰。患者被随机分为安慰剂组(10)和干预组(20)。SVF是从腹部抽脂后的脂肪组织中获得的;使用流式细胞术对ADSC组分进行表征。通过超声引导的经阴道穿刺,每月进行三次相等的插入,根据卵巢体积进行调整。移植前未对SVF进行培养。安慰剂组的患者随后被转移到干预组,并接受单一SVF(最大浓度)插入(交叉组)。结果:每个患者在3个月内插入的SVF细胞的中位活细胞数及其间充质干细胞(MSC)的百分比分别为1.6×106和13.2%。抗苗勒管激素(AMH)的变化在整个治疗过程中是可变的,具有显著的安慰剂效应。卵巢早搏功能不全患者的AMH在干预组和安慰剂组中均无变化。尽管如此,仍有三分之一的患者在接受治疗时出现月经暂时恢复。年龄储备低的患者AMH增加,尽管与安慰剂相比没有统计学意义。在交叉组中,插入仅限于包括所有细胞的一次干预;106个SVF细胞,平均含有16.9%的MSCs。AMH无明显变化。迄今为止,已有12名患者在干细胞治疗后接受了卵巢刺激和体外受精;其中9人进行了胚胎移植,妊娠率为33%。还有2例自然受孕。结论:尽管SVF衍生的ADSCs在卵巢再生中的应用仍处于实验阶段,但目前的研究为该方法的安全性提供了进一步的支持,并对其在辅助生殖中的疗效提出了令人鼓舞的结果。
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引用次数: 0
Oocytes collected from small follicles after a dual trigger with gonadotropin-releasing hormone agonist (Gn-RHa) and human chorionic gonadotropin (hCG) for final oocyte maturation, in poor responder patient do not impact negatively ICSI cycles outcomes 在低反应患者中,用促性腺激素释放激素激动剂(Gn-RHa)和人绒毛膜促性腺激素(hCG)双重触发最终卵母细胞成熟后,从小卵泡收集的卵母细胞不会对ICSI周期结果产生负面影响
Pub Date : 2023-03-03 DOI: 10.1097/GRH.0000000000000067
Samira Barbara, Amina Oumeziane, Fatima Nanouche, Karima Djerroudib, Nadjia Boucekine, N. Chabane, Nawal Tazairt, Ahlem Lacheheb, Samia Chemoul, Rachida Bourihane, S. Mouhoub, P. Devroey
Introduction: Follicles (FOs) of 16–22 mm produce more mature oocytes compared with small FOs as reported. In patients with poor ovarian response, late trigger results in premature luteinization, and an early trigger increases the number of immature oocytes. The purpose of this study was to demonstrate that metaphase II oocytes collected from FO of 11–15 mm results in similar pregnancy outcomes as metaphase II of oocytes collected from FO >16 mm when a dual trigger is used in patients with poor ovarian response. Materials and method: This was a prospective cohort study. A total of 122 patients were included according to the Bologna criteria for “poor ovarian responders”. From 2018 to 2020, controlled ovarian stimulation using antagonist protocols was used for ovarian stimulation. Two-dimensional ultrasound combined with hormonal assessment were used to monitor ovarian stimulation. Ovulation was induced with 0.2 mg gonadotropin-releasing hormone agonist and 5000 IU human chorionic gonadotropin when at least 1 FO ≥16 mm; 36 hours later, oocyte retrieval was performed. FO were collected separately. For all laboratory steps, oocytes were treated according to size FO. A single cleavage stage embryo was transferred. The luteal phase was supported with micronized progesterone. Excess embryos were cryopreserved according to FO size. If pregnancy did not occur, a single frozen embryo was replaced. Two groups of punctate FOs were analyzed: group 1 (G1) =246 FO size 11–15 mm, group 2 (G2) =238 FO size ≥16 mm. Results: In all, 122 cycles were started, 27 were cancelled. Forty-six fresh embryo transfers in G1 and 49 in G2 were performed, 31 frozen embryo transfers for G1 and 10 for G2. There were no significant differences in fertilization rate, clinical pregnancy rate (CPR), and live birth rate. Logistic regression adjusting the CPR to FO size and other influencing factors revealed no predictors for CPR and live birth rate. Conclusion: Study showed similar pregnancy outcomes regardless of FO size.
引言:据报道,与小卵泡相比,16-22毫米的卵泡产生更多成熟的卵母细胞。在卵巢反应不良的患者中,晚期触发会导致过早黄体化,而早期触发会增加未成熟卵母细胞的数量。本研究的目的是证明,当对卵巢反应不良的患者使用双触发时,从11–15 mm的FO采集的中期II卵母细胞与从>16 mm的FO收集的中期II的卵母细胞的妊娠结果相似。材料和方法:这是一项前瞻性队列研究。根据博洛尼亚“卵巢反应不良”标准,共有122名患者入选。从2018年到2020年,使用拮抗剂方案的控制性卵巢刺激用于卵巢刺激。二维超声结合激素评估用于监测卵巢刺激。当至少1 FO≥16 mm时,用0.2 mg促性腺激素释放激素激动剂和5000 IU人绒毛膜促性腺激素诱导排卵;36小时后,取卵。FO分别收集。对于所有的实验室步骤,卵母细胞都按照FO大小进行处理。移植单个卵裂期胚胎。黄体期由微粉化的黄体酮支持。根据FO大小冷冻保存多余的胚胎。如果没有发生妊娠,则替换单个冷冻胚胎。分析了两组点状FOs:第1组(G1)=246 FO大小11-15 mm,第2组(G2)=238 FO大小≥16 mm。在G1期进行了46次新鲜胚胎移植,在G2期进行了49次冷冻胚胎移植,其中在G1期和G2期分别进行了31次和10次冷冻胚胎转移。在受精率、临床妊娠率和活产率方面没有显著差异。将CPR调整为FO大小和其他影响因素的Logistic回归没有显示CPR和活产率的预测因素。结论:研究显示,无论FO大小,妊娠结局相似。
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引用次数: 0
Successful removal of heavy metals and environmental toxins using modern Mayr chelating detoxication in a patient: a model for prefertility treatment screening 使用现代Mayr螯合解毒在患者中成功去除重金属和环境毒素:优选治疗筛选的模型
Pub Date : 2023-02-14 DOI: 10.1097/GRH.0000000000000066
O. Ogunsola, Atinuke Adeyi, O. Ashiru
Introduction: Heavy metals are naturally existing constituents of the earth that have a high specific density (above 5 g/cm3) and atomic weights (>40.4 Da). Once taken into the body, heavy metals are distributed in the blood and deposited in tissues. The contamination chain follows a cyclic order: from industry, to the atmosphere, soil, water, and foods, then humans. At Martlife detox clinic, a comprehensive treatment plan based on the Mayr method of detoxification designed for the removal of heavy metals is available. To begin with, a bio-energetic test which reveals the types of heavy metals present in the patient’s body is conducted. Thereafter, therapies targeted at extracting the heavy metals and neutralizing their effect on the reproductive organs are commenced. Methods: Patient A underwent a metal toxicity test using urine samples at Genova Diagnostics laboratory in the United States. Patient A afterward underwent a bioenergetics test followed by a detoxification plan during the following month at the Martlife Detox Clinic. We performed a repeat test after detoxication at the Genova Diagnostics laboratory to know the outcome of the detoxication. Results: Genova Diagnostics laboratory’s first metal toxicity test revealed significantly high values of copper, manganese, vanadium, rubidium, gadolinium, and cesium. It also revealed similar outcomes with the bioenergetics testing before the detoxication process began at Martlife Detox Clinic. The repeat test showed that the detoxication process was successful. Conclusion(s): Our findings conclude that the modern Mayr method effectively reduces toxic levels of heavy metals. The bioenergetics test, which is less invasive, cheaper, and faster than the urine test, can also be used to check for toxins in the body.
重金属是地球自然存在的成分,具有较高的比密度(大于5 g/cm3)和原子量(>40.4 Da)。重金属一旦进入人体,就会分布在血液中并沉积在组织中。污染链遵循一个循环顺序:从工业到大气、土壤、水和食物,然后是人类。在Martlife排毒诊所,有一个基于Mayr排毒方法的综合治疗计划,旨在去除重金属。首先,进行生物能量测试,以揭示患者体内存在的重金属类型。此后,开始进行旨在提取重金属和消除其对生殖器官影响的治疗。方法:患者A在美国热那亚诊断实验室使用尿液样本进行了金属毒性测试。患者A随后接受了生物能量学测试,并在接下来的一个月在Martlife排毒诊所进行了排毒计划。我们在热那亚诊断实验室进行了解毒后的重复测试,以了解解毒的结果。结果:热那亚诊断实验室的第一次金属毒性测试显示,铜、锰、钒、铷、钆和铯的含量明显高。它还揭示了在Martlife排毒诊所开始排毒过程之前的生物能量学测试的类似结果。重复试验表明,脱毒过程是成功的。结论:我们的研究结果表明,现代Mayr方法有效地降低了重金属的毒性水平。生物能量测试比尿液测试侵入性更小、更便宜、更快,也可以用来检查体内的毒素。
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引用次数: 0
Myth and misconception about long-acting reversible contraception use among reproductive age group women in Debre Berhan governmental health centers, Ethiopia: qualitative study 埃塞俄比亚Debre Berhan政府卫生中心育龄妇女对长效可逆避孕的误解和误解:定性研究
Pub Date : 2023-01-27 DOI: 10.1097/GRH.0000000000000065
Kidane G. Haileyes, H. Asfaw, S. G. Ayele, L. D. kitawu
Background: Despite the effectiveness, convenience, and reversibility of fertility, long-acting reversible contraceptive (LARC) method use is still low in the world and Sub-Saharan Africa, including Ethiopia. Myths and misconceptions are believed to be one of the major reported barriers and impediments to LARC use. Objective: The purpose of this study was to investigate myths and misconceptions about LARC use among women of reproductive age in Debre Brehan town, Ethiopia, at governmental health centers. Methods: A qualitative study using a qualitative descriptive design was conducted from January 24 to April 15, 2022. Twenty-nine reproductive-age women who came for family planning services and 6 key informants were selected using a purposive sampling technique, and an in-depth interview technique with semistructured questionnaires was used to collect the data. The analysis was conducted using the thematic analysis method and ATLAS. ti9 qualitative software was used to support the analysis. Result: The findings of this study revealed that women had a variety of myths and misconceptions about the use of long-acting reversible contraception, including that it had an adverse impact on reproductive health problems and a predisposition to maternal and fetal illness; that the method was unsafe and ineffective in its characteristics; and that, socio-culturally, it was an unacceptable and undesirable method for women to use. Conclusion: This study indicates that there are widespread myths and misconceptions regarding long-acting reversible contraception use in reproductive-age women, which emanate from different concerns in the community. Measures should be taken by the concerned body to dispel or at least reduce these myths and misconceptions.
背景:尽管生育具有有效性、便利性和可逆性,但在世界和撒哈拉以南非洲,包括埃塞俄比亚,长效可逆避孕(LARC)方法的使用率仍然很低。神话和误解被认为是LARC使用的主要障碍和障碍之一。目的:本研究的目的是调查埃塞俄比亚Debre Brehan镇政府卫生中心育龄妇女使用LARC的神话和误解。方法:采用定性描述设计,于2022年1月24日至4月15日进行定性研究。采用有目的抽样的方法,选取29名前来接受计划生育服务的育龄妇女和6名关键举报人,采用半结构化问卷的深度访谈法进行数据收集。采用专题分析法和ATLAS进行分析。采用Ti9定性软件支持分析。结果:这项研究的结果表明,妇女对使用长效可逆避孕有各种误解和误解,包括认为它对生殖健康问题有不利影响,容易患孕产妇和胎儿疾病;该方法的特点是不安全和无效的;从社会文化的角度来看,这对女性来说是一种不可接受和不受欢迎的方法。结论:本研究表明,关于育龄妇女使用长效可逆避孕存在广泛的误解和误解,这些误解和误解源于社会各界的不同关注。有关机构应采取措施消除或至少减少这些神话和误解。
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引用次数: 0
WHO fact sheet on infertility (definition of infertility), published in Global Reproductive Health (2021) 世卫组织关于不孕症的情况介绍(不孕症的定义),发表于《全球生殖健康》(2021年)
Pub Date : 2023-01-01 DOI: 10.1097/grh.0000000000000060
B. Ibitoye, O. Akadiri, F. Ibitoye, Olaleke A. Fasasi
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引用次数: 0
Trends in engagement in surrogacy by nationality 2018–2020: a survey of surrogacy agencies 2018-2020年各民族代孕趋势:代孕机构调查
Pub Date : 2022-12-26 DOI: 10.1097/GRH.0000000000000064
S. Everingham, A. Whittaker
Introduction: Global reproductive destinations are constantly changing, and so is the cross-border reproductive movement of both gametes and intended parents seeking to build families. Quantifying the use of cross-border surrogacy is difficult given no reliable data exists on the global patterns of use of CBRC generally or surrogacy in particular. Methods: Approximately 150 surrogacy agencies in countries offering surrogacy to foreigners were invited to provide consolidated data on the number of commissioning singles and couples who signed with their agency for surrogacy services over the 2018–2020 calendar years, by nationality of the biological intended parent(s). Twenty-four agencies (16%) reported on 5968 clients. Results: Other than the United States, agencies were involved predominately in arrangements for foreigners. In the United States, other than the large domestic market, France, Australia, and Israel were large source countries. Australia and France were also large source countries for Canada. China was overwhelmingly the largest source country engaging in Ukraine. In Georgia, other than Georgian nationals, China, Israel, and the United States were the largest foreign source countries. In Greece, apart from locals, the largest source countries were Italy and Australia. Colombia reported a wide spread of foreign clientele with Israel, the United States, and Canada as the largest. COVID-19 had a significant impact on enrolments in Georgia and Ukraine—each experienced large declines in enrolments when comparing 2019–2020. In contrast, despite travel bans in 2020, agencies in 3 of 4 unregulated countries continued to report increases in enrolments. Conclusions: The global cross-border surrogacy market remains highly volatile, experiencing rapid growth and decline, especially in newer destinations. Source countries providing surrogacy clients are based partly on proximity and cultural ties, but more so on affordability. Further research is required to monitor the effects of engagement in newer destinations with fewer protections.
简介:全球的生殖目的地在不断变化,配子和寻求建立家庭的意向父母的跨界生殖运动也在不断变化。对跨境代孕的使用进行量化是很困难的,因为没有可靠的数据表明中国银监会的全球使用模式,特别是代孕的使用模式。方法:邀请各国约150家为外国人提供代孕服务的代孕机构提供2018-2020日历年间与该机构签订代孕服务的委托单身人士和夫妇数量的综合数据,按亲生父母的国籍分列。24家机构(16%)报告了5968名客户。结果:除美国外,中介机构主要参与安排外国人。在美国,除了庞大的国内市场外,法国、澳大利亚和以色列是最大的来源国。澳大利亚和法国也是加拿大的主要来源国。中国绝对是参与乌克兰的最大来源国。在格鲁吉亚,除格鲁吉亚国民外,中国、以色列和美国是最大的外国来源国。在希腊,除了当地人,最大的来源国是意大利和澳大利亚。据报道,哥伦比亚的外国客户分布广泛,其中以色列、美国和加拿大是最大的客户。2019冠状病毒病对格鲁吉亚和乌克兰的入学人数产生了重大影响——与2019-2020年相比,格鲁吉亚和乌克兰的入学人数均大幅下降。相比之下,尽管2020年实施了旅行禁令,但在4个不受管制的国家中,有3个国家的旅行社报告报名人数继续增加。结论:全球跨境代孕市场仍然高度不稳定,经历了快速的增长和下降,特别是在较新的目的地。提供代孕客户的来源国部分是基于邻近和文化联系,但更多的是基于负担能力。需要进一步的研究来监测在保护较少的新目的地参与的影响。
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引用次数: 0
Willingness and associated factors of comprehensive abortion services provision by health care professionals in selected public health facilities of Addis Ababa, Ethiopia 埃塞俄比亚亚的斯亚贝巴选定的公共卫生设施中保健专业人员提供全面堕胎服务的意愿及其相关因素
Pub Date : 2022-11-16 DOI: 10.1097/GRH.0000000000000062
A. Sahile, G. E. Bekele, Kidist Bibiso, Z. M. Gebremariam
Background: Globally, abortion-related maternal deaths significantly decreased, but the opposite was true for Sub-Saharan Africa, where there was a significant increment in abortion-related maternal deaths. Health care providers are in constant conflict with the legalization of abortion, for viewing induced abortion as immoral. Objective: To assess the willingness and associated factors of comprehensive abortion care among health care professionals in Public health facilities of Bole Sub-City, Addis Ababa, Ethiopia, 2021. Methods: An institution-based cross-sectional study was undertaken among 367 health care professionals from April 1 to August 30, 2021. Willingness was measured as willing and not willing, as well as the level of agreement to provide abortion care under justifiable conditions. The data were collected by a structured and pretested self-administered questionnaire. Binary (bivariate and multivariate) logistics regression was used for the identification of predictors of willingness with its respective 95% CI and a P-value of <0.05 statistically significant levels. The finding was presented in texts and tables. Findings: A total of 367 study participants were involved in the study giving a response rate of 100%. The overall level of willingness was 42.3% (95% CI: 37.25%–47.35%). Being male [adjusted odds ratio (AOR): 1.987, 95% CI: 1.111–3.551, P<0.05], having a lower weekly religious attendance (AOR: 2.88; 95% CI: 1.687–4.930, P<0.001), and perceiving unsafe abortion as a health problem (AOR: 6.15; 95% CI: 3.79–9.97; P<0.05) were predictors associated with an increased level of willingness. Conclusions and Recommendations: A low level of willingness to provide comprehensive abortion was observed in the study. Being male, having a lower religious attendance, and having the perception that unsafe abortion is a health problem were predictors associated with an increased level of willingness to provide comprehensive abortion care. Stakeholders, government, and policymakers were recommended to work on the identified predictors of willingness in the study settings.
背景:在全球范围内,与堕胎相关的孕产妇死亡人数显著下降,但撒哈拉以南非洲的情况正好相反,那里与堕胎相关孕产妇死亡人数大幅增加。医疗保健提供者经常与堕胎合法化发生冲突,因为他们认为人工流产是不道德的。目的:评估2021年埃塞俄比亚亚的斯亚贝巴博乐市公共卫生机构卫生保健专业人员的综合堕胎护理意愿及其相关因素。方法:2021年4月1日至8月30日,对367名卫生保健专业人员进行了一项基于机构的横断面研究。意愿被衡量为愿意和不愿意,以及在合理条件下提供堕胎护理的协议水平。数据是通过结构化和预先测试的自填问卷收集的。二元(双变量和多变量)物流回归用于确定意愿的预测因素,其各自的95%CI和<0.05的P值具有统计学意义。这一发现以文本和表格形式呈现。研究结果:共有367名研究参与者参与了这项研究,应答率为100%。总体意愿水平为42.3%(95%置信区间:37.25%–47.35%)。男性[调整后的比值比(AOR):1.987,95%可信区间:1.111–3.551,P<0.05],每周参加宗教活动的人数较低(AOR:2.88;95%可信区间1.687–4.930,P<0.001),以及将不安全堕胎视为健康问题(AOR:6.15;95%置信区间3.79–9.97;P<0.05)是与意愿水平增加相关的预测因素。结论和建议:研究中观察到提供全面堕胎的意愿较低。男性、宗教参与率较低以及认为不安全堕胎是一个健康问题,是提供全面堕胎护理意愿提高的预测因素。建议利益相关者、政府和政策制定者在研究环境中研究已确定的意愿预测因素。
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引用次数: 0
Multilevel analysis of factors predicting pregnancy loss experiences among pregnant women in Ghana: a further analysis of nationally representative data 加纳孕妇流产经历预测因素的多水平分析:对全国代表性数据的进一步分析
Pub Date : 2022-11-11 DOI: 10.1097/GRH.0000000000000063
D. Klu
Background: Pregnancy loss experiences due to stillbirths, miscarriages, and abortion among women have a negative effect on maternal health, leading to maternal mortality and strain on the health system. This study, therefore, seeks to examine the individual, proximate, and household factors associated with pregnancy loss experiences among ever pregnant women in Ghana. Methods: Data for this study were obtained from the 2014 Ghana Demographic and Health Survey (GDHS) conducted between early September and mid-December 2014. The weighted sample comprised 2321 ever pregnant women aged 15–49 years. Data were analyzed with SPSS version 25 using both descriptive and multilevel logistic regression modelling. Results: The study found that 48% of ever pregnant women have experienced pregnancy loss in Ghana. The multilevel regression analysis shows that ever pregnant women aged 25–34 years and 35–49 years had a higher likelihood of losing pregnancy. Pregnant women with secondary/higher education were less likely to lose their pregnancy. pregnant women who reside in urban areas has lower odds of pregnancy loss. Ever pregnant women who were currently married and those who were formerly married were more likely to experience pregnancy loss than never married women. Ever pregnant women who had access to an improved source of drinking water had a higher probability of losing their pregnancy. Interestingly, ever pregnant women who attended antenatal care services 1–3 times and 4 or more times were more likely to experience pregnancy loss. Conclusion: Individual, household, and proximate factors, such as pregnant women’s age, educational level, place of residence, religion, marital status, occupational type, household source of drinking water, and a number of antenatal visits, are strong significant predictors of pregnancy loss experiences among pregnant women in Ghana. These factors should be considered in strengthening existing programs and developing new interventions to decrease pregnancy loss and ensure safe motherhood.
背景:妇女因死产、流产和堕胎而失去妊娠的经历对产妇健康产生负面影响,导致产妇死亡并给卫生系统带来压力。因此,这项研究试图检验加纳有史孕妇中与流产经历相关的个人、邻近和家庭因素。方法:本研究的数据来自2014年9月初至12月中旬进行的2014年加纳人口与健康调查(GDHS)。加权样本包括2321名15-49岁的孕妇。数据使用SPSS 25版进行分析,使用描述性和多水平逻辑回归模型。结果:研究发现,在加纳,48%的孕妇经历过流产。多水平回归分析显示,25-34岁和35-49岁的孕妇流产的可能性更高。受过中等/高等教育的孕妇流产的可能性较小。居住在城市地区的孕妇流产的几率较低。目前已婚和以前已婚的有史孕妇比从未结婚的妇女更有可能经历流产。有过改善饮用水源的孕妇失去妊娠的几率更高。有趣的是,参加过1-3次和4次或更多次产前护理服务的孕妇更有可能经历流产。结论:个人、家庭和邻近因素,如孕妇的年龄、教育水平、居住地、宗教、婚姻状况、职业类型、家庭饮用水来源和多次产前检查,是加纳孕妇流产经历的重要预测因素。在加强现有计划和制定新的干预措施以减少妊娠损失和确保安全孕产时,应考虑这些因素。
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引用次数: 0
A novel method of intraovarian instillation of platelet rich plasma to improve reproductive outcome in young Indian women with diminished ovarian reserve 一种卵巢内灌注富血小板血浆的新方法,可改善卵巢储备功能减退的年轻印度妇女的生殖结局
Pub Date : 2022-05-12 DOI: 10.1097/GRH.0000000000000059
F. Parikh, Sujatha G. Sawkar, Sapna Agarwal, P. Makwana, Meenal S. Khandeparkar, Nandkishore Naik, Mangesh V. Sanap, S. Joshi, A. Athalye
Introduction: To evaluate the effects of intraovarian platelet-rich plasma (IOPRP) instillation in young Indian women with diminished ovarian reserve (DOR). Methods: This prospective, ongoing, cohort study was performed by recruiting 45 consenting Indian women with DOR (group A). Up to 3 cycles of IOPRP instillation were performed after minimal ovarian stimulation. Outcome measures were changes in antral follicle counts (AFC), anti-Müllerian hormone (AMH) levels, an increase in total and mature oocytes retrieved and establishment of pregnancy. The pregnancy rates in 51 women with the same inclusion criteria during the same time period were compared (group B). Results: In group A, baseline mean AFC was 3.44±2.35 (n=45); mean AFC increased after IOPRP-1 (3.89±2.21, n=45, P=0.1198<0.05 vs. baseline), IOPRP-2 (4.91±2.79, n=33, P=0.0056<0.05 vs. baseline), and IOPRP-3 (4.95±2.84, n=19, P=0.0002<0.05 vs. baseline). Mean AMH was 0.85±0.44 ng/mL. The changes in average AMH levels showed significance after IOPRP-2 (P=0.048<0.05). In group B, mean baseline AFC was 4.74±2.19, mean baseline AMH was 0.98±0.38 ng/mL. In group A, frozen embryo transfer was performed in 32/45 women and 15 clinical pregnancies were established. In group B, 44/51 women underwent frozen embryo transfer, 11 clinical pregnancies were established. The clinical pregnancy rate per transfer was 46.88%/embryo transfer in group A versus 25%/embryo transfer in group B. Conclusions: IOPRP instillation can improve AFC and can enhance pregnancy results in women with DOR. Increase in AMH levels and the number of total and mature oocytes was observed after 2 IOPRP. Significantly higher pregnancy rates (P=0.0009<0.05) were observed in women with IOPRP versus matched controls without IOPRP.
引言:评价阴道内富血小板血浆(IORP)滴注对卵巢储备减少(DOR)的印度年轻女性的影响。方法:这项前瞻性、持续性队列研究通过招募45名同意DOR的印度女性(A组)进行。在最低限度的卵巢刺激后进行长达3个周期的IORP滴注。结果指标包括窦卵泡计数(AFC)、抗米勒激素(AMH)水平的变化、回收的总卵母细胞和成熟卵母细胞的增加以及妊娠的建立。比较了在同一时间段内具有相同纳入标准的51名妇女的妊娠率(B组)。结果:A组基线平均AFC为3.44±2.35(n=45);平均AFC在IORP-1(3.89±2.21,n=45,P=0.0189<0.05与基线相比)、IORP-2(4.91±2.79,n=33,P=0.0056与基线相比<0.05)和IORP-3(4.95±2.84,n=19,P=0.0002与基线相比P<0.05)后增加。平均AMH为0.85±0.44 ng/mL。B组平均基线AFC为4.74±2.19,平均基线AMH为0.98±0.38 ng/mL。在A组中,32/45名妇女进行了冷冻胚胎移植,并确定了15例临床妊娠。在B组中,44/51名妇女接受了冷冻胚胎移植,11例临床妊娠成功。A组每次胚胎移植的临床妊娠率为46.88%,B组为25%。在2次IORP后观察到AMH水平以及总卵母细胞和成熟卵母细胞数量的增加。与没有IORP的对照组相比,患有IORP的女性的妊娠率显著较高(P=0.00009<0.05)。
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引用次数: 4
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Global reproductive health
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