Women Of Childbearing Age Research Articles

The ABCs of post-preeclampsia outpatient nephrology care: the Le Mans strategy.

Preeclampsia and hypertensive disorders of pregnancy complicate 3 to 5% of all pregnancies. Chronic kidney disease (CKD), at any stage, reportedly affects 3% of women in childbearing age but most of the time is underdiagnosed, especially in asymptomatic early stages. The link between preeclampsia/hypertensive disorders of pregnancy and CKD is bidirectional and women experiencing a preeclampsia/hypertensive disorder of pregnancy episode are at higher risk for developing CKD later in life, as well as metabolic and cardiovascular diseases. In turn, CKD is a risk factor for preeclampsia/hypertensive disorders of pregnancy. Thus, it is important to follow up patients after an episode of preeclampsia/hypertensive disorders of pregnancy in order to make a timely diagnosis of CKD or reduce the risk of another episode of preeclampsia/hypertensive disorder of pregnancy during a subsequent pregnancy. In Le Mans, we set up a dedicated outpatient clinic for women who experienced an episode of preeclampsia/hypertensive disorder of pregnancy. Inthis point of view paper, we present how we manage post-preeclampsia, in the hope that sharing this experience can promote the creation of dedicated outpatient clinics in other settings that will contribute to women's health.

Effects of the Affordable Care Act on Contraception, Pregnancy, and Pregnancy Termination Rates.

To investigate the effects of the Affordable Care Act (ACA) and its elimination of cost-sharing on contraception utilization, pregnancy rates, and abortion rates. We conducted a retrospective cohort study within a healthcare system serving over 4.5 million insured members across 21 medical centers and 250 clinics. The study included women aged 18-45 with continuous health plan membership for at least two years in the pre-ACA (2007-2012) and post-ACA (2013-2018) periods. We analyzed out-of-pocket (OOP) costs for contraception, including oral contraceptives and long-acting reversible contraception (LARC), before and after the ACA's implementation. We then examined how the elimination of OOP costs affected contraception use, pregnancy rates, and abortion rates. The study identified 1,523,962 women of childbearing age. In 2013, cost sharing for contraception sharply declined, with average annual OOP costs dropping from $88-$94 pre-ACA to nearly zero post-ACA. Contraceptive use increased overall, rising from 30.2% pre-ACA to 31.9% by the study's end, with a notable rise in LARC use. In interrupted time-series analyses, while contraception use continued to increase post-ACA, new pregnancy rates declined at a faster rate than pre-ACA, and abortion rates continued to fall, though at a slightly slower pace than pre-ACA (p<0.05 for all trends). The Affordable Care Act's elimination of contraception cost-sharing led to increased contraception use, particularly LARC methods, and contributed to declines in both pregnancy and abortion rates. This suggests that improving access to effective contraception is a key strategy in reducing unintended pregnancies.

The Role of Gender in Turkish Women’s Pregnancy Experiences

Background: Apart from the biological changes women experience throughout pregnancy, their exposure to a gender discrimination stemming from cultural values adopted by the society in which they live can make it difficult for them to adapt to pregnancy and thus lead to negative pregnancy experiences. Aim: This research was conducted using a cross-sectional and relation-seeking approach to evaluate the effects of social gender inequality on pregnancy experiences. Methods: Data for this cross-sectional and relation-seeking study were gathered between 25 November 2019 and 25 January 2020 using face-to face interviews the researcher conducted with childbearing women who visited the outpatient clinic and non-stress test units of a hospital for the pregnancy follow-up. Results:: When using the Pregnancy Experiences Scale to assess childbearing women, higher scores indicated more positive emotions than negative emotions. Independent variables that affect the scores on the Pregnancy Experiences Scale include a willingness to be pregnant, the baby's sex, the woman’s income status, gestational week and the Perception of Gender Scale (p&lt;0.005). A positive but weakly significant relationship was found among the total score on the Perception of Gender Scale, the total score on the Pregnancy Experiences Scale and the average scores of positive emotions intensity and frequency in all sub-dimensions (p&lt;0.005). Conclusion: Based on the data, we conclude that women’s pregnancy experiences are generally positive, and that social gender inequality is a significant determinant affecting pregnancy experiences.

Clinical implications of dual therapy of acarbose plus myo-inositol on the thyroid profile in women with polycystic ovary syndrome

Context: Polycystic ovary syndrome (PCOS) and thyroid are the most common endocrine disorders affecting women of childbearing age, causing anovulation and infertility. There is an increased prevalence of thyroid dysfunction reported among PCOS women. Aims: To evaluate the benefits of acarbose plus myo-inositol therapy on the thyroid profile of PCOS. Methods: An open-labelled, parallel randomised clinical trial on 80 PCOS women based on inclusion and exclusion criteria was performed at the Department of Gynaecology, SRM Medical College Hospital and Research Centre, Kattankulathur. Institutional ethics committee approval and prior informed consent were obtained. The trial was registered in CTRI (No: CTRI/2022/04/041877). Group A (n = 38) received metformin 500 mg TID, and group B (n = 39) received acarbose 50 mg TID along with myoinositol 1000 mg BID. Assessment of metabolic and hormonal profile was done at baseline and at the end of six months. Results: Both groups showed significant reductions in luteinising hormone (p &lt;0.0001), total testosterone (p&lt;0.05), thyroid stimulating hormone (p&lt;0.05), fasting insulin (p&lt;0.05), and homeostatic model assessment for insulin resistance (p&lt;0.0001). The follicle-stimulating hormone was increased only in the metformin group. No significant changes in body mass index, free triiodothyronine, free tetraiodothyronine, and fasting glucose were observed in any group. Both therapies were safe, and no side effects or hypoglycaemia were recorded. Conclusions: In consideration of the beneficial effects of the study, we conclude that the administration of acarbose plus myo-inositol exerts positive effects on the thyroid and other endocrinological profiles in PCOS women.

Iron Deficiency Anemia Among Women in Skardu, Gilgit-Baltistan

ABSTRACT Objective: To determine the frequency of iron deficiency anemia among women in Skardu, Gligit-Baltistan. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Skardu, Pakistan, from Dec 2021 to May 2022. Methodology: A total of 202 women were selected through consecutive sampling from General Medical OPD of Combined Military Hospital, Skardu, Pakistan. Hemoglobin globin levels (Hb gram/deciliter), mean corpuscular volume (MCV fL) and red cell distribution width (RDW%) were determined for all enrolled patients. Results: Mean age of participants in this study was 34.46±10.93 years. Reduced Hb was observed in 62(30.69%) women with a mean hemoglobin level of 9.48±1.59 gl/deciliter and mean corpuscular volume of 79.97±10.7d fL. Among these women, 5(2.47%) were severely anemic (6.56±0.39 gl/deciliter), 28(13.86%) moderately anemic (8.51±0.83 gl/deciliter) while 29(14.35%) were mildly anemic (10.92±0.48 gl/deciliter). Women of younger age group, between18-35 years, were found to suffer more from iron deficiency anemia (39.14%) with mean hemoglobin levels of 11.31±1.80 and mean corpuscular volume of 79.34±10.86 fL. Conclusion: Iron Deficiency Anemia is present in female population of Gilgit-Baltistan in general and woman of childbearing age in particular. Emergency measures for awareness and fortification of basic food items with iron should be undertaken at large scale.

Effect of an educational intervention program on pregnant women’s ability to cope with childbirth pain in Western Kenya

INTRODUCTION Childbirth pain has remained a major challenge to women of child-bearing age over the years. Studies have shown that most women are not aware of the coping strategies to employ during childbirth. Severe childbirth pain can lead to adverse maternal and neonatal outcomes. Therefore, it is imperative to develop safe and innovative methods to cope with childbirth pain. The study aimed to investigate the effects of an educational program on women's ability to cope with childbirth pain in the context of lower and middle-income countries. MATERIALS AND METHODS A Quasi-experimental design was used to assess the impact of an educational intervention built on self-efficacy theory. Pregnant mothers were recruited at antenatal care services and were assigned to either the control group or the intervention group. The intervention group received two sessions of 2 hours each of the intervention between the 32nd– 35th weeks of gestation. Follow-up and evaluation on outcome measures were conducted within 48 hours after delivery. The strength of pain was measured by the visual analogue pain scale and the Mac-Gill pain questionnaire. RESULTS Findings indicate that relative to the control group, the intervention group was significantly more likely to demonstrate lower perceived pain both on the visual analogue scale (P&lt;0.001) and the McGill pain questionnaire (P&lt;0.001). Further analysis revealed that the non-intervention group had increased severe pain [OR=3.099,95% CI (1.080-8.887), P=0.035], unbearable pain [OR=27.930,95% CI (9.354-83.399), P=&lt;0001], while permanent employment reduced unbearable pain [OR=0.038 95% CI (0.003-0.549), P=0.016]. CONCLUSION AND RECOMMENDATIONS The educational intervention program was effective in decreasing pain intensity and severity during childbirth. Training programs should be integrated into the antenatal care program and offered to mothers during the third trimester of pregnancy to enhance women's coping skills during childbirth.

Research Progress on Luteinizing Hormone and Polycystic Ovary Syndrome

Polycystic ovary syndrome is a common endocrine disease in women of childbearing age, with an incidence of about 6% to 10%, which is the main cause of anovulatory infertility. With the development of assisted reproductive technology, up to 60% of patients with polycystic ovary syndrome need to be pregnant successfully through in vitro fertilization and embryo transfer. Ovarian controlled ovulation induction is an important process in assisted reproductive therapy. Luteinizing hormone plays an important role in the development and maturation of follicles in the ovary, and high levels of luteinizing hormone have a negative effect on pregnancy outcome. at present, it is still controversial that the appropriate level of luteinizing hormone will improve the pregnancy outcome, and the mechanism of how luteinizing hormone affects the pregnancy outcome is still unclear. This article will mainly review the above two aspects in order to provide reference for clinical research in the future.

Proceedings of the Conference “CMV Vaccine Development—How Close Are We?” (27–28 September 2023)

Congenital cytomegalovirus (cCMV) is the most common infectious cause of disability in children, including sensorineural hearing loss. There is interest in developing a pre-conception vaccine that could confer protective immunity on a woman of child-bearing age, hence resulting in a reduced cCMV disease burden. Other populations, including solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) patients, could also benefit from CMV vaccination. To review and discuss vaccines that are in clinical development, a workshop, sponsored by the National Institutes of Health (NIH) and the National Institute of Allergy and Infectious Diseases (NIAID), was empaneled. At this workshop, correlates of protective immunity against CMV, epidemiologic features of CMV transmission, and vaccine platforms in development were reviewed. Representatives from academia, pharma, and the NIH engaged in discussion on the current state-of-the-art in CMV vaccinology. A summary of the presentations from this is provided in this report.

Beyond Awareness: Hope for a CMV Vaccine! An Introduction to the Conference, “CMV Vaccine Development—How Close Are We?” (27–28 September 2023)

Congenital cytomegalovirus (cCMV) is the most common infectious cause of disability in children. The major theme of this National Institute of Allergy and Infectious Diseases (NIAID) workshop, “CMV Vaccine Development—How Close Are We?”, was to report progress on the development of a pre-conception vaccine that could confer protective immunity for women of child-bearing age. Such a vaccine could result in a reduced cCMV disease burden, although other populations, including solid organ transplant and hematopoietic stem cell transplant patients, could benefit as well. To frame the compelling need for a cCMV vaccine, a keynote lecture by Dr. Megan Pesch, immediate past-president of the National CMV Foundation and a leading cCMV researcher from the University of Michigan, was given. This manuscript provides a summary of Dr. Pesch’s presentation from this workshop, which was written as the introductory conference report for the meeting.

Pregnancy protection in women of child-bearing age prescribed ACE inhibitors, ARBs or statins - A nationwide cohort study

Abstract Background Cardiometabolic disorders, including hypertension, type-2 diabetes, and hyperlipidemia are increasingly prevalent among younger people. Consequently, women of child-bearing age may be prescribed renin-angiotensin system (RAS) inhibitors and statins. Both angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are known teratogens. Statins are considered possibly teratogenic. In Denmark, ACEIs and ARBs have a ‘Do not use’ recommendation in pregnancy while statins ‘Should not be used’ in pregnancy. Previous studies have reported widespread use of RAS inhibitors without concomitant contraception among women of child-bearing age. This study investigated the situation in Denmark. Purpose To examine prescribing patterns of RAS inhibitors and statins alongside use of concomitant contraception among women of child-bearing age in Denmark. Methods Using nationwide Danish registers, women aged 15–50 years initiating ACEIs, ARBs and statins during 1995–2021 were identified and use of concomitant contraception was evaluated. Contraception was categorized as oral pill, implant, intrauterine device (IUD), or non-use. The duration of protection was assumed to be 1 year for oral contraceptives, 2 years for implants and 4 years for IUDs. Where multiple types of contraceptives were retrieved by individual patients, they were categorized as taking the contraceptive retrieved most recently. Data on non-prescription contraceptives were unavailable, e.g., condoms. Women unable to conceive due to infertility were excluded. Results 79 547 women (median age: 44 years; [interquartile range (IQR): 39–47]) on ACEIs, 64 326 women (median age: 44 years [IQR: 38–48]) on ARBs, and 71 499 women (median age: 45 years [IQR: 40–48]) on statins were included (Figure 1). Correspondingly, 69.1%, 62.8%, and 73.5% were not on contraceptives when starting treatment. Among women prescribed contraception: 70.2%/56.2%/63.1% were on oral contraceptives, 25.3%/30.9%/26.6% had IUDs and 4.5%/12.9%/10.3% had implants, respectively (Figure 1). Younger patients aged 15–29 years were least likely to be unprotected with 41.8%/29.7%/33.4% being unprotected. Among women aged 25 to 35 years the percentage of unprotected women was 51.3%/41.1%/47.7%. Older patients were more likely to have IUDs. Conclusion Substantial numbers of women of child-bearing age were prescribed ACEIs, ARBs and statins from 1995–2021. Most were not prescribed contraceptives. The lack of prescribed pregnancy protection was prevalent even among the youngest women aged 15–29 years and women aged 25 to 35 years, who are the most likely to become pregnant—inferring a potential risk of teratogenic exposure during pregnancy (Figure 2). Subsequent studies should investigate the extent of exposure to ACEIs, ARBs, and statins during pregnancy and the impact of the exposure on pregnancy outcomes.Figure 1 Contraceptive useFigure 2 Study rationale

Serum Concentrations of Folate Forms Following Supplementation of Multimicronutrients with 400µg or 800µg Mix of (6S)-5-Methyltetrahydrofolate and Folic Acid (1:1) in Women of Childbearing Age.

A mixture of (6S)-5-methyltetrahydrofolate-calcium salt ((6S)-5-MTHF-Ca) and folic acid (FA) from multimicronutrient supplements may show a dose-dependent effect on serum folate concentrations. The study compares fasting concentrations of serum folate spices after 8 weeks of either 400 or 800µgday-1 of 1:1 folate mixture in 172 nonpregnant women. Serum (6S)-5-MTHF concentrations raise from a mean (SD) of 19.1 (13.4) to 73.9 (19.6) nmolL-1 in the 800µg group and from 17.5 (9.4) to 54.5 (21.1) nmolL-1 in the 400µg group (p < 0.001 within-group changes). The raise in serum (6S)-5-MTHF is stronger in the 800µg compared to the 400µg group (p < 0.001 between-group). The prevalence of FA concentrations ≥0.20nmolL-1 increases between baseline and week 8 in both groups, but is not different between the groups (p = 0.116). The mean percentage of (6S)-5-MTHF of total serum folate increases in both intervention groups, but is not different between the groups at 8 weeks (95.5 (4.1)% versus 94.4 (5.7)%, p = 0.309). Supplementation of multimicronutrients with 800µg folate mix for 8 weeks causes higher serum (6S)-5-MTHF concentrations, but not a higher prevalence of detectable FA compares to 400µg folate.

U. Parvum serovars exhibit distinct pathogenicity in Chinese women of childbearing age: a multicentre cross-sectional study

BackgroundUreaplasma spp. can be classified into different serovars. It is unknown whether distinct serovars are associated with clinical signs and symptoms.MethodsWe conducted a multicentre cross-sectional study. U. parvum serovars were identified on the basis of their multiple-banded antigen (MBA) genes. After adjusting for demographic variables and other reproductive tract infections, the odds ratio (OR) and 95% confidence interval (CI) were calculated to determine the impact of U. parvum serovars on clinical symptoms.ResultsAmong 5,277 individuals, U. parvum serovars 3 and 6 were the most prevalent serovars (17.9% and 16.0%, respectively). Potential confounders, such as age, body mass index (BMI), ethnicity, education level, contraceptive methods, number of sexual partners, gravidity, parity, and other sexually transmitted infections (STIs) that are associated with clinical symptoms (P < 0.1) were adjusted for in the univariate analysis. U. parvum serovar 14 was strongly positively associated with certain clinical symptoms, including redness and swelling of the vaginal wall (crude OR: 3.53, 95% CI: 1.92–6.49; adjusted OR: 5.21, 95% CI: 2.56–10.58), cervical bleeding and swelling (crude OR: 3.89, 95% CI: 2.38–6.36; adjusted OR: 7.37, 95% CI: 3.82–14.23), and cervical ectropion (crude OR: 2.08, 95% CI: 1.25–3.45; adjusted OR: 3.04, 95% CI: 1.60–5.74). In contrast, U. parvum serovar 3 was negatively associated with a variety of clinical symptoms, whereas no correlations were detected between U. parvum serovars 1and 6 with clinical symptoms.ConclusionsDifferent U. parvum serovars exhibit distinct correlations with clinical symptoms, suggesting that U. parvum serovars are pathogenically heterogeneous and that further differentiation of serovars may be necessary.Trial registrationThe study was registered with ClinicalTrials.gov (https://www.clinicaltrials.gov; ID: NCT04694495; Registration Date: 2021–01-05).

Diabetes, hypertension, and hospitalizations during pregnancy: a multivariate analysis

Abstract Introduction The study analyzes the correlation between socio-demographic variables and pathologies encountered by women during pregnancy. The presence of these pathologies is recorded at the time of compiling the CAP (Certificate of Assistance for Birth). Methods Data analysis pertains to the Certificate of Assistance for Birth (CAP) concerning residents in the territory of AUSL South-East Tuscany in the years 2021 and 2022. The number of women of childbearing age in Tuscany in 2022 is 150,959, while the number of births analyzed in the study is 9,053. The study conducts multivariate analysis between socio-demographic variables and pathological outcomes. Results Controlling for age, citizenship and other factors, the risk of gestational diabetes is significantly higher (p &amp;lt; 0.05) among mothers: over 40 years old (OR = 1.56), with citizenship in PFPM countries (OR = 1.60) and particularly, compared to Italians, among women from Indian subcontinent (OR = 3.73) and the Maghreb (OR = 2.04), with lower educational levels (OR = 1.28) compared to graduates, obese (OR = 2.43). The risk of gestational hypertension is significantly higher (p &amp;lt; 0.05) among mothers: over 40 years old (OR = 1.71), obese (OR = 2.50), nulliparous (OR = 1.60). The risk of one or more hospitalizations during pregnancy is significantly higher (p &amp;lt; 0.05) among mothers: not employed (OR = 1.31) and homemakers (OR = 1.32) compared to employed, from Indian subcontinent (OR = 1.82) and the Maghreb (OR = 1.75) compared to Italians, with gestational hypertension (OR = 2.06). Conclusions Unlike gestational diabetes and hospitalizations during pregnancy, gestational hypertension does not show significant associations with the mother’s socio-demographic characteristics. However, gestational diabetes and hospitalizations during pregnancy are correlated with different variables: they are more common among women over 40, foreigners, homemakers, with lower educational levels, obese, and with low family economic status. Key messages • It has been observed that some variables are also risk factors for adult age pathologies, such as diabetes and hypertension. • The importance of Early Childhood Development and early interventions can improve children’s health and well-being.

Determinants of health and pregnancy and birth outcomes: an overview

Abstract Introduction This study examines the influence of health determinants on pregnancy and birth outcomes. The aim is to provide a clear and updated view of the overall framework characterizing the birth experience, with crucial implications for clinical practice, research, and health policy. Methods Data analysis pertains to the Certificate of Assistance for Birth (CAP) concerning residents in the territory of AUSL South-East Tuscany in the years 2021 and 2022. The number of women of childbearing age in Tuscany in 2022 is 150,959, while the number of births analyzed in the study is 9,053. The study conducts multivariate analysis between factors and pregnancy-related outcomes. Results Controlling for age, citizenship and others factors, the risk of cesarean section is significantly higher (p &amp;lt; 0.05) among mothers: over 40 years old (OR = 2.09), with education levels of lower secondary (OR = 1.21) and upper secondary (OR = 1.23) compared to a degree, not employed (OR = 1.25) and homemakers (OR = 1.45) compared to employed, overweight/obese (OR = 1.41), with gestational diabetes (OR = 1.16), smoking during pregnancy (OR = 1.27), with gestational hypertension (OR = 2.81). Controlling for age, citizenship and others factors, the risk of term low birth weight is significantly higher (p &amp;lt; 0.05) among mothers: over 40 years old (OR = 1.76), not employed (OR = 1.76) and homemakers (OR = 1.34) compared to employed, smoking more than 3 cigarettes daily during pregnancy (OR = 1.31) not significant, with gestational hypertension (OR = 5.57), nulliparous (OR = 1.42). Controlling for age, citizenship and other factors, the risk of premature birth is significantly higher (p &amp;lt; 0.05) among mothers: with gestational hypertension (OR = 5.22), nulliparous (OR = 1.89), smoking during pregnancy (OR = 1.59). Conclusions The results underscore the importance of carefully monitoring and managing these risk factors during pregnancy to improve outcomes for both mother and baby. Key messages • Understanding the determinants that influence birth outcomes plays a fundamental role. • The importance of Early Childhood Development and early interventions can improve children’s health and well-being.

An observational study on the efficacy of intralesional steroids in patients with idiopathic granulomatous lobular mastitis in a tertiary care centre

Background: Granulomatous lobular mastitis (GLM) is a rare benign disease of the breast which usually affects young women of childbearing age. The patients usually present with a painful breast mass or with multiple discharging sinuses of breast. Diagnosis is usually established by means of clinical examination followed by radiological, microbiological and histopathological evaluation. The ideal management of patients with GLM is still a matter of debate and treatment modalities such as surgery, systemic and intra-lesional steroids, as well as immunosuppressive agents are being used in clinical practice. In our study, we assessed the clinical response of patients with GLM, treated with intra-lesional steroid injection. Methods: In this prospective observational study, from December 2021 to December 2023, a total of 29 patients who were diagnosed as having GLM and who opted for intra-lesional steroid therapy as the solo treatment, were enrolled. After obtaining informed consent, intra-lesional steroid injection was administered in all the 29 patients. The treatment response was assessed after a period of 3 months from the date of injection. Results: A complete resolution of symptoms and signs was found in majority of the patients (75.9%), 4 (13.8%) had a partial resolution and 2 (6.9%) had persistence of symptoms. One patient (3.4%) was lost to follow up. None had any worsening of symptoms. Conclusions: Intra-lesional steroid can be effectively used in the treatment of GLM and this modality can be completed in a few minutes in an Outpatient setting and is extremely cost effective.

Appendectomy for suspected appendicitis during pregnancy– a retrospective comparative study of 99 pregnant and 1796 non-pregnant women

IntroductionSuspected appendicitis is the most common indication for non-obstetric surgery during pregnancy. Diagnosis and management of these patients can be challenging. Atypical clinical presentation has been described before, but the current literature consists mostly of small case series. Therefore, we conducted a large retrospective study to analyze the frequency and diagnostic accuracy of clinical signs, laboratory findings and imaging modalities in pregnant woman undergoing surgery for suspected appendicitis compared to a control group of non-pregnant women of childbearing age. We further describe intra- and postoperative findings in both groups.MethodsData from consecutive patients who underwent appendectomy for suspected appendicitis during pregnancy were retrieved from the electronic patient database and analyzed. Preoperative clinical, laboratory and imaging findings as well as intra- and postoperative characteristics were compared between pregnant and non-pregnant women.ResultsBetween January 2008 and June 2023, 99 pregnant woman and 1796 non-pregnant woman between the ages of 16 and 49 underwent emergency surgery for suspected appendicitis. Pregnant women were less likely to have right lower quadrant tenderness (p = 0.002), guarding (p = 0.011) and rebound tenderness (p = 0.097). A greater percentage of pregnant women had a symptom duration of more than 24 h before presentation (p = 0.003) Abdominal ultrasound showed a reduced diagnostic accuracy in pregnant women (p = 0.004). MRI was used in eight pregnant women and showed a diagnostic accuracy of 100%. Pregnant women had a longer operating time (p = 0.006), a higher rate of open appendectomies or conversion (p < 0.001) and a longer postoperative hospital stay (3.2 days vs. 2.2 days, p < 0.001). The perforation rate was also higher in pregnant women at 16% vs. 10% (p = 0.048).ConclusionThe diagnosis of acute appendicitis during pregnancy presents a challenge for the clinician. Our data confirm the paradigm of “atypical presentation” which should lead to an extended diagnostic workup. Ultrasound showed less diagnostic accuracy in pregnant women in our study. MRI is a useful tool to reduce uncertainty and the rate of negative appendectomies.

Investigation of pregnancy tendency, reproductive characteristics, and disability in women with multiple sclerosis: A secondary data analysis of the national registry in Iran

Abstract Background: Multiple sclerosis (MS) predominantly affects women of childbearing age, significantly impacting their quality of life (QOL).The diagnosis of MS can influence pregnancy intention, and the level of disability associated with MS may change before and after pregnancy. This study aims to analyze the reproductive characteristics of Iranian female patients with MS (PwMS) and their association with the Expanded Disability Status Scale (EDSS) and pregnancy tendency, providing valuable insights into disease progression and the development of tailored treatments. Methods: A cross-sectional study was conducted using data from the nationwide MS registry of Iran (NMSRI) from 2018 to 2021. Patients without a documented history of pregnancy, MS type, or EDSS score were excluded from the study. Various statistical methods, including nonparametric tests, the generalized estimating equation (GEE) model, and multiple logistic regression, were employed to analyze the data. Results: The study included 1120 PwMS with a median diagnostic age of 31 and a disease duration of 6 years. The majority had relapsing-remitting MS (RRMS) and the mean EDSS score at bassline was 1.5 ± 1.4. A history of pregnancy or abortion was associated with higher EDSS scores. Multiparity before MS diagnosis was linked to EDSS score ≥ 5, while this EDSS range was associated with decreased parity after MS diagnosis (all P-values &lt; 0.05). Conclusion: Pregnancy and parity can affect the disability in female PwMS irrespective of clinical symptoms, diagnosis age, and MS type. Moreover, the chance of parity may be affected by a higher disability score, which should be considered in the clinical setting.

Characterizing clinical and hormonal profiles of acne in north African women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the leading endocrine disorder in young women of childbearing age. Dermatological issues, particularly acne, are a major reason for medical consultations. The aim of this study is to determine the prevalence of PCOS in patients presenting with acne as their main dermatological complaint and to compare the metabolic and hormonal clinical characteristics of acne patients with PCOS to those with isolated acne. This was a prospective study with analytical aims, carried out in the Endocrinology Department and the Dermatology Department of Farhat Hached University Hospital in Sousse. The study included patients seeking treatment for acne from January 2023 to January 2024, divided into two groups: those with confirmed PCOS (G1) and those with isolated acne (G2). All patients underwent hormonal assessment and ovarian ultrasound. We conducted a study involving 212 patients. We found that 65.6% of acne patients had been diagnosed with PCOS. Nodular lesions were significantly more frequent in 'PCOS' (p = 0.02). Acne was linked with hirsutism, which was more prevalent in 'PCOS' (94.2% 'PCOS' vs. 67.1% 'isolated acne'), as well as androgenic alopecia (51% 'PCOS' vs. 21.9% 'isolated acne') (p < 10- 3). 'PCOS' showed evidence of biological hyperandrogenism, with a mean testosterone level of 0.72 ± 0.27 ng/mL, significantly higher than in 'isolated acne'. The LH/FSH ratio was greater than 1 in 72.7% of cases in 'PCOS', demonstrating a significant difference compared to 'isolated acne', where it was greater than 1 in 24.7% of cases (p < 10- 3). In our study, acne in 'PCOS' appeared to be more severe and was associated with hypertestosteronemia (p = 0.041) and hyperprolactinemia (p = 0.008). According to our results, phenotype A was the most likely to cause severe acne (p = 0.043). Our work is unique in that it brings to light this hidden aspect of the dermatological impact of PCOS, prompting physicians to screen for this endocrine disorder in all adult women seeking acne treatment.

Decreased Insulin and Interleukin-6 Levels in Rattus Norvegicus Model of Polycystic Ovary Syndrome-Insulin Resistance Treated with a High Protein Diet

Hypercaloric in women of childbearing age is one of the causes of polycystic ovary syndrome (PCOS) with insulin resistance. Increased inflammation (tumor factor necrosis-α (TNF-α) and interleukin-6 (IL-6)) is the impact of endocrine and metabolic disorders involved due to metabolic syndrome, obesity, and diabetes mellitus. This study aims to evaluate whether a high-protein diet can reduce insulin and interleukin-6 levels, which are key indicators of polycystic ovary syndrome, and whether these changes can help in the treatment of the syndrome. This study used a prepost test only control design, true experimental, with a total sample of 6 female Rattus norvegicus rats aged 2–3 years (150–200 g). It consists of 4 groups, namely the negative control group (K-), the positive control group (K+), the treatment group (P), and the group without treatment (P-). The study examined the rat blood serum ELISA measurement of insulin and IL-6 levels. Anova test results of IL-6 levels (p = 0.002). Post-hoc test results of group K- and group P (p = 0.002), group K + and group P (p = 0.037), group K- and group K + (p = 0.437). The Anova test results of insulin levels between groups found a significant difference (p = 0.001). Post-hoc test of insulin levels of group K- and group P (p = 0.002), group K- and group K+ (p = 0.000), and group K+ with group P (p = 0.356). In group K and group P, the results of the ANOVA and post hoc tests on IL-6 levels and insulin levels with the provision of a high-protein diet show significant differences. This study suggests that a high-protein diet may be an effective therapeutic alternative in reducing the symptoms of polycystic ovary syndrome, especially in controlling high insulin and interleukin-6 levels.

The Correlation between Husband Support and Reproductive Age Couple Self-Efficacy in LARC Election in Choosing LARC

Husband support is a strengthening factor in choosing long-term contraceptive methods. The problem is the husband's strong influence in determining the wife’s contraception. A wife becomes more confident in herself through the positive support of her husband. This study aims to find out the correlation between the husband's support with the self-efficacy of women of childbearing age in choosing LARC. The research design used is a correlational descriptive with a cross-sectional approach. The population of LARC acceptor PUS was 42 people, sampling using proportional random sampling with 38 respondents who met the inclusion criteria. The research instrument uses husband support query sheets and self-efficacy questionnaires that have been tested for validity and reliability. The Spearman correlation test shows a correlation coefficient of 0.564 which is strongly correlated. As well as the significance level of 0.000 &lt; 0.05, which means there is a correlation between the husband's support and PUS self-efficacy in choosing LARC. The promotional action to increase the confidence of the use of LARC is to increase the provision of information on LARC contraception.