Future Pregnancies Research Articles

Less-invasive autopsy for early pregnancy loss.

Autopsy investigations provide valuable information regarding fetal death that can assist in the parental bereavement process, and influence future pregnancies, but conventional autopsy is often declined by parents because of its invasive approach. This has led to the development of less-invasive autopsy investigations based on imaging technology to provide a more accessible and acceptable choice for parents when investigating their loss. Whilst the development and use of more conventional clinical imaging techniques (radiographs, CT, MRI, US) are well described in the literature for fetuses over 20weeks of gestational age, these investigations have limited diagnostic accuracy in imaging smaller fetuses. Techniques such as ultra-high-field MRI (>3T) and micro-focus computed tomography have been shown to have higher diagnostic accuracy whilst still being acceptable to parents. By further developing and increasing the availability of these more innovative imaging techniques, parents will be provided with a greater choice of acceptable options to investigate their loss, which may in turn increase their uptake. We provide a narrative review focussing on the development of high-resolution, non-invasive imaging techniques to evaluate early gestational pregnancy loss.

Twenty years of experience with less radical fertility-sparing surgery in early-stage cervical cancer: Pregnancy outcomes

IntroductionThe standard procedure in cervical cancer is radical hysterectomy and pelvic lymphadenectomy (PLND). Because of the increasing age of women bearing children, fertility has become a major challenge. We present pregnancy results after less radical fertility-sparing surgery in women with IA1, LVSI positive, IA2 and IB1 (<2 cm, infiltration less than half of the cervical stroma). Materials and methodAll women (n = 91) underwent laparoscopic sentinel lymph node mapping with frozen section followed by PLND and “selective parametrectomy” (removal of afferent lymphatic channels from the paracervix) if sentinel nodes (SLN) are negative. If lymph nodes were verified negative by definitive histopathology, patients were treated by simple trachelectomy (IB1) or large cone (IA1/IA2) biopsy 1 week after primary surgery. ResultsFrom 1999 to 2018, 91 women were enrolled in the study (median age 29.1 years, range 21–40). Fertility was spared in 76 (83.5%) women; 13 (17.1%) women did not plan future pregnancy and 63 (82.9%) had pregnancy desires. Fifty-four of 63 women conceived (pregnancy rate 85.7%) and 48 of 63 delivered 58 babies (delivery rate 76.2%). Thirty-nine women delivered in term (67.2%): 13 women between 32 and 36 + 6 weeks of pregnancy, 3 between 28 and 31 + 6 weeks and 3 between 24 and 27 + 6 weeks. Only one woman still plans pregnancy. One woman is currently pregnant. ConclusionThe goal of fertility-sparing surgery is to produce good oncological results and promising pregnancy outcomes. Pregnancy results after less radical fertility-sparing procedures show promise (pregnancy rate 82.9% and delivery rate 76.2%).

COVID-19 Infection as a Barrier to Postpartum Tubal Ligation [ID: 1355689

INTRODUCTION: About half of patients who do not obtain a requested postpartum tubal ligation experience pregnancy within the following year. There are many challenges to fulfilling postpartum tubal requests. Obstacles are exacerbated for those without private insurance, including Medicaid consent form requirements. Our institution considers postpartum tubal ligations “elective” and created policy prohibiting them for COVID-positive patients. We aimed to study how this creates additional barriers and delays to care for our patients. METHODS: This retrospective study identified patients with documented COVID infection at time of vaginal delivery who were unable to receive a requested postpartum tubal ligation at our institution between February 2020 and February 2022. Sociodemographic information, documented contraception ultimately obtained, and documented future unintended pregnancy were evaluated. Institutional review board approval was obtained. RESULTS: In a 2-year period, 24 patients were unable to receive requested postpartum tubal ligations at our institution because of COVID infection. 42% (n=10) of such patients were uninsured and 54% (n=13) had Medicaid. 92% (n=22) were Hispanic/Latinx. Average age was 33, and average number of prior pregnancies was 5. Only 21% (n=5) received an interval tubal ligation after delivery; no uninsured patients received an interval tubal ligation. Of the remaining patients (n=19), 37% (n=7) never received any contraception, 37% (n=7) received long-acting reversible contraceptives, and 26% (n=5) received another type of contraception. One patient had a future documented unintended pregnancy. CONCLUSION: Our institution's policy not to perform postpartum tubal ligations for COVID-positive patients prevented about 80% of patients requesting permanent sterilization after vaginal delivery from ever accessing this procedure.

The Impact of Pelvic Osteotomies on Birth Canal Anatomy and Cesarean Section Rates: A Systematic Review

Background: Various pelvic osteotomies can be performed to improve femoral head coverage for patients with hip dysplasia and other childhood hip disorders with the goal of delaying or preventing osteoarthritis. During preoperative discussions, female patients and their parents often ask about the influence of these osteotomies on future pregnancy. The literature on this topic is varied with no consensus on the appropriateness of elective cesarean section (C-section) for such patients. Therefore, this study sought to review and summarize the literature regarding the impact of different pelvic osteotomies on birth canal anatomy and C-section rates.Methods: All studies assessing the impact of pelvic osteotomies on birth canal anatomy or pregnancy outcomes for patients were identified through a systematic search of four online databases (PubMed, Embase, CINAHL, and Cochrane Library). PRISMA guidelines were then used to evaluate all identified studies for appropriateness, leading to the final inclusion of 17 articles evaluating five general types of pelvic osteotomies.Results: The Salter, double, and triple osteotomies were found to decrease the size of the pelvic outlet in modelbased and radiographic studies. The Chiari osteotomy decreased the dimensions of the pelvic inlet/mid-pelvis and was associated with higher reported C-section rates. The Bernese periacetabular osteotomy was not associated with any changes in pelvic diameters, with reported increased rates of C-section noted to result from obstetrician preference. For osteotomies performed prior to skeletal maturity, resulting pelvic deformities largely remodeled with growth.Discussion: Pelvic osteotomies can alter normal pelvic parameters and may influence the ability for vaginal delivery. Obstetricians may recommend C-section for patients undergoing non-PAO osteotomies depending on skeletal maturity status at the time of their osteotomy and other obstetric-related factors such as fetal size and natural pelvic relaxation. The literature on this subject, however, remains limited.Levels of Evidence: Level IVKey Concepts•Pelvic osteotomies for residual hip dysplasia or other childhood hip disorders alter normal pelvic parameters that may preclude the possibility of vaginal birth, particularly when performed after skeletal maturity.•The Chiari osteotomy primarily alters the dimensions of the pelvic inlet and mid-pelvis, while the Salter, double, and triple osteotomies decrease the size of the pelvic outlet.•The Bernese periacetabular osteotomy does not influence bony birth canal anatomy.•Pelvic deformities resulting from pelvic osteotomies performed before skeletal maturity often remodel with growth.•Obstetricians may recommend cesarean section after pelvic osteotomy, particularly when performed bilaterally, dependent on obstetric-specific factors.

Undetected Maternal Cell Contamination in Products of Conception Analysis May Mask Recurrence Risks for Future Pregnancies: A Case Report and Discussion [ID: 1377203

INTRODUCTION: Maternal cell contamination (MCC) in products of conception (POC) tissue is common; some studies report 59% of 46,XX results represent MCC. METHODS: Products of conception tissue and maternal blood samples were shipped to a laboratory for genotyping using Illumina CytoSNP-12b microarrays and bioinformatics (IRB E&amp;I 19040-03A). Patient informed consent was obtained for submission of a case report. RESULTS: A 25-year-old woman with a family history of recurrent pregnancy loss (RPL) was first offered POC analysis after her second loss. The result was normal female; however, MCC could not be ruled out because a maternal sample was not provided. Thus, the result was presumed normal, and the patient was informed her testing did not identify a genetic cause for her loss. The patient's third miscarriage was sent for POC analysis with a parental sample, which identified a maternally derived 26.8-Mb terminal deletion and 39.3-Mb terminal duplication of chromosome 4. The submitted maternal sample allowed for reanalysis of the second loss confirming MCC. Maternal karyotype analysis revealed an abnormal result: 46,XX,inv(4)(p15.2q31.3). The patient was referred to reproductive endocrinology for discussion of options, including in vitro fertilization with preimplantation genetic testing. CONCLUSION: Undetected MCC can lead to erroneous normal female results, masking fetal findings that could affect recurrence risks. Since 5% of couples with RPL have a balanced chromosome rearrangement, almost six couples for every 1,000 losses are at risk for undetected MCC masking recurrence risks (calculated using a 50% expected aneuploidy rate and 59% of 46,XX results actually representing MCC).

Dysregulated Gln-Glu-α-ketoglutarate axis impairs maternal decidualization and increases the risk of recurrent spontaneous miscarriage

Recurrent spontaneous miscarriage (RSM) affects 1%-2% of fertile women worldwide and poses a risk of future pregnancy complications. Increasing evidence has indicated that defective endometrial stromal decidualization is a potential cause of RSM. Here, we perform liquid chromatography with mass spectrometry (LC-MS)-based metabolite profiling in human endometrial stromal cells (ESCs) and differentiated ESCs (DESCs) and find that accumulated α-ketoglutarate (αKG) derived from activated glutaminolysis contributes to maternal decidualization. Contrarily, ESCs obtained from patients with RSM show glutaminolysis blockade and aberrant decidualization. We further find that enhanced Gln-Glu-αKG flux decreases histone methylation and supports ATP production during decidualization. Invivo, feeding mice a Glu-free diet leads to a reduction of αKG, impaired decidualization, and an increase of fetal loss rate. Isotopic tracing approaches demonstrate Gln-dependent oxidative metabolism as a prevalent direction during decidualization. Our results demonstrate an essential prerequisite of Gln-Glu-αKG flux to regulate maternal decidualization, suggesting αKG supplementation as a putative strategy to rectify deficient decidualization in patients with RSM.

The impact of Myasthenia Gravis antibody status on pregnancy and neonatal outcomes (P1-8.007)

<h3>Objective:</h3> The objective of this study to assess the impact of Myasthenia Gravis (MG) serological status on pregnancy-related and neonatal outcomes. <h3>Background:</h3> Pregnancy has a variable effect on the course of MG. Current knowledge describes an increased likelihood of flares in the first trimester and the postpartum period, an increased risk of caesarean section and ICU admission, transient neonatal MG and arthrogryposis. It’s unknown if serological status impacts pregnancy and neonatal outcomes. <h3>Design/Methods:</h3> An online survey was developed in conjunction with patient representatives from the Myasthenia Gravis Foundation of America. Respondents who have (or had) ovaries, uterus, and/or cervix with a diagnosis of MG. For the current analysis, those with at least one pregnancy in prior 10 years were included. Information on disease course, pregnancy complications, antibody status, fetal and neonatal outcomes was collected. <h3>Results:</h3> 157 opened the survey, and 142 met entry criteria for a response rate of 90%. 96 pregnancies were analyzed. MG symptoms appeared to worsen regardless of antibody status in the first trimester and postpartum. Antibody negative vs AchRAB and MUSK participants respectively, reported a greater risk of ICU admission (23% vs 16% and 12%, P =0.058 ) intubation ( 50% vs 4% and 17% P value 0.007) C-section ( 92% vs 23% and 42%, put p-0.001), neonatal MG rates (67% vs 8% and 0%, P value 0.001), and unplanned pregnancy (75% vs 21% and 50%, put p-value 0.004). <h3>Conclusions:</h3> This is the first know study of the association between negative serological status and poor pregnancy outcomes and although limited in size, may influence future preconception counselling and pregnancy monitoring. Highlighting the importance of interdisciplinary preconception and antenatal care including Neurology, Maternal-Fetal-Medicine and Neonatology. Findings of transient neonatal myasthenia gravis and arthrogryposis in seronegative individuals suggests that another, currently unknown antibody or biological process may be present in the seronegative group. Future, larger studies are warranted. <b>Disclosure:</b> Dr. Al Hussona has nothing to disclose. Dr. Izenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Izenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Izenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genzyme. Dr. Izenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aaron Izenberg. Dr. Barnett Tapia has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Barnett Tapia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. Dr. Barnett Tapia has received personal compensation in the range of $0-$499 for serving as a Consultant for Sanofi. Dr. Barnett Tapia has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Barnett Tapia has received research support from Department of defense. The institution of Dr. Barnett Tapia has received research support from Muscular dystrophy canada. The institution of Dr. Barnett Tapia has received research support from MgNet. The institution of Dr. Barnett Tapia has received research support from NIH. Dr. Barnett Tapia has received intellectual property interests from a discovery or technology relating to health care. Dr. Berndl has nothing to disclose.

Effect of lifestyles on fear of pregnancy: Development and psychometric testing of the fear of pregnancy scale

ObjectivePregnancy may be a cause of fear for some women. Fear of pregnancy is a woman’s belief that her health or life may get worse due to pregnancy. This study aimed to develop a valid and reliable instrument to measure fear of pregnancy in women, and determine the effect of lifestyle on fear of pregnancy. MethodsThis study was conducted in three phases. For the first phase, item generation and selection were made through qualitative interviews and literature review. In the second phase, items were administered to 398 women of reproductive age. The scale development phase was completed with exploratory factor analysis and internal consistency analysis. In the third phase, the Fear of Pregnancy Scale was developed, and was administered, together with the Lifestyle Scale, to women of reproductive age (n = 748). ResultsThe Fear of Pregnancy Scale was found to be a valid and reliable instrument for women of reproductive age. Perfectionism, control and self-esteem lifestyles were found to influence fear of pregnancy. Furthermore, fear of pregnancy was significantly more common in primiparous women and women with insufficient information about pregnancy. ConclusionThis study found that fear of pregnancy was moderate and varied with lifestyle. Factors associated with fear of pregnancy that remain unspoken, and how they affect women’s lives are not yet known. Evaluation of fear of pregnancy in women can be an important step in showing adaptation to future pregnancy, and revealing its effects on reproductive health.

Active COVID-19 infection as a barrier to postpartum tubal ligation

ObjectivesTo identify patients unable to obtain postpartum bilateral tubal ligations (ppBTLs) due to policy prohibiting “elective” procedures for COVID-positive patients at a single academic medical center in New Jersey. ResultsUpon retrospective chart review of patients requesting ppBTLS, of 110 ppBTL requests between identified via retrospective chart review between February 1, 2020, and February 28, 2022, 24 (22%) were canceled due to COVID infection. Of these patients, 10 (42%) were uninsured, 13 (54%) had Medicaid, and 22 (92%) were Hispanic/Latinx. Postpartum, five (21%) obtained interval tubal ligation, seven (37%) never received contraception, and one had a future pregnancy. ConclusionsThis policy affected uninsured patients by preventing access to permanent contraception.

Effect of different conization ranges on pregnancy outcomes

Purpose: To analyze the influence of different conization on pregnancy outcomes. Methods: The data of 78 women at childbearing age having cervical conization in our hospital from January 2013 till December 2015, was collected and analyzed. The control group comprised of 80 women of childbearing age with matched clinical data, who did not undergo cervical conization. Data on the conization procedure were analyzed and pregnancy and obstetric outcomes were assessed. using the. Comparisons were made using the 2test or the Fisher exact test and Student T-test as appropriate. Results: Cold knife cervical conization prolonged the time to conception in patients. Following the procedure, the incidence of premature delivery and premature rupture of membranes were significantly increased as also the rate of early abortions. The depth and circumference of conization was found to be directly correlated with the rate of premature delivery and premature membrane rupture, but not with fetal growth restriction and macrosomia. Conclusion: The depth and circumference of resection should be based on the type of cervical lesions as well as the prognosis and the future pregnancy plans of the patients.

The experience of being a partner to a childbearing woman whose pregnancy is complicated by pre-eclampsia: A Swedish qualitative study

BackgroundPre-eclampsia affects 3–5% of all pregnant women and is among the leading causes of maternal morbidity and mortality as well as iatrogenic preterm birth worldwide. Little is known about the experience of partners of women whose pregnancy is complicated by pre-eclampsia. AimTo describe partners’ experience of having a spouse whose pregnancy was complicated by pre-eclampsia. MethodsA qualitative study with in-depth interviews. Eight partners of women whose pregnancy was complicated by pre-eclampsia were interviewed and data were analysed using content analysis. FindingsPartners found themselves in an unfamiliar and unexpected situation. They experienced an information gap in which they tried to make sense of the situation by interpreting subtle signs. The situation left them feeling emotionally stretched, feeling like an outsider while trying to provide support for their extended family. The partners experienced a split focus after the baby was born, prioritising the baby while worrying about their spouse. Post-partum, they expressed needing time to process and heal after childbirth. A need for professional support was highlighted and concerns about a future pregnancy were voiced. ConclusionHaving a spouse who is diagnosed with pre-eclampsia is challenging and overwhelming. Our findings imply a need to develop a model of care for women with pre-eclampsia that includes their partner, i.e., the other parent.

Considerable doubt about rubella screening and vaccination among unvaccinated orthodox protestant women: a mixed-methods study

BackgroundWomen who are susceptible to rubella are advised to vaccinate against rubella to prevent infection in future pregnancies, and thus avert the risk of congenital rubella syndrome in their unborn child. Rubella outbreaks periodically occur in the under-vaccinated orthodox Protestant community in the Netherlands. The objective of this mixed-methods study was to determine and understand personal experience with rubella, perceived rubella susceptibility, and intention to accept rubella screening and vaccination among unvaccinated orthodox Protestant women. The ultimate aim of this study was to inform policy and practice and contribute to the prevention of cases of congenital rubella syndrome.MethodsA mixed-methods study was conducted combining an online survey and semi-structured interviews among unvaccinated Dutch orthodox Protestant women aged 18–40 years. Descriptive analysis was used for quantitative data. Qualitative data was analysed using codes and categories.ResultsResults of the survey (167 participants) showed that most participants had personal experience with rubella (74%, 123/167) and 101 women (61%, 101/167) indicated they had had rubella themselves. More than half of the women were undecided whether to accept rubella susceptibility screening (56%; 87/156) or rubella vaccination (55%; 80/146). Qualitative findings (10 participants) showed that most women thought they were not susceptible to rubella. Indecisiveness and negative attitudes to accept rubella vaccination were related with religious arguments to object vaccination and with women’s perception of absence of imminent threat of rubella. Furthermore, results showed presence of misconceptions among women in the interpretation of their susceptibility and high confidence in their parents’ memory that they had experienced rubella as a child although no laboratory screening had been conducted.ConclusionsIn light of an imminent rubella outbreak in the Netherlands, a tailored education campaign should be prepared aimed at and established in cooperation with the under-vaccinated orthodox Protestant community. Health care providers should provide adequate information on rubella and support decision-making in order to stimulate women to make a deliberate and informed decision on rubella screening and, if necessary, subsequent vaccination.

Radiofrequency Ablation of Leiomyomas.

Radiofrequency ablation (RFA) of leiomyomas represents a significant advancement in the treatment of this common uterine condition. In the appropriately selected patient, both laparoscopic and transcervical options provide effective treatment for bleeding and bulk symptoms in a uterine-sparing manner. Compared with other minimally invasive leiomyoma treatment options, RFA procedures have comparable or favorable safety profiles, recovery timelines, and reintervention rates. Data on future fertility and pregnancy are limited, although early reports are promising.

Genetic variations in the DYNC2H1 gene causing SRTD3 (short-rib thoracic dysplasia 3 with or without polydactyly).

Background and aims: Short-rib thoracic dysplasia 3 with or without polydactyly (SRTD3) represents a type of severe fetal skeletal dysplasia (SD) characterized by shortened limbs, narrow thorax with or without polydactyly, which is caused by the homozygous or compound heterozygous mutations in the DYNC2H1 gene. SRTD3 is a recessive disorder, identification of the responsible genetic variation would be beneficial to an accurate prenatal diagnosis and well-grounded counseling for the affected families. Material and methods: Two families having experienced recurrent fetal SDs were recruited and submitted to a multiplatform genetic investigation. Whole-exome sequencing (WES) was performed with samples collected from the probands. Sanger sequencing and fluorescent quantitative PCR (qPCR) were conducted as validation assays for suspected variations. Results: WES identified two compound heterozygous variations in the DYNC2H1(NM_001080463.2) gene, namely c.2386C>T (p.Arg796Trp) and c.7289T>C (p.Ile2430Thr) for one; and exon (64-83)del and c.8190G>T (p.Leu2730Phe) for the other, respectively. One variant in them, exon (64-83)del, was novelly identified. Conclusion: The study detected two compound heterozygous variation in DYNC2H1 including one novel deletion: exon (64-83) del. Our findings clarified the cause of fetal skeletal dysplasia in the subject families, provided guidance for their future pregnancies, and highlighted the value of WES in diagnosis of skeletal dysplasia with unclear prenatal indications.

Abstract 6644: Investigating the effect of immune checkpoint inhibitors (ICI) on ovarian function in young patients with melanoma

Abstract Immune related adverse events (irAEs) from immune checkpoint inhibitors (ICIs) are well documented for nearly every organ system, except for the reproductive system. Mouse models have demonstrated that ICIs can decrease ovarian follicular reserve and impair oocyte maturation, which may have implications for fertility (PMID: 36008687). There are no studies investigating the effect of ICIs on fertility in humans. We sought to evaluate ovarian function in women treated with ICIs compared to untreated women by evaluating non-invasive surrogate markers of ovarian reserve, anti-müllerian hormone (AMH) and antral follicle counts (AFC). We enrolled women 18 - 40 years old diagnosed with stage III or IV melanoma. Participants underwent phlebotomy for AMH levels and a pelvic ultrasound to assess AFC. The medical record was retrospectively reviewed to obtain data on patient characteristics, treatments, and outcomes. A total of 14 patients with stage IIIA - IV melanoma participated. Six patients received ICI treatment before AMH and AFC testing while 8 had no prior ICI exposure. The ICI group ages ranged from 22-40 years with a median age of 31 years. The untreated group ages ranged from 25-39 years with a median age of 32 years. The time between starting an ICI and enrolling in the study ranged from 28 - 351 days. ICI regimens included ipilimumab/nivolumab, nivolumab, pembrolizumab, and atezolizumab (on a clinical trial). Four of these six patients experienced an irAE during their course, including: dermatitis, hepatitis, colitis, thyroid dysfunction, and adrenal insufficiency. Median AMH levels were lower for patients treated with ICIs (2.9 vs 4.0 ng/mL), as was median AFC (22.5 vs 23.5 ng/mL). Only three patients’ clinicians discussed fertility preservation. None of the patients underwent fertility preservation. Our study found lower AMH and AFC in women with melanoma who were treated with an ICI compared to untreated women. Although AMH and AFC are surrogate markers for ovarian reserve and fertility, and our study is a small cohort, these early results suggest that ICIs may impact ovarian function. Age is less likely to be a confounding factor as the median age of the treated group was younger than the untreated group. While these results are preliminary, when considered in conjunction with recent pre-clinical data showing changes within the ovaries after ICI treatment, fertility consultation should be considered for young women prior to ICI initiation. We are investigating associations between AMH, AFC, age, ICI exposure, and future pregnancies in an ongoing prospective study. Citation Format: Ashley Hickman, Katherine Smith, Zaraq Khan, Elizabeth Ann Enninga, Yulian Zhao, Elizabeth Cathcart-Rake, Haidong Dong, Lisa Kottschade, Svetomir Markovic, Heather Montane, Anastasios Dimou, Yiyi Yan. Investigating the effect of immune checkpoint inhibitors (ICI) on ovarian function in young patients with melanoma. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6644.

Cultural beliefs and practices on perinatal death: a qualitative study among the Lango community in Northern Uganda

BackgroundPerinatal death has profound psychosocial effects on women and their families. Sociocultural contexts influence the burden, rituals and bereaved’s support. Little is known about cultural beliefs and practices related to perinatal death. This study explored the cultural perspectives of the Lango community on perinatal death.MethodsThis study utilised a focused ethnographic design anchored on a symbolic interactionist framework to understand the meanings attached to beliefs and practices on stillbirth or neonatal death among the Lango community in Lira District, Northern Uganda. Participants were sampled purposively for FGD while key informants were identified through snowballing technique. Data were audio recorded in Lango, transcribed, and later translated, a codebook was developed and data entered into Atlas. ti version 8.4.26 and then coded. It was analysed both deductively and inductively into themes.ResultsStillbirth and early neonatal death both attract similar rituals as would an older child. Burial is not rushed and is attended by family members and close friends. Stillbirths and children that die before naming are buried without names. Bereaved families are comforted and encouraged about future pregnancies. Currently, Lango associates the deaths to biomedical explanations such as teenage pregnancies, inadequate pregnancy care, health system challenges and poor health-seeking behaviour, unlike previously when they were attributed to consequences of unacceptable social behaviours, superstitious beliefs and witchcraft. Antenatal care and health facility childbirths are currently preferred over traditional practices for good pregnancy outcomes.ConclusionStillbirth or early neonatal death is viewed as the death of a child, different from other settings. Thus, rituals are performed to honour, create memory, and maintain the connection with deceased babies. Bereaved parents are supported. Health care workers need to provide culturally sensitive support to parents after perinatal loss. The prevailing beliefs of perinatal death cause in terms of biomedical explanations consistent with known determinants and preference for health facility care for prevention creates an opportunity for improving perinatal health.

Acute coronary syndromes in pregnancy: a literature review

Key content Maternal mortality from cardiovascular disease has not improved in almost 20 years; this contrasts to significant sustained improvement in cardiovascular outcomes in the nonpregnant population, particularly regarding acute coronary syndrome (ACS). Many of the women who died in recent MBRRACE‐UK reports presented with cardiac symptoms and signs, but this was not always recognised upon clinical review. The incidence of ACS is increasing alongside advancing maternal age, with an accompanying increased prevalence of typical and pregnancy‐specific cardiac risk factors. Early involvement of senior clinicians and a multidisciplinary approach is crucial for improving maternal outcomes. Counselling women on long term prognosis and implications for future pregnancy is vital. Learning objectives To be aware of the latest data for ACS in pregnancy, including the changing trends in prevalence of this condition and the suggested reasoning behind this. To understand the various presentations of ACS in pregnancy and its differential diagnosis. To understand the possible investigation and management of ACS in pregnancy in a multidisciplinary setting.

V12-11 ROBOTIC SACROHYSTEROPEXY WITH CONCURRENT RECTOPEXY USING FASCIA LATA GRAFT

You have accessJournal of UrologyCME1 Apr 2023V12-11 ROBOTIC SACROHYSTEROPEXY WITH CONCURRENT RECTOPEXY USING FASCIA LATA GRAFT Poone Shoureshi, Alexandra Dubinskaya, David Magner, and Karyn S. Eilber Poone ShoureshiPoone Shoureshi More articles by this author , Alexandra DubinskayaAlexandra Dubinskaya More articles by this author , David MagnerDavid Magner More articles by this author , and Karyn S. EilberKaryn S. Eilber More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003347.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sacrohysteropexy with concurrent rectopexy can be performed in women of childbearing age, with multicompartment prolapse, who wish to preserve their uterus. There is limited data regarding the use of mesh for prolapse repair in this population, therefore a biologic graft is often used to decrease the risk of contamination with colorectal surgery and allow for future pregnancy. We present the surgical management of prolapse repair in a young woman who presented with uterine and rectosigmoid prolapse, causing rectal outlet obstruction. METHODS: Our patient is a 21-year-old woman with over a decade of severe constipation and abdominal pain. Her past medical history includes anxiety, depression and sexual abuse. She previously underwent robotic rectopexy for intra-rectal intussusception and mucosal prolapse with immediate improvement in her symptoms; however, two months after rectopexy, she suffered from persistent abdominal pain and severe difficulty passing stool. Dynamic resonance imaging demonstrated descent of the bladder with significant uterine prolapse, causing impingement of rectum and rectocele, blocking the evacuation of stool. The patient was thus indicated for concurrent sacrohysteropexy and rectopexy. RESULTS: She underwent a robotic procedure. Given the patient’s age, in an effort to preserve future child-bearing potential, we elected to perform the surgery with a biologic graft made of fascia lata. The sacrohysteropexy was performed by suturing the graft to the posterior cervix. Intraoperatively she was noted to have an intact enterocele repair and posterior rectopexy from her previous surgery; however, the rectosigmoid attachment appeared to have stretched, creating an angulation at the rectosigmoid. This was corrected by performing a rectopexy to the fascia lata graft. The patient was discharged home the day of surgery without incident. CONCLUSIONS: Biologic grafts can be used for multicompartment prolapse repair in women of child-bearing age. Fascia lata provides a safe alternative to mesh to allow for future pregnancy. Also, sacrohysteropexy with concurrent rectopexy can be performed with same day discharge. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1068 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Poone Shoureshi More articles by this author Alexandra Dubinskaya More articles by this author David Magner More articles by this author Karyn S. Eilber More articles by this author Expand All Advertisement PDF downloadLoading ...

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.

TO DETERMINE THE PREGNANCY OUTCOMES IN PATIENTS WITH PREVIOUS SPONTANEOUS ABORTIONS

Aim: To determine pregnancy outcomes in previous spontaneous abortions. Objectives: 1.To test whether previous unfavourable pregnancy outcome increases the risk of adverse outcome in subsequent pregnancies. 2. To look for the association between previous spontaneous abortions with adverse maternal outcomes like Prom, Preterm delivery ,abortions ,placental complications and neonatal outcomes like Low birth weight ,IUGR,IUD and stillbirth in future pregnancies. Materials and method: 200 pregnant women with history of upto 3 previous spontaneous abortion were in study group .200 pregnant woman with history of previous normal deliveries were considered in control group. This is a prospective study undertaken to compare the obstetric outcome between two groups .Study conducted at our tertiary care centre in department of obstetrics and gynaecology at Smt.KashibaiNavale medical college and hospital,Narhe, Pune, for period of 6 months from Aug.2021 to Jan.2022. The outcome has been analysed with respect to following factors: 1. Age distribution of Subjects. 2. Full term deliveries 3.Preterm deliveries.4.Abortions 5.LSCS 6.PROM 7.IUGR8.LBW. 9. IUD. Results: With increase in number of previous abortions the rate of preterm delivery ,abortions LSCS were found to be increased. P values of these were of statistical significance. Conclusion: Previous abortions have definite impact on future pregnancy outcomes hence careful antenatal care is mandatory for early detection of possible complications.