Bilateral Tubal Ligation Research Articles

The outcome of embryo transfer after three different procedures for laparoscopic correction of hydrosalpinx.

To compare the effect of three different surgical approaches: simple terminal salpingostomy, bilateral proximal tubal ligation plus terminal salpingostomy, and bilateral salpingectomy. A retrospective analysis was conducted on the clinical data of 292 patients who underwent laparoscopic surgery for hydrosalpinx and embryo transfer within 2 years postoperatively from January 2018 to August 2021. The patients were divided into three groups: Group A (68 cases) underwent simple terminal salpingostomy, Group B (199 cases) underwent ligation plus terminal salpingostomy, and Group C (25 cases) underwent bilateral salpingectomy. Age, body mass index, surgical time, intraoperative bleeding, length of hospital stay, and infertility type showed no significant differences among the different surgical groups (P > 0.05), except for the age 30-39 group, which showed statistically significant differences in surgical time (P < 0.001) and length of hospital stay (P < 0.001); the age 40 or above group showed statistically significant differences in intraoperative bleeding (P = 0.008). A total of 336 oocyte retrievals and 451 embryo transfers were successfully performed in the 292 patients within 2 years postoperatively. The choice of surgical approach for hydrosalpinx does not affect pregnancy rates after embryo transfer within the same age group.

Utilization of Immediate Postpartum Contraception and Its Association with Interpregnancy Interval: 10-Year Experience at a Single Center.

Increasing availability of immediate postpartum long-acting reversible contraception (LARC) has added contraceptive alternatives to bilateral tubal ligation (BTL) in the immediate postpartum period. The resultant access to long-term contraception has provided patients with improved control over the timing of pregnancies. Our objective is to evaluate changes in the utilization of immediate postpartum contraceptive methods over a 10-year period and its association with interpregnancy interval (IPI). Retrospective cohort study of 36,445 patients delivered at a single academic hospital center from 2012 to 2020. Deliveries <23 weeks gestation and patients who underwent a cesarean hysterectomy or postpartum hysterectomy for obstetric indications were excluded. The primary outcome was the utilization of postpartum BTL, intrauterine devices, contraceptive implants, and Depo-Provera over the study time period. The secondary outcomes were IPI and interdelivery interval (IDI). Outcomes were compared using appropriate tests of trend. We adjusted for significant covariates as assessed in baseline characteristics. A total of 35,281 patients were included in our study. Groups were different in baseline characteristics including age, race/ethnicity, parity, BMI, insurance status, comorbidity risk, and attendance at postpartum exam. Over the study period, there was a significant difference in utilization of Depo-Provera, LARC, intrauterine device (IUD), and implant (p < 0.001). There was a significant increase in IPI (p < 0.001) and IDI (p < 0.001). We observed a significant increase in utilization of immediate postpartum LARC over the study period which corresponded to a significant increase in IPI and IDI. Our findings emphasize the importance of the availability of immediate postpartum contraception as well as its effectiveness in improving family planning options for reproductive-aged patients. We found significantly increased IPI and IDI associated with increased utilization of long-acting reversible contraceptives immediately postpartum. Our findings emphasize the importance of providers offering these options to patients as well as being comfortable initiating immediate postpartum contraception. · Immediate postpartum LARC access has increased over the past 10 years.. · Access to more methods of contraception allows patients more options for family planning.. · Increased utilization of LARC led to increased IPI and IDI..

Obstructed Labor at a Tertiary Hospital in Nigeria: A Six-Year Review

Introduction: Unlike most developed countries, obstructed labor with a dead fetus is still a reality in many developing countries, and it is a well-known cause of maternal and perinatal morbidity and mortality. Objective: To highlight the characteristics of patients presenting with obstructed labor at a tertiary hospital and determine fetomaternal outcomes. Methodology: A retrospective descriptive study of 45 cases of obstructed labor that were managed in a tertiary hospital from January 2009 to December 2014. Relevant information was extracted from patients’ case files, and the data obtained were analyzed. Results: Obstructed labor constituted 0.75% of all deliveries. All patients were referred in, and thirty (2/3) of them were nulliparous, while 25 (55.6%) were between the ages of 16 and 25. Forty-one (91.1%) of the patients were delivered by emergency caesarean section, while four patients had exploratory laparotomy with uterine repair and bilateral tubal ligation. Thirty-eight (84.5%) of the babies weighed between 2.6-4kg and five (11.1%) weighed more than 4kg. Most of the patients, 91.1%, had prolonged hospital stay with 25% staying over 3 weeks postpartum before being discharged. Eight (17.8%) suffered severe birth asphyxia, and there were five perinatal and two maternal mortalities. The commonest complication was puerperal sepsis. Conclusion: The study showed obstructed labor remains a cause of perinatal and maternal morbidity and mortality. Effective use of partographs in the peripheral centers, where all the women came from, would ensure early referral before labor became obstructed.

Educational Intervention Effects on Bilateral Tubal Ligation Knowledge among Women Attending Antenatal and Family Planning Clinics in Bomet County

Bilateral Tubal Ligation (BTL) is a highly effective contraceptive method with more than 99% effectiveness at preventing pregnancy. Its uptake remains low in Sub-Saharan Africa, at 1.6%. The Kenya Health and Demographics Survey 2014, indicated that almost half of the married women did not desire further childbearing. The low acceptance of BTL as a method of contraception in this region has been attributed to a lack of knowledge and cultural and religious misconceptions. This study aimed to determine the level of knowledge about BTL at baseline and the impact of an educational intervention among women attending ANC/Family planning clinics at Tenwek and Longisa Hospitals in Bomet County. A quasi-experimental study design was used. Demographic characteristics, knowledge of BTL, perceived risks, and benefits were assessed at baseline and post-intervention. A difference measure was used to assess the impact of the intervention at 95% CI, with a p-value of 0.05 considered significant. The data was analyzed using STATA version 18. The mean age of the participants at baseline and post-intervention was 29.0±5.8 years and 29.2±5.6 years, respectively. Overall, 62% of participants said they would choose BTL, with 52% in the post-intervention arm. When asked if their religion allowed BTL, 80.6% said yes and were supported by their husband (92%), However, 62% said they couldn't have it if their spouse was against it. In general, lower knowledge scores were obtained in the post-intervention arm, implying that the educational intervention provided did not influence participants' knowledge of BTL. There was no statistically significant difference in the participants' knowledge levels at baseline and post-intervention [3.3 (-3.2 to 9.9); p-value=0.3]. Educating families, particularly women of childbearing age, about alternative family planning methods would increase uptake, allowing families to achieve desired family sizes while limiting the impact of unwanted pregnancies and maintaining a healthy population.

Influence of Pregnancy Intention on Postpartum Contraceptive Choice at an Urban Academic Medical Center.

This study aimed to describe postpartum contraception preferences in the context of pregnancy intention (PI). A prospective cohort study analyzing postpartum contraceptive choice (PCC) in 431 postpartum women who delivered at a single academic medical center. PCC in women with an unintended or mistimed pregnancy was compared to contraceptive choice in women with an intended pregnancy using the adapted National Survey of Family Growth categorization. Mistimed and unintended pregnancies were grouped for analysis. Generalized linear modeling estimated the relative influence of PI on PCC adjusting for maternal age, race, and parity. Nearly three out of four (71.9%) pregnancies were mistimed or unintended. These pregnancies were more likely in women who were non-Hispanic Black (62.3%), unmarried (86.3%), 18 to 24 years (51.3%), and insured by Medicaid or Medicare (82.1%), compared to women with an intended pregnancy, p-value <0.001. Women with mistimed or unintended pregnancy were 83% more likely to choose highly effective, user-independent methods compared to any other or no method, adjusted relative risk (aRR) = 1.83 (95% confidence interval [CI]: 1.36, 2.47), and more likely to desire voluntary sterilization, aRR = 2.70 (95% CI: 1.58, 4.59). Additionally, women with these pregnancies were 56% more likely to use user-independent methods compared to user-dependent methods, aRR = 1.56 (95% CI: 1.18, 2.06). Women with mistimed or unintended pregnancies are 83% more likely to choose highly effective postpartum contraception or voluntary sterilization, and thus initiatives are necessary to increase access and affordability to these methods before hospital discharge after delivery. · Nearly three out of four pregnancies in this study were mistimed or unintended.. · Women with mistimed or unintended pregnancies are more likely to choose highly effective postpartum contraception or voluntary sterilization.. · Public health initiatives to improve access to family planning services and postpartum contraception, including surgery for bilateral tubal ligation before discharge from the hospital postdelivery, are important areas of focus to help attenuate the rates of unintended pregnancy in the United States..

In vitro effect of hyoscine-N-butyl bromide and diclofenac sodium in human tuba uterina.

To investigate the in vitro effect of diclofenac on tubal smooth muscle as an alternative to hyoscine-N-butyl bromide, which is used for premedication before hysterosalpingography (HSG). Fallopian tubes were retrieved from seven healthy women after bilateral tubal ligation and in vitro contractility and histological studies were conducted using tissue bath and immunohistochemistry. Diclofenac sodium and hyoscine-N-butyl bromide did not significantly change the basal mean tension; however, they decreased the contractions induced by potassium chloride (KCl). The relaxant effect of diclofenac sodium and hyoscine-N-butyl bromide was not statistically significantly different. The presence of cyclooxygenase (COX)-2 enzyme in the fallopian tube was demonstrated by immunohistochemical studies. The in vitro relaxant effect of diclofenac sodium on the fallopian tube is similar to hyoscine-N-butyl bromide. Diclofenac may have the potential to be used as an alternative to hyoscine-N-butyl bromide in premedication in HSG.

Outcomes for Women Denied Postpartum Tubal Ligation During the Initial COVID-19 Surge.

To evaluate the utilization and outcomes of postpartum long-acting reversible contraception (PPLARC) following unmet postpartum bilateral tubal ligation (PPBTL) requests during a time in which elective surgeries were canceled due to the initial COVID-19 surge. We conducted a mixed-methods study using an embedded design. Using a retrospective cohort design, we collected data from patients seeking PPBTL following vaginal delivery between March 15, 2020, and June 20, 2020; this reflects a time period during which elective surgery was canceled thus making PPBTL unavailable. We recorded demographic data, method of contraception at time of discharge and 18 months postpartum, and incidence of interval pregnancy at 18 months postpartum. Additionally, we conducted five semistructured interviews to gain deeper insights into patient experiences with PPLARC as a bridge method. Forty-five patients had unfilled PPBTL requests with follow-up data available for 35. The median age was 34 years. Ten (22%) accepted PPLARC as a bridge to interval bilateral tubal ligation (BTL). At the 18-month mark, only 1 out of 7 (14.3%) PPLARC users had undergone an interval BTL procedure, compared to 11 out of 28 (39.3%) nonusers. None of the PPLARC users experienced pregnancies, while 6 out of 28 (21.6%) nonusers became pregnant. Qualitative interviews underscored themes such as inadequate counseling preparation for unmet PPBTL requests and persistent barriers to BTL access. Raising awareness of unmet PPBTL risks may drive greater adoption of PPLARC as a bridge method. While not a substitution for PPTBL, PPLARC provides a reliable form of interval contraception for patients seeking to delay pregnancy. It is essential to recognize that patient security with PPLARC's contraceptive efficacy may introduce delays in achieving the desired interval sterilization. Enhancing antenatal counseling on contraception options and providing transparency regarding barriers to sterilization could mitigate the challenges associated with unmet PPBTL requests.

Where Microsurgical Tubal Reanastomosis Stands in the In vitro Fertilization Era.

Among various options of contraception, bilateral tubal ligation (BTL) remains the most frequently used method for women worldwide even at present. However, up to 30% of those who undergo BTL eventually change their minds and wish to conceive again for a variety of reasons, such as a change in marital status or simply wanting more children. In this case, we can either approach it surgically with tubal re-anastomosis (TA) or by in vitro fertilization (IVF)-embryo transfer. Despite the many advantages of TA which lead the American Society of Reproductive Medicine Committee Opinion to recommend it as the primary choice of treatment in posttubal ligation infertility in 2012, IVF is widely being chosen as the first-line treatment nowadays. This study will review the efficacy of TA in various aspects, including pregnancy rate, cost-effectiveness, feasibility, and accessibility, based on review of the literature and our experience. Through this study, we intend to provide a basis for gynecologists to consider TA as the first option in women who wish to conceive again after BTL in this day and age of IVF.

The Impact of an educational intervention on the knowledge of bilateral tubal ligation (BTL) among women attending antenatal and family planning clinics in Bomet county: An interventional study

Background: Bilateral tubal ligation (BTL) is a highly effective contraceptive method with more than 99%efficacy in preventing pregnancy. Its uptake remains low in Sub-Saharan Africa at 1.6%. The KenyaHealth and Demographics Survey 2014 indicated that almost half of the married women did not desirefurther childbearing. The low acceptance of BTL as a contraceptive method in this region has beenattributed to a lack of knowledge and cultural and religious misconceptions.Objective: This study aimed to determine the baseline level of knowledge about BTL and the impact ofan educational intervention among women attending antenatal care and family planning clinics at Tenwekand Longisa Hospitals in Bomet County.Methods: A quasi-experimental study design was employed. Demographic characteristics, knowledge ofBTL, perceived risks, and benefits were assessed at baseline and postintervention. A difference measurewas used to assess the impact of the intervention at 95% CI, with a p-value of 0.05 consideredsignificant. The data were analyzed using STATA version 18.Results: The mean age of the participants at baseline and postintervention was 29.0±5.8 years and29.2±5.6 years, respectively. Overall, 62% of the participants reported they would choose BTL, with 52%in the postintervention arm. When asked if their religion allowed BTL, 80.6% responded yes and weresupported by their husband (92%); however, 62% reported they could not have it if their spouse wasagainst it. In general, lower knowledge scores were obtained in the postintervention arm, implying thatthe educational intervention did not influence participants' knowledge of BTL. There was no statisticallysignificant difference in the participants' knowledge levels at baseline and postintervention [3.3 (-3.2 to9.9); p-value=0.3].Conclusion: Educating families, particularly women of childbearing age, about alternative family planningmethods would increase their adoption, allowing families to achieve desired family sizes while limiting theimpact of unwanted pregnancies and maintaining a healthy population.

Association between uterine leiomyoma and fragmented QRS waves: a prospective case-control study.

The aim of this study was to evaluate the relationship between uterine leiomyoma and fragmented QRS, a non-invasive indicator of cardiovascular risk and myocardial ischemia, in women with uterine leiomyoma. In this prospective case-control study, a total of 47 patients diagnosed with uterine leiomyoma (case group) and 47 healthy individuals without uterine leiomyoma (control group) who had undergone bilateral tubal ligation surgery were included. Various demographic, clinical, and laboratory parameters and the presence of fragmented QRS were recorded. The leiomyoma group showed significantly higher body mass index (27.46±2.18 vs. 25.9±2.87 kg/m2, p=0.005) and waist circumference (91.34±9.30 vs. 84.97±9.3 cm, p=0.001) compared with the control group. Uterine volumes were also significantly higher in the leiomyoma group (235.75±323.48 vs. 53.24±12.81 mm3, p<0.001). The presence of fragmented QRS was detected in 18.1% of the patients. Multiple regression analysis identified age, fasting blood glucose value, and the presence of fragmented QRS as independent risk factors for the presence of leiomyoma. This study provides valuable insights into the relationship between uterine leiomyoma and fragmented QRS. The presence of fragmented QRS was identified as an independent risk factor for the presence of leiomyoma. Further research is needed to better understand the underlying mechanisms connecting uterine leiomyoma and cardiovascular health.

The Incidental Diagnosis of Adenomatoid Tumour on Fallopian Tubes Submitted for Tubal Ligation at a Tertiary Laboratory in Northern Pretoria, South Africa.

Adenomatoid tumours are the most common benign mesothelial neoplasms of the fallopian tube. They are usually diagnosed incidentally in specimens submitted for bilateral tubal ligation and can be mistake for vascular or epithelial lesions. A retrospective analysis of cases with adenomatoid tumour of the fallopian submitted for tubal ligation from 2012 to 2020. The clinicopathological characteristic data was retrieved from the laboratory information system. A total of 11 cases with adenomatoid tumour of the fallopian tubes submitted for tubal ligation were identified in women with average age of 30.9 years. In all the cases, only 1 fallopian tube was affected. Grossly, the fallopian tubes did not show any discernible tumour. Immunohistochemical stains confirmed the diagnosis of adenomatoid tumours in all the cases. Adenomatoid tumours in fallopian tubes are infrequent, and pathologists shouldn't overlook them especially in unsuspicious instances. As frequent as adenomatoid tumour of the fallopian tubes are uncommon, pathologists show be aware of as their misdiagnosis could lead mismanagement of patient with far reaching complication.

Histopathologic and Preneoplastic Changes in Tubal Ligation Materials.

Background and Objectives: To investigate histopathological changes and serous carcinoma precursors such as secretory cell outgrowths (SCOUTs) and p53 signature in the bilateral tubal ligation (BTL) materials used during cesarean section (S/C). Materials and Methods: In total, 138 patients underwent S/C and tubal sterilization (TS) between October 2020 and May 2021 at Konya City Hospital. Patients' data were obtained from the hospital's system. All data and findings were investigated and statistically evaluated. Results: The mean age was 34.62 years (22-44), the mean gravity was 4.89 (2-15) and the mean parity was 3.46 (1-10). In total, 5.79% SCOUT, 7.24% atypia and 9.42% p53 signatures were observed. Significant correlations were shown between the epithelial cell lineage and age between Ki-67, SCOUT, and gravity; between the Ki-67 results and gravity and parity; and between the p53 score and age. Conclusions: TS is a common, safe, and effective method worldwide. Today, BTL is increasing along with increasing S/C ratios. In addition to the reduced risk of ovarian cancers with ligation alone, precursor lesions such as hyperplasia, SCOUT, p53 signature, and STIL/Serous tubal intraepithelial carcinoma (STIC) are encountered in the ampulla materials obtained. Considering the low rates of re-anastomosis, tubal excision may be recommended instead of ligation in women of relatively higher gravity and age.

CASE OF SCAR PREGNANCY MISDIAGNOSED FIRST AS INEVITABLE MISCARRIAGE.

This abstract is about scar pregnancy case which was initially misdiagnosed as a case of inevitable miscarriage. Our patient g3 p1+1 presents in ERE as 7 weeks pregnancy with mild bleeding p/v. she was previous 1 LSCS. After scan and per speculum examination diagnosed as inevitable miscarriage as RPOCS was seen protruding through internal os on speculum examination. Patient was admitted for misoprostol as advised by consultant. Patient did not abort after Misoprostol. Consultant advised for evacuation under general anesthesia. As soon as registrar tried to hold RPPOCS with sponge holder patient started bleeding heavily. Registrar abandoned the procedure and called consultant on call. Consultant first tried to stop bleeding by compression methods but failed, so diagnosis of scar pregnancy with possible perforation was made and laparotomy started and RPOCS removed from scar and uterus closed in layers. Hemostasis secured with difficulty bilateral tubal ligation done, vasopressin given and vertical compression sutures applied. (GTG NO 21 / 2016 NICE clinical guideline 154. Manchester: NICE; 2012). Abdomen closed in layers. In ward 2 units of packed RBCS transfused. Patient discharged in stable condition on second postoperative day.

A-167 Repeatedly Positive Serum and Urine Beta-HCG Results in Non-Pregnant Patients—Application of Clinical Decision Support

Abstract Background In January of 2020, a 48-year-old woman, status post bilateral tubal ligation was postponed colonoscopy due to a positive urine and serum pregnancy point of care (POC) test. The quantitative serum HCG levels were normal at 4.9 mIU/mL (reference range 0–8 mIU/mL). Follow-up showed that over the prior year there were other 6 similar incidents when nonpregnant patients showed positive qualitative pregnancy results with quantitative HCG levels within “nonpregnancy” normal range being brought to the attention of the laboratory. Methods We assessed the possibility of a detection/measurement error including possible interfering antibodies. The likelihood of interfering substances/antibodies that would interact with 2 different types of POC detection systems (urine qualitative—Clinitest HCG Pregnancy test from Siemens Medical Solutions USA, serum qualitative—Pregnancy HCG Rapid Test from Cardinal Health) and serum quantitative—is very low, especially given that both serum and urine specimens were affected, and interfering antibodies are not normally excreted into urine. Testing of the diluted sample showed results like the neat specimen which further excludes interferences in the quantitative reaction as well as a possible hook effect. Based on this we concluded that the results were accurate.Chart review showed that 6 months prior, she had another quantitative HCG test performed using the same instrumentation obtaining a value of 6.6 mIU/mL. At this time a transvaginal ultrasound excluded the presence of any masses or abnormal findings. FSH (47.8 mIU/ml) and LH (49.8 mIU/ml) were found to be within the perimenopausal range. Qualitative serum and urine test were found to be repeatedly positive, while the quantitative tests were within nonpregnancy range, over several months. Retrospective chart review of the other 6 cases revealed similar pattern. Pregnancy, certain tumors (gestational trophoblastic neoplasia, ovarian germ cell tumor), kidney failure and menopause will manifest with increased HCG production. In (peri)menopausal women the pituitary produces HCG up to 14 mIU/mL in association with increased levels of FSH. The qualitative tests were repeatedly positive over several months while the quantitative results remained unchanged, excluding the diagnosis of pregnancy or tumors, and supporting the conclusion that these results are menopause related. Results To avoid similar future incidents we added the following comment to the POC test results: “If the result does not fit the clinical picture, please repeat testing on a new sample collected 48–72 h later or order serum HCG quantitative” We also added for the quantitative HCG result, the following comment: “Peri- and postmenopausal patients may have increased HCG of pituitary origin up to 14 mIU/mL. If the result does not fit the clinical picture, FSH measurement can be used for additional information.” During the 12 months preceding the implementation of the comments we had 6 incidents of positive qualitative HCG results in non-pregnant (peri)menopausal patients brought for investigation, and none during the 24 months after that. Conclusion The addition of the interpretative comment as clinical decision support increased the efficiency of the medical service, staff engagement and most importantly, patient satisfaction and safety.

Pregnancy risk and contraception among reproductive-age women with rheumatic heart disease attending care at a tertiary cardiac center in Tanzania: a hospital-based cross-sectional study

BackgroundRheumatic heart disease (RHD) remains prevalent in the developing world and reproductive-age women are disproportionately affected. It is among the common est cardiac diseases during pregnancy and is associated with poor pregnancy outcomes. Despite its importance among reproductive-age women, there are no local studies that characterize the clinical characteristics, risk of poor pregnancy outcomes and contraception which represents one effective way to prevent unplanned pregnancies in this population.MethodsThis was a hospital-based descriptive cross-sectional study. Non-pregnant reproductive-age women with echocardiographically diagnosed RHD were consecutively recruited from in- and out-patients units of the Jakaya Kikwete Cardiac Institute (JKCI). A clinical research form was used to gather socio-demographic, clinical characteristics, contraception status and echocardiographic information. The maternal/pregnancy risk class was determined using the modified World Health Organization (WHO) classification of maternal risk.ResultsTwo hundred thirty-eight women of reproductive age with RHD were recruited. The median age (range) was 36 years (15–49). Two-thirds were dyspneic on moderate exertion and 17.2% had New York Heart Association class IV heart failure. A quarter had atrial fibrillation/flutter. On echocardiography, mitral regurgitation was the most common valvular lesion (68.1%), followed by mitral stenosis (66.8%), and 12.2% of participants had reduced left ventricular ejection fraction. Two-thirds (66%) had a high pregnancy risk (class IV) based on the modified WHO classification system. The proportion of participants using contraception was 7.1% and common methods were: bilateral tubal ligation 5 of 17 (29.4%) and hormonal implant (4 of 17). The most common reason for the choice of a method was safety, 10 out of 17 (58.8%).ConclusionThe majority of women of reproductive age with RHD in our hospital cohort are at the highest pregnancy risk based on the modified WHO classification and a very small proportion of them are on contraception. These results call for action among clinicians to offer counselling to these patients, educating them on their risk and offering appropriate contraception advice while waiting for definitive interventions.

Dual contraceptive use and associated factors among female sex workers in Gulu City, Uganda in 2023

BackgroundDual contraception is an essential approach to mitigating the heightened risks of unintended pregnancies and sexually transmitted infections faced by female sex workers (FSWs). We determined the prevalence and factors associated with dual contraceptive use among FSWs in Northern Uganda.MethodsA cross-sectional study was conducted in Gulu city, Uganda between February, and March 2023. Purposively selected FSWs aged 18 years or older who provided verbal informed consent were enrolled in the study. A sample size of 374 was estimated. Data on sociodemographic and reproductive health characteristics were collected using an interviewer-administered semi-structured questionnaire. Current dual contraception was defined the as concurrent use of a barrier and any other modern contraceptive methods within the last 3 months. Continuous variables were summarized using mean and standard deviation and categorical variables were summarized using frequencies and percentages. Modified Poisson regression analysis was used to determine factors associated with dual contraceptive use.ResultsWe enrolled 314 FSWs, with a mean age of 28.8 ± 6.4 years. About 13.8% (n = 41) were living with HIV. In total, 66.2% (95%CI 60.8–71.3) of the participants (n = 208) reported current dual contraceptive use. The most common modern contraceptive method used was the implants (52.4%, n = 109), followed by injectable contraceptives (22.6.0%, n = 47), and bilateral tubal ligation (0.5%, n = 1) was the least utilized. Having had at least one previous pregnancy was positively associated with dual contraceptive use (adjusted PR: 1.87, 95%CI 1.40–2.51, p < 0.001).ConclusionsA high proportion of FSWs in Gulu city were currently using dual contraceptives. Interventions are needed to facilitate the use of dual contraception, particularly among FSWs without a history of previous pregnancies.

Contraception and sterilization selection at delivery among pregnant patients with malignancy.

Since malignancy during pregnancy is uncommon, information regarding contraception selection or sterilization at delivery is limited. The objective of this study was to examine the type of long-acting reversible contraception or surgical sterilization procedure chosen by pregnant patients with malignancy at delivery. This cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample in the USA. The study population was vaginal and cesarean deliveries in a hospital setting from January 2017 to December 2020. Pregnant patients with breast cancer (n = 1605), leukemia (n = 1190), lymphoma (n = 1120), thyroid cancer (n = 715), cervical cancer (n = 425) and melanoma (n = 400) were compared with 14 265 319 pregnant patients without malignancy. The main outcome measures were utilization of long-acting reversible contraception (subdermal implant or intrauterine device) and performance of permanent surgical sterilization (bilateral tubal ligation or bilateral salpingectomy) during the index hospital admission for delivery, assessed with a multinomial regression model controlling for clinical, pregnancy and delivery characteristics. When compared with pregnant patients without malignancy, pregnant patients with breast cancer were more likely to proceed with bilateral salpingectomy (adjusted odds ratio [aOR] 2.30) or intrauterine device (aOR 1.91); none received the subdermal implant. Pregnant patients with leukemia were more likely to choose a subdermal implant (aOR 2.22), whereas those with lymphoma were more likely to proceed with bilateral salpingectomy (aOR 1.93) and bilateral tubal ligation (aOR 1.76). Pregnant patients with thyroid cancer were more likely to proceed with bilateral tubal ligation (aOR 2.21) and none received the subdermal implant. No patients in the cervical cancer group selected long-acting reversible contraception, and they were more likely to proceed with bilateral salpingectomy (aOR 2.08). None in the melanoma group chose long-acting reversible contraception. Among pregnant patients aged <30, the odds of proceeding with bilateral salpingectomy were increased in patients with breast cancer (aOR 3.01), cervical cancer (aOR 2.26) or lymphoma (aOR 2.08). The odds of proceeding with bilateral tubal ligation in pregnant patients aged <30 with melanoma (aOR 5.36) was also increased. The results of this nationwide assessment in the United Statessuggest that among pregnant patients with malignancy, the preferred contraceptive option or method of sterilization at time of hospital delivery differs by malignancy type.

P-012 GARENGEOT'S HERNIA WITH ACUTE APPENDICITIS: A RARE CASE

Abstract Garengeot's hernia is a rare entity that refers to the herniation of the vermiform appendix through the femoral canal, being even rarer the presence of acute appendicitis in a Garengeot hernia as presented in the clinical case, with an overall incidence of 0,08%-0,13%. A 52 years old female patient, attended the Emergency Service complaining of abdominal pain in the right lower quadrant and fever for the last 2 days. As pathological background, she had bilateral tubal ligation, right crural hernioplasty and iatrogenic uterine perforation after placement of a intrauterine device (IUD). On physical examination, she complained of pain in iliac fossa/right inguinal region showing a positive Blumberg sign. Abdominal ultrasonography revealed acute appendicitis. In the laparoscopic approach, we identified the ileocecal appendix contained in a right crural hernia with abscessed acute appendicitis. We proceeded with appendectomy and, given the soiling of operative field, we chose not to correct the hernia at that moment. Empirical antibiotic therapy with Amoxicillin/Clavulanic acid was performed and patient was discharged after 3 days. Diagnosis of Garengeot hernia with acute appendicitis is difficult, being more frequently diagnosed intraoperatively. There's no standard therapeutic approach regarding hernia repair simultaneously, being licit not to do it due to the risk of postoperative infection.

A 10-Year Retrospective Analysis of Uterine Rupture in a University Teaching Hospital in Nnewi, Nigeria

Background: One of the most serious obstetric emergencies that seriously endanger both mother and fetus and dramatically increase maternal and perinatal mortality in our community is uterine rupture. The aim of the study is to ascertain the prevalence of uterine rupture and the various aetiologies/predisposing factors associated with it. Methods: From January 1, 2007, to December 31, 2016, patients with ruptured uteruses were studied retrospectively and cross-sectionally at the Nnamdi Azikiwe University Teaching Hospital in Nnewi, Nigeria. Outcome measures included prevalence rate, surgical choices, maternal and fetal outcomes, and maternal case fatality rate. Stata 13.0 (StataCorp LP, Texas, USA) was used to analyze the data. Results: There were 10,777 deliveries and a total of 66 cases of ruptured uterus were treated, giving a ratio of 1 in 163 deliveries or prevalence of 6.0/1000 deliveries. Sixty four case notes were retrieved giving retrieval rate of 97.0% and prolonged obstructed labour was the commonest aetiologic factor identified (42.2%). Other associated factors were grand multiparity (36.0%), previous caesarean section (28.1%), previous myomectomy (3.1%), injudicious use of oxytocin (25.0%), use of misoprostol (3.1%) and abnormal lie (17.2%). Twenty of the patients (31.3%) had repair of the ruptured uterus alone, and 28(43.8%) had repair with bilateral tubal ligation. Six of the patients (9.4%) had total abdominal hysterectomies while 10(15.6%) had sub-total hysterectomies. There were a total of 4 maternal deaths giving a case fatality rate of 6.3%. The fetal outcome was poor with only 11 (17.2%) survivors. Conclusion: Only 17.2% of surviving fetuses had a good result, and 6.1 per 1000 deliveries involved uterine rupture. The rupture of gravid uterus will be decreased, if not completely eliminated, by adequate health education, widespread availability of comprehensive obstetric care facilities, enhanced antenatal care, a decline in the prevalence of primary caesarean sections, and population empowerment of women

Patient's Perception of Access to Reproductive Health and Family Planning During the COVID-19 Pandemic Quarantine Period [ID: 1372575

INTRODUCTION: The objective of this study was to assess patient perception of access to reproductive health and family planning care during the COVID-19 pandemic quarantine period, at which time routine annual visits were deferred. METHODS: Patients aged 18–44 seen at Temple University Hospital for an annual gynecology visit from March 2018 to December 2020 were identified. Pregnant patients, those with a history of permanent sterilization (bilateral tubal ligation, hysterectomy), women who were not heterosexually active, prisoners, non-English or non-Spanish speakers, and those with intellectual disability were excluded. Using a random number generator, 99 eligible patients were randomly selected from this population. Eligible patients were contacted via telephone and verbally consented. If agreeable, these patients were administered a 20-question survey. RESULTS: Of 99 patients selected, 27 (27.3%) responded to the telephone survey. 0% of responders felt that they faced barriers to contraceptive care during the quarantine period. Survey responders and nonresponders had no significant differences in age (P=.26), race (P=.50), insurance type (P=.15), gravida (P=.78), parity (P=.10), and number of induced abortions (P=.51). However, nonresponders were significantly more likely to have no-showed a gynecology appointment in 2020 (P&lt;.05). CONCLUSION: This study found that patients at Temple University Hospital did not perceive barriers to accessing contraceptive care during the COVID-19 quarantine period. Additionally, the majority of patients felt that contraceptive care was an important reason to have an in-person visit.