Incidence Of Pregnancy Research Articles

Pregnancy in patients with chronic kidney disease undergoing dialysis.

Women with chronic kidney disease are less likely to become pregnant and are more susceptible to pregnancy complications when compared to patients with normal kidney function. As a result, these are considered high-risk pregnancies, both maternal and fetal. Over the years, there has been an increase in the incidence of pregnancies in dialysis patients, and an improvement in maternal and fetal outcomes. It is believed that the optimization of obstetric and neonatal care, the adjustment of dialysis treatment (particularly the increase in the number of hours and weekly frequency of dialysis sessions), and the use of erythropoiesis-stimulating agents have provided better metabolic, volume, blood pressure, electrolyte, and anemia control. This review article aims to analyze pregnancy outcomes in chronic kidney disease patients undergoing dialysis and to review nephrological medical management in this scenario. Due to the growing interest in the subject, clinical recommendations for care practice have become more consistent in both drug and dialysis management, aspects that are addressed in this review.

Risk factors for ectopic pregnancy occurrence: Systematic review and meta-analysis.

Given the high incidence of ectopic pregnancy (EP) in the general population and the high maternal morbidity and mortality rates associated with it, determining risk factors for the occurrence of EP is essential for directing attention and care to risk groups, aiming for early diagnosis, favorable outcomes, and the development of prevention strategies. The aim of this study was to identify risk factors for the occurrence of EP. A systematic review with meta-analysis was performed on the electronic databases MEDLINE/PubMed, LILACS, The Cochrane Library, and Virtual Health Library (VHL), searching the following terms "Ectopic Pregnancy" or "Ectopic Gestation" and "Risk Factors" or "Predisposing Factors". The inclusion criteria were observational studies published in English and Portuguese. We excluded studies with undefined methodology and those published before the year 2000. The authors independently read the titles, abstracts, and full texts, using pre-defined inclusion and exclusion criteria, and discussed any differences. Data extraction and assessment of methodological quality were performed by each author in a standardized way. Sixteen risk factors were evaluated. The meta-analysis calculations were performed using the Reviewer Manager 5.3 software (RevMan 5.3). The study found 715 studies, of which 11 were selected for review. The surveys were conducted between 2003 and 2019 and included 25 051 patients. The study revealed that several factors were strongly associated with the occurrence of EP. These included EP history (OR 9.03; 95% CI: 7.18-11.35; I2 = 67%), pelvic inflammatory disease (OR 4.00; 95% CI: 3.46-4.61; I2 = 0%), infertility (OR 3.70; 95% CI: 3.23-4.23; I2 = 48%), abdominal and pelvic surgeries (OR 5.60; 95% CI: 4.83-6.49; I2 = 81%), and previous tubal ligation (OR 5.59; 95% CI: 2.49-12.55; I2 = 0%). Furthermore, the study showed that advanced maternal age, smoking, number of partners exceeding one, history of spontaneous and induced abortion, previous use of emergency contraception, and intrauterine device, demonstrated a slightly increased risk. Advanced maternal age within the range of 30-34 years (OR 1.13; 95% CI: 1.03-1.24; I1 = 11%) and ≥ 40 years (OR 1.46; 95% CI: 1.19-1.78; I1 = 88%), marital status (OR 1.19; 95% CI: 1.03-1.37; I2 = 88%), and the use of oral contraceptives (OR 0.77; 95% CI: 0.66-0.90; I2 = 86%) were also found to be associated with a slightly increased or decreased risk of EP, respectively. The impact of condom use on the occurrence of EP seems to be very limited (OR 0.93; 95% CI: 0.83-1.05; I2 = 83%). Based on the study findings, it is suggested that the presence of strong risk factors warrants the implementation of a screening policy for EP among these women.

When pulmonary arterial hypertension and pregnancy meet: a multidisciplinary clinical experts review.

Pulmonary hypertension (PH) is a rare condition characterized by elevated pulmonary arterial pressure and pulmonary vascular resistance, potentially leading to right ventricular failure. Pulmonary arterial hypertension (PAH) is the most common type of PH in women of childbearing age and, as per the modified World Health Organization (mWHO) classification of maternal cardiovascular risk, it falls into mWHO class IV and pregnancy is contraindicated. These patients face an exceptionally high risk of maternal mortality and morbidity, with estimated maternal cardiac event rates ranging from 40 to 100% during pregnancy, because physiological changes happening in pregnancy exacerbate the disorder. Despite these recommendations, there is a growing incidence of pregnancy among women with PAH. Early referral to specialized centers, personalized therapies and expert multidisciplinary care involving pulmonary hypertension specialists, obstetricians, critical care specialists, anesthesiologists, and neonatologists are crucial steps to ensure positive outcomes for both mother and fetus. This review aims to examine the current understanding of pregnancy in patients with PAH, drawing on the experience of our center in the multidisciplinary management of pregnant women with this condition. In particular, we want to focus the attention of clinicians on the following aspects: early referral of pregnant patients to specialized centers, detailed counseling on the implications of pregnancy, initiation of therapy in treatment-naive patients and potential adjustment of therapy in non-naive patients, periodic risk assessment, evaluation of the appropriate timing of delivery, multidisciplinary management of the most critical periods, which are delivery and the post-partum phase.

Fertiloscopy and its place in the gynaecologist's armamentarium.

Infertility is a prevalent issue worldwide. Current investigation of female pelvic infertility uses transabdominal laparoscopy, exposing patients to its associated risks. An alternative method is fertiloscopy, comprising hysteroscopy, tubal dye studies, and transvaginal hydrolaparoscopy (TVHL), falling under the broader category of VNOTES. This study reviews fertiloscopy cases in Australia to assess its role in managing infertility. Retrospective analysis of 76 cases was performed with review of imaging results, fertiloscopy findings and interventions, and fertility outcomes. Statistical analysis was conducted via R Studio v4.1 with means and averages used for descriptive data and a Kruskal-Wallis analysis of variance test used to evaluate differences in continuous variables. Kaplan-Meier curves were constructed to describe cumulative pregnancy incidence, with differences evaluated using log-rank tests. Statistical tests were two-tailed, and a P-value < 0.05 was considered significant. Of 76 cases, 70 underwent fertiloscopy and 35 an intra-operative intervention. Of the cohort, 53 conceived, 18 spontaneously. The highest chance of spontaneous conception was 44% by day 283. The failure rate of fertiloscopy was 5.3%, and complications occurred in 1.3% of cases. The highest chance of spontaneous conception post-fertiloscopy was 44% by day 283, possibly indicating the time between the procedure and referral to reproductive therapies. This study identified a low associated failure and complication rate, supporting fertiloscopy as a low-risk procedure. Despite limitations, this study highlights spontaneous pregnancy outcomes and associated low complication and failure rates, emphasising fertiloscopy's role in managing infertility in Australia as a lower risk surgical alternative to standard laparoscopy.

One fresh cleavage-stage single embryo transfer (SET) plus one frozen-thawed blastocyst-stage SET or one fresh cleavage-stage double embryo transfer? A retrospective matched cohort study.

Are there significant differences in fertility outcomes between transferring two cleavage-stage embryos in a single fresh cycle and transferring one cleavage-stage embryo in a fresh cycle and one blastocyst-stage embryo in the subsequent frozen-thawed cycle? In women aged <38 years with two embryos available, transferring one cleavage-stage embryo in a fresh cycle and one blastocyst-stage embryo in the subsequent frozen-thawed cycle increased live birth rates and decreased multiple live birth rates compared to transferring two cleavage-stage embryos in a single fresh cycle. The strategy of repeated single embryo transfer (SET) has emerged as a solution to address the reduced live birth rates associated with SET per cycle. There is substantial evidence indicating that the cumulative live birth rate after repeated SET is comparable to that of double embryo transfer (DET), while significantly reducing the incidence of multiple pregnancies. Evidence regarding the outcomes of transferring two cleavage-stage embryos in a single fresh cycle versus transferring one cleavage-stage embryo in one fresh cycle and one blastocyst-stage embryo in the subsequent frozen-thawed cycle is scarce. This study is a retrospective matched cohort study, where data were gathered from the clinical database of women who underwent IVF treatment at the Reproductive Center of Peking University Third Hospital between January 2011 and December 2019, with follow-up extending until December 2021. The study group included cycles with a fresh cleavage-stage SET and a subsequent frozen-thawed blastocyst-stage SET (2xSET, N = 976). Fresh cleavage-stage DET was the control group (DET, N = 976). Included cycles were divided into subgroups based on age (≥38 years vs <38 years) and total number of utilizable (transferred or cryopreserved) embryos (=2 vs >2). The duration of infertility, prevalence of unexplained infertility, and controlled ovarian stimulation regimes differed significantly between the two groups and were adjusted for in the further analysis. We observed a significant increase in clinical pregnancies (55.5% vs 42%, adjusted odds ratio (OR) 1.87 [1.55-2.26]) and live births (44.8% vs 34.5%, adjusted OR 1.63 [1.35-1.97]) in favor of the 2xSET group. The preterm birth rate was lower in the study group (adjusted OR 0.64 [0.42-0.96]). Neonatal birth weight of singletons was similar between the two groups (adjusted B 4.94 g [-84.5 to 94.4]). The beneficial effect on the live birth rate disappeared in cases where aged 38 years and older or when only two embryos were utilizable. This study is limited by differences in baseline characteristics of the two groups. Analyzing two consecutive SETs at the cleavage stage was not feasible. Additionally, the homogeneous population limits generalizability to other ethnic groups, which should be considered when interpreting the results broadly. We recommend a combination strategy for women under 38 years old and with more than two embryos available: transfer one cleavage-stage embryo in the fresh cycle, followed by one blastocyst-stage embryo in the subsequent frozen-thawed cycle. This strategy reduces the risk of blastocyst culture failure while maintaining a high success rate. It offers hope to families seeking additional children and avoids unnecessary embryo disposal. B.W.M. had received grants from NHMRC, Ferring, Merck, and Guerbet, consulting fees and stock options from ObsEva, is on the advisory board of ObsEva, and reports consultancy for Guerbet, none of which are in relation to the present manuscript. All other authors have no conflict of interest to declare. N/A.

Ultrasonic diagnosis of hepatic ectopic pregnancy: a case report

Hepatic ectopic pregnancy is an extremely rare ectopic pregnancy. Ectopic pregnancy is one of the reasons for acute abdominal pain. Ectopic pregnancy refers to the growth and development of zygotes outside the uterine cavity, and tubal pregnancy is the most common. Abdominal ectopic pregnancy is very rare, accounting for only 1.3% of all ectopic pregnancy including small intestine and large intestine, sigmoid colon, omentum, liver, diaphragm, pancreas, peritoneum and spleen [1], of which the incidence of hepatic ectopic pregnancy is about 1:15,000 per inner uterus pregnancy [2]. The present report describes the case of a 36-year-old woman who presented with continuous brown vaginal secretions after 57 days of amenorrhea. The patient was initially diagnosed with liver ectopic pregnancy by abdominal ultrasound and this was confirmed by laparoscopic exploration. The pathological examination revealed a pregnancy material in the liver tissue. The patient made good progress post-surgery, with serum levels returning to normal during a follow-up examination 1 month later. Overall, ultrasound and β-HCG levels are crucial in diagnosing ectopic pregnancy before patients show clinically consistent symptoms.

Long-Acting Reversible Contraception Use after Non-Receipt of Postpartum Permanent Contraception: A Retrospective Analysis.

Objective: To evaluate long-acting reversible contraception (LARC) use versus permanent contraception (PC) use at hospital discharge through 1 year postpartum after an unfulfilled immediate postpartum PC request. Study Design: We present a secondary analysis of a retrospective cohort study of patients across four study sites between 2018 and 2019 with PC as their documented inpatient postpartum contraceptive plan. We abstracted demographic and clinical characteristics, contraceptive plans and time to contraceptive fulfillment, reasons for non-fulfillment, and pregnancy incidence up to 1 year postpartum from medical records. Results: Of 3,013 patients initially desiring PC, 1,759 patients (58.4%) received PC and 136 patients (4.5%) received LARC on discharge; with an additional 217 patients receiving PC and an additional 176 patients receiving LARC in the 1 year postpartum. Participants who received inpatient LARC were more likely to be younger, to be unmarried, to have Medicaid insurance, and to have delivered vaginally compared with participants who received inpatient PC. Of the 304 patients who received LARC rather than PC during the year postpartum, 49 (16.1%) expressed an interest in LARC prenatally. Reasons for non-fulfillment of PC were varied at different time points postpartum, with 50.3% stating they did not receive PC by 1 year postpartum because they had changed their mind. Conclusions: Ten percent of patients with an unmet postpartum PC request use LARC methods instead at 1 year postpartum. Patients who do use LARC are unlikely to bridge to receipt of PC. Institutions should prioritize fulfillment of desired postpartum PC prior to hospital discharge.

Pityriasis rosea

Pityriasis rosea is a benign self-limiting rash, usually lasting 6 to 8 weeks. In classic pityriasis rosea a ‘herald patch’ is the initial finding, a large oval patch usually found on the torso. Smaller, scaly oval pink eruptions follow after 1 to 2 weeks on the chest, back and limbs, and can resemble a Christmas tree pattern on the back. It is seen more commonly in women, with a higher incidence in pregnancy, and has an estimated prevalence of around 1.3%. The rash usually heals without scarring and often no treatment is required. Symptomatic treatment is used occasionally to alleviate pruritus. This article will explore different presentations of pityriasis rosea, how to make a diagnosis and the main management options.

A-311 Evaluating the Predictive Value of the sFlt-1/PlGF Ratio in Hypertensive Pregnancies for Preeclampsia

Abstract Background Preeclampsia (PE) is a hypertensive pregnancy disorder affecting around 5% of all pregnancies, and it continues to be a leading cause of maternal and neonatal morbidity and mortality in the United States. The incidence of hypertensive pregnancies is on the rise, attributed to the increasing prevalence of obesity and chronic hypertension. The development of a straightforward diagnostic test to accurately differentiate PE from gestational or chronic hypertension is crucial to avoid unnecessary hospitalizations. Despite the ongoing development of prediction models for PE, conventional clinical and laboratory measures have not been effective in predicting disease progression. Recent research has focused on the ratio of two serum biomarkers: soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), particularly in patients with a clinical suspicion of PE in acute settings. These studies have shown promise, with many indicating that the sFlt-1/PlGF ratio can effectively predict the presence or absence of PE. This study was conducted to assess the predictive value of the sFlt-1/PlGF ratio in pregnancies complicated by hypertension, aiming to contribute to the early detection and management of PE. Methods Pregnant individuals with hypertensive disorders at or above the age of 18 receiving prenatal care at NewYork-Presbysterian-Weill Cornell Hospital were enrolled in this study. We measured the levels of sFlt-1 and PlGF using fully automated Elecsys immunoassays (Roche Diagnostics). Subsequently, a prospective analysis of the serum sFlt-1/PlGF ratio was performed. A receiver operating characteristic (ROC) curve was used to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ratio in predicting PE. To assess the prognostic accuracy of the sFlt-1/PlGF ratio, patients were randomly assigned to a development and a validation cohort at a ratio of 30:70. Results We collected a total of 137 serum samples of hypertensive pregnancies, with all ≥20 weeks of gestational age (GA). Of these, 47 (34.3%) developed PE within 2 weeks. The samples were divided into two cohorts: 98 were included in the development cohort, and 39 in the validation cohort. Within these groups, 34 (34.7%) of the development cohort and 13 (33.3%) of the validation cohort developed PE within 2 weeks, respectively. In the development cohort, the median sFlt-1/PlGF ratio was 85 (Interquartile range, [IQR], 44-164) among pregnant women who developed PE within 2 weeks. This was significantly higher compared to a median ratio of 8 (IQR, 3-35) observed in those who did not develop PE (p&amp;lt;0.001). The area under the ROC curve was 0.87, indicating good discriminative ability. An optimized cutoff ratio of 38 was determined, based on the max of combined sensitivity and specificity. When applied into the validation cohort, this cutoff yields a 90% (95% confidence interval [CI], 70-97) NPV and 58% (95%CI, 37-76) PPV with an 85% sensitivity (95%CI, 58-96) and a 69% specificity (95%CI, 50-83). Conclusions In women with a hypertensive disorder of pregnancy presenting GA≥20 weeks of gestation, the measurement of serum sFlt-1/PlGF ratio demonstrated clinical value in predicting the development of PE.

Quality of Caregiver-Adolescent Relationship on HIV, Herpes Simplex Virus Type-2, and on Pregnancy Among Young Women in South Africa Enrolled in HIV Prevention Trials Network 068

PurposeAdolescent girls and young women (AGYW) are at an increased risk of acquiring HIV and HSV-2, and unintended pregnancies are high in AGYW. Despite the protective impact of caregiver-adolescent relationships on risk behaviors, less attention has been paid to the association of these relationships and sexually transmitted infections (STIs) and pregnancy. MethodsWe used longitudinal data from HIV Prevention Trial Network 068, which was conducted among 2,533 AGYW (13 – 20 years) over 5 years in Agincourt, South Africa. Kaplan-Meier and Cox models were used to estimate the effect of quality of caregiver-adolescent relationships (caring and closeness) on STIs and pregnancy. Also, we assessed effect measure modification by age (14–19 vs. 20–25 years) for STI risk using stratum-specific estimates and likelihood ratio tests, with a p value <.1 indicative of effect measure modification. ResultsThere were no significant differences in the hazard of HIV by our exposures (caring: hazard ratio (HR): 1.03, 95% CI: 0.75, 1.42; closeness: HR: 0.80, 95% CI: 0.57, 1.11). Among 14–19-year-olds, those who reported caregiver caring were less likely to acquire HSV-2 (HR: 0.69, 95% CI: 0.51, 0.94, likelihood ratio tests= 3.89, p-value = .0487), in contrast, there were no significant differences among 20 – 25-year-olds. AGYW who reported high-quality relationships had a lower hazard of pregnancy incidence (caring: HR: 0.79, 95% CI: 0.68, 0.93; closeness: HR: 0.76; 95% CI: 0.64, 0.91). DiscussionPositive caregiver-adolescent relationships are associated with reduced risk of HSV-2 among younger AGYW and pregnancy incidence.

Effect of low-molecular-weight heparin calcium combined with magnesium sulfate and labetalol on coagulation, vascular endothelial function and pregnancy outcome in early-onset severe preeclampsia.

This paper was aimed at unveiling the effect of low-molecular-weight heparin calcium (LMWH) combined with magnesium sulfate and labetalol on coagulation, vascular endothelial function, and pregnancy outcome in early-onset severe preeclampsia (EOSP). Pregnant women with EOSP were divided into the control group and the study group, each with 62 cases. Patients in the control group were treated with labetalol and magnesium sulfate, and those in the study group were treated with LMWH in combination with the control grou Blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]), 24-h urine protein, coagulation indices [D-dimer (D-D), plasma fibrinogen (Fg), prothrombin time (PT), activated partial thromboplastin time (APTT), and prothrombin time (TT)], endothelial function [endothelin (ET-1) and nitric oxide (NO)], oxidative stress indices [oxidized low-density lipoproteins (ox-LDL), lipid peroxidation (LPO), superoxide dismutase (SOD), and malondialdehyde (MDA)], pregnancy outcome, and adverse effects occurred in the two groups were compared. After treatment, lower SBP, DBP, and 24-h urine protein levels; lower Fg and D-D levels; higher PT, APPT, and TT levels; higher NO levels; lower ET-1 levels; lower ox-LDL, MDA, and LPO levels; higher SOD levels; and lower incidence of adverse pregnancy and adverse reactions were noted in the study group in contrast to the control group. EOSP patients given with LMWH combined with magnesium sulfate and labetalol can effectively reduce the patient's blood pressure and urinary protein level; improve coagulation function, oxidative stress, and vascular endothelial function indices; reduce the adverse pregnancy outcomes; and improve the safety of treatment.

Comparison of 2-year reproductive outcomes of tubal ectopic pregnancies treated with surgery, methotrexate or expectant management.

To compare the 2-year reproductive outcomes of tubal ectopic pregnancies (EP) treated with surgery, methotrexate (MTX) or expectant management. This case-control study was conducted retrospectively at the Obstetrics-Gynecology and Perinatology Clinics of Etlik Zubeyde Hanim Women's Health Education and Training Hospital. 985 of 1156 patients, who were managed between January 2015 and December 2019 for a tubal EP, tried to conceive in 2years after treatment: 366 patients underwent surgical treatment; 549 patients were treated with MTX, and 70 patients had expectant management. Clinical data and fertility outcomes were retrieved by medical and hospital records. We compared the three groups based on the 2-year reproductive outcomes of three treatment modalities of tubal EP. There was a significant difference in the frequency of no pregnancy in patients who underwent surgery compared to patients who received expectant management and MTX therapy (p < 0.001). The frequency of no pregnancy was higher in patients who underwent surgery. There was no significant difference between expectant management and MTX therapy (p = 0.411). In the reproductive outcomes of patients who underwent surgery, the incidence of viable pregnancies was statistically lower than in the group treated with expectant management and MTX therapy (p = 0.003). Patients with an EP often have a future desire to have children, the treatment options are also important. The earlier the diagnosis is made, the more likely it is that expectant management or MTX treatment will be considered. With these two treatment methods, the likelihood of having a child in the future is higher than with surgical treatment.

Gonadotropins combined with and without 100mg Clomiphene Citrate drug on ovulation induction and role of epidural analgesia in pregnancy outcome of infertility women.

Successful ovulation induction can overcome the common condition of infertility associated with ovulatory dysfunction. Monotherapy of clomiphene citrate (CC) or combined with gonadotrophins are the best treatment modalities for ovulation induction with a successful outcome. We concentrated on evaluating the effects of 100 mg Clomiphene Citrate, both with and without gonadotrophins, on ovulation induction and the outcome of labor analgesia in women with infertility. This prospective cohort consists of 136 women with infertility who were medicated with 100 mg of clomiphene citrate alone and 100 mg of clomiphene citrate with gonadotropins. We recorded the endometrial thickness, details of the dominant follicle, and the incidence of a positive pregnancy rate. Women with positive pregnancy were managed with epidural labor with labor analgesia to relieve labor pain and evaluated the foetal outcome. In CC alone, the ovulation rate was 57%, while in CC with gonadotrophins, it was 81%. The mean dominant follicle size and endometrial thickness were high in CC with gonadotrophins (p &lt; 0.05). The overall incidence of positive pregnancies was 28.98%. Levobupivacaine with dexmedetomidine significantly reduced the mean VAS score from baseline, resulting in a higher foetal body weight. Taking 100 mg of Clomiphene citrate with gonadotropins works better than taking Clomiphene citrate by itself at starting ovulation, increasing the size of the dominant follicle, and improving the thickness of the endometrium. With levobupivacaine plus dexmedetomidine, the labor analgesia showed better stability in hemodynamic parameters and effective control on labor pain scores.

Cohort profile: the ADAPT study, a prospective study of pregnancy preferences, pregnancy, and health and well-being in the southwestern USA

PurposeSignificant methodological shortcomings limit the validity of prior research on pregnancy decision-making and the effects of ‘unintended’ pregnancies on people’s health and well-being. The Attitudes and Decisions After Pregnancy Testing...

The Role of Parents in Preventing Teenage Pregnancy in Rural Areas of Banyumas District

Background:One of the factors contributing to Indonesia's high maternal mortality rate is the high incidence of teenage pregnancy in Banyumas. The family, particularly parents, plays a crucial role in influencing teenage pregnancy, as they are expected to act as educators, motivators, supervisors, communicators, and counselors for their teenagers. Objective:The purpose of this study was to identify the factors that influence the role of parents in the prevention of teenage pregnancy. Methods:A cross-sectional study design was employed, focusing on female participants. A cluster random sampling technique was used to obtain a sample size of 150 parents from the study population, using the proportion estimation formula. The validity and reliability of the questionnaire used were tested. Data were analyzed using logistic regression. Results:The univariate analysis revealed that 93.2% of respondents were female, 25.3% were aged between 38 and 42, 61.3% had only completed elementary school, 63.3% were housewives, 58% had incomes below IDR 1.350.000, 52% had monthly family expenses under IDR 1.350.000, and 42.7% had five or more dependents. The bivariate chi-square test showed an association between parental resources, the role of health professionals, knowledge, attitudes, and societal values in the prevention of teenage pregnancy. The multivariate analysis using logistic regression indicated that the value of people and resources significantly impacts the role of parents in this regard. Conclusion:The role of parents in preventing teenage pregnancy is influenced by the value placed on people and resources. Keywords: Maternal mortality; adolescent pregnancy; role of parents; knowledge; attitudes

Induced abortion incidence and associated factors in a cohort of women living with HIV in Rio De Janeiro, Brazil, 1996–2016

Background Abortion is a public health problem in Latin America and is more common among women living with HIV. Objective to verify the incidence and factors associated with induced abortion in a cohort of women living with HIV assisted in a reference service for care for individuals with HIV/AIDS in Rio de Janeiro/Brazil. Methods Prospective cohort during the period 1996–2016. We estimated the incidence of induced abortions during follow-up in the cohort by calculating person-time incidence rates [per 100 persons-years (PY)] and investigated the factors associated with the outcome “induced abortion” using a generalized linear mixed model. Results 753 women and 210 pregnancies were included in the present analysis. We estimated an induced abortion incidence rate of 0.68/100 persons-years (95% confidence interval [CI]: 0.47; 0.94) in the study period, with a significant reduction after 2006. The main factors associated with an induced abortion were currently living with a partner (adjusted OR [AdjOR] 0.32 95% CI: 0.10–0.98), number of children (2 children AdjOR 0.12, 95% CI: 0.02–0.95) and the type of antiretroviral treatment used (regimen without Efavirenz: AdjOR: 0.11, 95% CI 0.02–0.70). Conclusions We showed a significant reduction in the incidence of induced abortions in a cohort of women living with HIV in Rio de Janeiro, Brazil, probably due to a decrease in the incidence of pregnancies observed in the same period. The factors associated with a lower occurrence of induced abortion suggest a good integration between the clinical and reproductive assistance offered to those women.

The Impact of Pregnancy Readiness on Lupus Activity, Maternal Mental Health, and Pregnancy Outcomes.

Among individuals with systemic lupus erythematosus (SLE) who became pregnant, we explored the impact of medical readiness for pregnancy and personal readiness for pregnancy on the following aspects of maternal health: (1) provider-reported disease activity, (2) patient-perceived disease activity, (3) mood symptoms, (4) pregnancy-related health behaviors, and (5) pregnancy outcomes. All study participants were enrolled in a prospective registry, met Systemic Lupus Collaborating Clinics (SLICC) criteria for SLE, and had at least one pregnancy. Patient-reported outcomes were collected at the first rheumatology visit during pregnancy. "Medically ready" for pregnancy was defined as (1) <1 g of proteinuria, (2) no rheumatic teratogens at conception, and (3) continuing pregnancy-compatible SLE medications after conception. "Personally ready" was defined as planned pregnancy based on a London Measure of Unplanned Pregnancy score ≥10. Multivariable logistic regression models estimated the association of pregnancy readiness with each outcome of interest. Among the 111 individuals enrolled, lack of medical readiness for pregnancy was associated with significantly higher rates of active disease and worse pregnancy outcomes; however, these patients did not perceive themselves as having higher disease activity. Lack of personal readiness for pregnancy was associated with significantly higher patient-perceived disease activity. Although medical readiness did not impact depressive symptoms substantially, lack of personal readiness for pregnancy was associated with much higher maternal depressive symptoms. To improve pregnancy outcomes among individuals with SLE, greater focus is needed on improving medical optimization before conception. For maternal mental health and quality of life, greater focus is needed on decreasing the incidence of unplanned pregnancy.

New Insight of Lipiodol Flush on Pregnancy Outcomes in Women with Recurrent Implantation Failure Undergoing IVF/ICSI: a Prospective Study Based on Propensity Score Matching.

Pregnancy outcomes in women with recurrent implantation failure (RIF) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI): does treatment with lipiodol flush matter? In this propensity score-matched study, we recruited 966 RIF patients who underwent IVF/ICSI from two tertiary hospitals. These patients were divided into groups based on whether they received lipiodol flush or not. Further stratification was applied to investigate the effect of lipiodol flush on pregnancy outcomes in RIF patients with different cycle type of embryo transferred. Then, patients subjected to lipiodol flush were categorized into three groups based on the duration of the interval: short interval (≤ 3months), moderate interval (3-6months), and long interval (≥ 6months). The groups were well-matched at baseline. The lipiodol flush group exhibited a significantly lower incidence of biochemical pregnancy (46.27% vs. 56.22%, p = 0.046) and live birth (25.87% vs. 37.31%, p = 0.014). Subgroup analysis for fresh embryo transfer cycles revealed no significant differences in pregnancy outcomes. Among RIF patients underwent frozen-thawed embryo transfer cycle, a statistically significant difference in the live birth rate was observed in the lipiodol flush group when compared to the control group (26.40% vs. 37.21%, p = 0.030). Analysis of different lipiodol flush intervals demonstrated a significantly lower live birth rate in the lipiodol flush group. Our results challenge the value of lipiodol use in clinical practice for the treatment of RIF.Trial registration: Chinese Clinical Trial Registry, ChiCTR1900024273. Registered 4 July 2019.

Planning of National Policies on Maternal and Neonatal Safety

&lt;p&gt;台灣近年來，因晚婚、晚孕等因素，致使高危險妊娠案例增加；加之以醫療技術進步，原本難以懷孕的超高齡女性、患有嚴重子宮肌腺症而必須切除病灶者、因免疫或血栓問題而重複流產者，皆在獲得治療後成功懷孕，卻也使得高危險妊娠現象頻發，母嬰傷亡事故居高不下。為此，國家擬定孕產兒安全相關政策，茲就相對重要者略為概述，以幫助快速瞭解政策之規劃。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;In recent years, factors such as delayed marriage and late pregnancies have increased the incidence of high-risk pregnancies in Taiwan. Following advancements in medical technology, women who were originally unlikely to conceive&amp;mdash;such as those of advanced maternal age, those requiring lesion removal due to severe adenomyosis, and those experiencing recurrent miscarriages due to immune or thrombotic disorders&amp;mdash;have successfully achieved pregnancy following treatment. However, such treatment has also led to a higher frequency of high-risk pregnancies, with maternal and neonatal mortality and morbidity rates elevated. In response to this problem, the Taiwanese government has formulated policies related to maternal and neonatal safety. A brief overview of the more critical policies is provided herein to facilitate a fast understanding of relevant national strategies.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Influence of vodou rites and initiation practices on incidence of early pregnancy in the maritime region of Togo.

Togo, like other sub-Saharan African countries, is not spared from the phenomenon of teenage pregnancies. Each year, on average, about ten cases of teenage student pregnancies are recorded in schools. Despite multiple efforts by the Togolese government and non-governmental organizations to stem this phenomenon, it still persists and is growing. This paper aims to analyse the influence of the Vodou workshop practice on the occurrence of adolescent pregnancies. The paper relied on analysis of 105 Key Informant Interviews in four villages in the maritime region. The results reveal that the Vodou rites and initiations practices constitute a major preventable factor in the causation of early pregnancies among teenagers in rural Togo.