Interval In Women Research Articles

IJCM_94A: Risk Factors for Short Birth Intervals in women: A Case-Control Study from a Tertiary Health Care facility in Central India

Background: The interval between successive pregnancies, commonly referred to as the birth interval, plays a crucial role in maternal and child health outcomes. Optimal birth spacing is associated with improved maternal nutritional status, reduced risks of adverse pregnancy outcomes, and enhanced child survival. Conversely, short birth intervals, defined as intervals less than 24 months between two consecutive live births, have been linked to an increased likelihood of adverse maternal and child health consequences. Through a comprehensive examination of the contextualized risk factors, we aim to provide evidence that can guide healthcare practitioners, policymakers, and public health professionals in their efforts to improve maternal and child health outcomes in Central India. Objective: To determine risk factors for short birth interval among women in the tertiary health care centre of Central India. Methodology: A hospital-based unmatched case-control study was employed on 45 cases and 45 controls. Cases were women who gave birth within the last 6 months and with at least two consecutive alive births with a birth interval of less than 33 months. Controls were women who gave birth within the last 6 months and had a birth interval between 33 to 59 months between two successive live births. The data was collected by predesigned and pretested semi structured questionnaire from selected respondents. Results: Some important risk factors identified in the present study were age less than 30 years, use of contraception and shorter duration of breastfeeding. Conclusion: Encouraging postpartum family planning and effective breastfeeding will go a long way to reduce the prevalence of short birth interval and its consequences on maternal, neonatal and child health

A shortened electrocardiographic diastolic interval is involved in diastolic dysfunction and HFpEF

Abstract Background Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by left ventricular diastolic dysfunction (LVDD). We hypothesized that a short electrocardiographic diastolic time predisposes to LVDD and HFpEF by deteriorating diastolic function. This effect may be more pronounced in women than men, given longer QT interval in women. Methods To experimentally test if incremental shortening of the diastolic interval indeed worsens the diastolic function, we shortened electrical diastole using right atrial (RA) pacing and QT-prolonging medication (sotalol) in six pigs. We used 12-lead ECG and echocardiography to assess electrical diastole (TQ interval) and diastolic function. We next analyzed electrocardiograms and corresponding information on LVDD and HF in electronic health record data from 85,145 patients that visited one of 13 Cardiology Centers of the Netherlands. We sex-specifically assessed the association between TQ interval on the one hand and LVDD or HFpEF on the other. Results In pigs, baseline TQ interval was 257 (±SD 66) ms, which decreased to 232 (±SD 36) ms during RA pacing (100 bpm), and further to 193 (±SD 52) ms with concomitant sotalol administration (2 mg/kg iv, bolus). These changes in TQ interval resulted in reversal of E/A ratio, with a significant correlation between TQ interval and decreasing e’/a’ ratio (r=0.382, p=0.024) (Figure 1). In patients who underwent cardiac evaluation with ECG and echocardiography, diastolic abnormalities were documented as LVDD (n=26,009 (30%)) and HFpEF (n=2,551 (3%)). TQ intervals were significantly shorter in patients with LVDD and HFpEF (479 (±SD 128) and 485 ms (±SD 138), respectively) compared to the ones without LVDD or HFpEF (523 (±SD 137) ms). A shorter TQ interval increased the risk for having LVDD and HFpEF when adjusted for confounders (LVDD; ORadjusted= 1.37 (95% CI: 1.28, 1.45), HFpEF; ORadjusted= and 1.16 (95% CI: 1.01, 1.35) (Table 1). There was significant sex-interaction (p= 0.039) for TQ and LVDD risk, with stronger associations in women (ORadjusted= 1.43 (95% CI: 1.32, 1.56) compared to men (ORadjusted= 1.35 (95% CI: 1.10, 1.64) (Table 1). Conclusion Experimentally decreasing the electrical diastolic interval leads to diastolic function abnormalities in pigs. In humans, a shorter diastolic interval is associated with a higher risk of having either LVDD or HFpEF. Our findings imply that a shortened electrical diastolic interval may precede diastolic dysfunction and HFpEF. Therefore, prolonging or preserving electrical diastole may be effective in preventing or treating HFpEF, especially in women.Figure 1Table 1

Preferred and Actual Interbirth Intervals in Women With Multiple-Partner Fertility

Mothers with multiple-partner fertility have longer interbirth intervals (IBIs) than mothers with single-partner fertility, suggesting that partner change hinders achieving the preferred IBI. Previous studies have, however, overlooked possible differences in preferred IBI between these two groups. Using data from 724 Finnish mothers, we investigated how partner change between the first and second child moderated the association between actual and preferred IBI. Mothers with multiple-partner fertility had 54 months longer IBIs than mothers with single-partner fertility. The association between actual and preferred IBI was weaker in mothers with multiple-partner fertility. Our results further indicated that this difference could partly be explained by the mothers’ deliberate actions, such as contraceptive use and abortions among mothers with multi-partner fertility. Family planning support could gain from mapping out the reasons among women with a partner change for postponing otherwise desired pregnancies and offering increased support in these areas.

Comparison of oral mifepristone with intracervical foleys catheterisation for induction of labour in term pregnancy: A randomized control trial

The purpose of this study is to compare the efficacy of oral Mifepristone with the efficacy of intracervical Foley catheterisation for induction of labour in term pregnancy. The primary outcome of this study is to compare both methods of induction of labour in terms of induction to delivery interval and the secondary outcome is to compare the two methods in terms of route of delivery, indications of caesarean section and the neonatal outcomes. This study is a randomized control trial conducted from May 2022 to December 2022 in Department of Obstetrics and Gynecology, SSG Hospital, Baroda Medical College. 180 term pregnant patients were enrolled in this study based on a pre-established criteria. Patients were randomised into group A and B. Group A included patients who were given Tablet Mifepristone 200 mg PO followed by per vaginum Tablet Misoprostol and Group B included patients who underwent intracervical Foleys catheterisation followed by placement of per vaginum Tablet Misoprostol. The study concluded that there was significantly decreased induction-delivery interval in women induced with intracervical Foleys catheterisation (Group B) as compared to those given oral Tablet Mifepristone (Group A). There was no significant difference between the two groups in terms of the route of delivery, rate of C Sections and neonatal outcomes.Mifepristone is effective for inducing indicated term pregnancies, despite no decrease in induction delivery interval. Incidence of fetal distress with oral Mifepristone is comparable to intracervical foley's catheterization. Further research is needed to assess tachysystole/hyperstimulation and fetal distress caused by Mifepristone.

Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse

BackgroundRapid delivery is important in cases of umbilical cord prolapse to prevent hypoxic injury to the fetus/neonate. However, the optimal decision-to-delivery interval remains controversial.ObjectiveThe aim of the study was to investigate the association between the decision-to-delivery interval in women with umbilical cord prolapse, stratified by fetal heart rate pattern at diagnosis, and neonatal outcome.Study designThe database of a tertiary medical center was retrospectively searched for all cases of intrapartum cord prolapse between 2008 and 2021. The cohort was divided into three groups according to findings on the fetal heart tracing at diagnosis: 1) bradycardia; 2) decelerations without bradycardia; and 3) reassuring heart rate. The primary outcome measure was fetal acidosis. The correlation between cord blood indices and decision-to-delivery interval was analyzed using Spearman’s rank correlation coefficient.ResultsOf the total 103,917 deliveries performed during the study period, 130 (0.13%) were complicated by intrapartum umbilical cord prolapse. Division by fetal heart tracing yielded 22 women (16.92%) in group 1, 41 (31.53%) in group 2, and 67 (51.53%) in group 3. The median decision-to-delivery interval was 11.0 min (IQR 9.0–15.0); the interval was more than 20 min in 4 cases. The median cord arterial blood pH was 7.28 (IQR 7.24–7.32); pH was less than 7.2 in 4 neonates. There was no correlation of cord arterial pH with decision-to-delivery interval (Spearman’s Ρ = − 0.113; Ρ = 0.368) or with fetal heart rate pattern (Spearman’s Ρ = .425; Ρ = .079, Ρ = − .205; Ρ = .336, Ρ = − .324; Ρ = .122 for groups 1–3, respectively).ConclusionIntrapartum umbilical cord prolapse is a relatively rare obstetric emergency with an overall favorable neonatal outcome if managed in a timely manner, regardless of the immediately preceding fetal heart rate. In a clinical setting which includes a high obstetric volume and a rapid, protocol-based, response, there is apparently no significant correlation between decision-to-delivery interval and cord arterial cord pH.

Personalized medicine comes to a blood center near you

Personalized medicine comes to a blood center near you

Recurrent pregnancy loss and incident arthritis in midlife: an exploratory longitudinal analysis of the Study of Women's Health Across the Nation

To explore the association between recurrent pregnancy loss (RPL) and incident arthritis in midlife women. We analyzed the U.S. Study of Women's Health Across the Nation, a multi-ethnic cohort following pre- or peri‑menopausal women, using data from baseline up to the tenth annual follow-up visit. Discrete survival analysis was used to estimate adjusted hazard ratios and 95% confidence intervals for risk of incident arthritis at annual intervals in women with versus without RPL. Of the 2159 participants analyzed, 8.5% reported a history of RPL. Cumulative incidence of arthritis was 43.3% in women with RPL and 40.1% in women without RPL, though differences between groups varied over time. Significant associations were observed only at visits three to seven, with the strongest associations at visits four to six. The adjusted hazard ratios (95% confidence intervals) were 1.80 (1.30-2.50) at visit 4 (median age=50 years), 1.95 (1.38-2.75) at visit 5 (median age=51 years), and 1.82 (1.28-2.58) at visit 6 (median age=52 years). Women with previous RPL may have elevated risk of arthritis specifically when entering their 50s, on average. Additional research is needed to determine whether women with a history of RPL may benefit from early detection of arthritis in midlife.

The relationship of total progressive motile sperm count with the outcome of IUI? An analysis of 5171 cycles

Background: The role of motile sperm count in intrauterine insemination (IUI) success rate is controversial. This retrospective cohort study performed among unselected infertile couples undergoing IUI was to explore the association between the total progressive motile sperm count (TPMSC) and the live birth rate (LBR) following IUI. Methods: The total cohort of 5363 cycles, 2666 infertile couples between January 2015 and December 2018 and finally 5171 cycles, 2647 couples were included for analysis in Sun Yat-sen memorial hospital of Sun Yat-sen University. The primary outcome was LBR per cycle. And the secondary outcome measure was clinical pregnancy rate (CPR) per cycle. Results: From the receiver operating characteristic (ROC) analysis of female age predicting live birth, female age cutoff was defined as 28 years. With a female age of ≤28 years, the CPRs were 11.5%, 14.9%, 16.1%, and 15.8% in quartile groups of pre-wash TPMSC, respectively. For the LBRs the values were 9.4%, 12.9%, 14.4%, and 11.3%, and there were also no significant differences in quartile groups of pre-wash TPMSC with ≤24 million (M), [24M–50M], [50M–97M], >97M. No statistically significant differences in the CPRs (p = .051) and LBRs (p = .088) were also observed in the quartiles groups of post-wash TPMSC. With a female age of >28 years, the CPR in couples with post-wash TPMSC ≤22.32 M was significantly lower than with post-wash TPMSC >81.0 M (p = .007). There was an obvious trend in which CPRs and LBRs increased with the post-wash TPMSC during the <81 M interval in women >28 years. Conclusions: The optimal female age cutoff for live birth was 28 years in IUI cycles. Pre-wash and post-wash TPMSC were not significantly associated with CPR and LBR per cycle. When female age >28 years, there was a better outcome with post-wash TPMSC >22.32 million.

Clinical Correlates of Cardiac Conduction in Bipolar Disorder

Introduction Patients with bipolar disorder (BD) have an increased risk for cardiovascular morbimortality. Clinical risk factors, specifically for arrhythmias and sudden cardiac death remain understudied.ObjectivesThis study was conducted to assess differences in cardiac conduction among BD patients.MethodsWe included patients with BD in a cross-sectional design, confirmed by structured interview, age 18 through 80. Clinical characteristics were obtained using a structured questionnaire or medical records review. ECG intervals duration and morphology were manually assessed by cardiologists and compared among clinical subgroups using Chi-square, Mann-Whitney, and Kruskall-Wallis tests. Exploratory multivariable linear and logistic regression models were fitted to adjust for potential confounders.ResultsWe included 117 patients (60.7% women, 76.9% bipolar I, 50% history of psychosis, 22.6% suicide attempts). We found a significantly longer QTc interval in BD patients with hypertension (difference: 9.5 ms, p=0.006), obesity (difference: 25 ms, p=0.001), and metabolic syndrome (difference: 13 ms, p=0.007). Hypertension remained a significant predictor of longer QTc after adjusting for age, gender, and antipsychotic use (estimate 17.718, p=0.018). We observed a significantly shorter PR interval in women (difference: 6 ms, p=0.029), early age of onset (difference 6 ms, p=0.025), non-users of lithium (difference 4 ms, p=0.002), and early trauma (difference 4 ms, p=0.038). Finally, we identified significant correlations between symptom severity, blood glucose and PR interval (r=0.298, p=0.001; r=0.278, p=0.003; respectively).ConclusionsPatients with BD and hypertension may have an increased risk for QTc prolongation. Careful cardiovascular monitoring may be warranted.DisclosureNo significant relationships.

Evidence from a BreastScreen cohort does not support a longer inter-screen interval in women who have no conventional risk factors for breast cancer.

ObjectivesTo determine screening outcomes in women who have no recorded risk factors for breast cancer.MethodsA retrospective population-based cohort study included all 1,026,137 mammography screening episodes in 323,082 women attending the BreastScreen Western Australia (part of national biennial screening) program between July 2007 and June 2017. Cancer detection rates (CDR) and interval cancer rates (ICR) were calculated in screening episodes with no recorded risk factors for breast cancer versus at least one risk factor stratified by age. CDR was further stratified by timeliness of screening (<27 versus ≥27 months); ICR was stratified by breast density.ResultsAmongst 566,948 screens (55.3%) that had no recorded risk factors, 2347 (40.9%) screen-detected cancers were observed. In screens with no risk factors, CDR was 50 (95%CI 48–52) per 10,000 screens and ICR was 7.9 (95%CI 7.4–8.4) per 10,000 women-years, estimates that were lower than screens with at least one risk factor (CDR 83 (95%CI 80–86) per 10,000 screens, ICR 12.2 (95%CI 11.5–13.0) per 10,000 women-years). Compared to timely screens with risk factors, delayed screens with no risk factors had similar CDR across all age groups and a higher proportion of node positive cancers (26.1% vs 20.7%). ICR was lowest in screens that had no risk factors nor dense breasts in all age groups.ConclusionsMajority of screens had no recorded breast cancer risk factors, hence a substantial proportion of screen-detected cancers occur in these screening episodes. Our findings may not justify less frequent screening in women with no risk factors.

Is there an optimal inter-delivery interval in women who underwent trial of labor after cesarean delivery (TOLAC)?

BackgroundInter-delivery interval (IDI) has been proven to be a factor associated with adverse maternal and neonatal outcomes. However, the optimal IDI in trial of labor after cesarean delivery (TOLAC) remains unclear. We aimed to investigate the association between IDI and major maternal and neonatal outcomes in women who underwent TOLAC.MethodsA multicenter, retrospective cohort study including five hospitals was conducted between January 2018 and December 2019 in Foshan, China. This study included 1080 pregnant women with one or two cesarean deliveries who attempted a TOLAC. Data on maternal and neonatal outcomes were collected from the electronic record system. Maternal and neonatal outcomes in different groups of IDI were compared by univariate and multivariable analyses.ResultsA short IDI of < 24 months did not show a statistically significant association with uterine rupture in the univariate analysis (P = 0.668). In multivariable analysis, the incidences of postpartum hemorrhage (OR 19.6, 95% CI:4.4–90.9, P < 0.05), preterm birth (OR 5.5, 95% CI:1.5–21.3, P < 0.05), and low birth weight (OR 3.5, 95% CI:1.2–10.3, P < 0.05) were significantly increased in women with an IDI of < 24 months than in those with a normal interval (24–59 months). Infection morbidity (OR 1.8, 95% CI:1.4–7.9, P < 0.05), transfusion (OR 7.4, 95% CI:1.4–40.0, P < 0.05), and neonatal unit admission (OR 2.6, 95% CI:1.4–5.0, P < 0.05) were significantly increased in women with an IDI of 120 months or more than in those with a normal interval. Postpartum hemorrhage (P = 0.062) had a trend similar to that of a significant IDI of 120 months or more. We found no statistically significant difference in maternal and neonatal outcomes between 24–59 months and 60–119 months.ConclusionsAn IDI of less than 24 months or 120 months or more increased the risk of major maternal and neonatal outcomes. We recommend that the optimal interval for women who underwent TOLAC should be 24 to 119 months.

A specific protocol to shorten the decision-to-delivery interval for emergency caesarean section

The achievement of recommended decision-to-delivery interval (DDI) of ≤30 minutes in emergency caesarean section (CS) is relatively low in developing countries. This study was aimed to compare DDI in emergency CS before and after the implementation of a specific care process improvement protocol, called ‘code blue’. A total of 300 women underwent emergency CS were included; 150 consecutive cases before (during 2015–2016) and the other 150 consecutive cases after (during 2017–2018) ‘code blue’ implementation. Timing of decision-to-delivery process was compared. The results showed that median DDI was significantly shorter after ‘code blue’ implementation (22 vs. 52.5 minutes, p<.001). DDI of ≤30 minutes was achieved in 80% of the women under ‘code blue’ compared to 8% before implementation (p<.001). Significant improvements were observed regardless of decision time. Pregnancy and neonatal outcomes were comparable between the two periods. The implementation of ‘code blue’ protocol for emergency CS results in significantly shorter DDI and other time intervals. Impact Statement What is already known on this subject? Achievement of recommended decision-to-delivery interval (DDI) of ≤30 minutes in emergency caesarean section is relatively low in developing countries. Various setting-specific care improvement processes have been reported to shorten DDI. What do the results of this study add? A multidisciplinary care improvement process (‘code blue’) that developed according to specific evidence and based on a hospital’s context can significantly shorten DDI as well as other time intervals in women requiring emergency CS. What are the implications of these findings for clinical practice and/or further research? The ‘code blue’ protocol could be used as a model for other hospitals and health care settings to develop their own specific quality improvement process in order to shorten DDI for emergency CS. Collaboration and communication between all staff members could help in better identification of significant barriers as well as development of appropriate solutions. Further studies are also needed to determine whether the shortened DDI could improve neonatal outcomes.

Cardiac Resynchronization Therapy Response Is Equalized in Men and Women byElectricalOptimization: PR Matters.

This study hypothesized that the shorter intrinsic PR interval observed in women allows a greater degree of fusion with intrinsic conduction, achieving a shorter QRS interval duration and, thus, a better response. Women benefit more from cardiac resynchronization therapy (CRT) than men. However, the reason for this difference remains elusive. A cohort of 180 patients included in the BEST (Fusion based optimization in resynchronization therapy [ECG Optimization of CRT: Evaluation of Mid-Term Response]; NCT01439529) study were retrospectively analyzed. Patients were initially randomized to either nonoptimized CRT (NON-OPT group; n=89) or electrocardiographically optimized CRT based on the fusion-optimized intervals (FOI) method (FOI group; n=91). Echocardiographic response was defined as a >15% decrease in left ventricular end-systolic volume at the 12-month follow-up. The basal PR interval was shorter in women as compared to men. In the NON-OPT group, CRT resulted in a shorter paced QRS interval in women than in men (134 ± 21ms vs. 151 ± 21ms, respectively; p=0.003, 95% confidence interval [CI]: -27 to -5.6) and better response in women than in men: 70.4% vs. 46.4%, respectively (odds ratio: 0.37; p=0.04; 95%CI: 0.14 to 0.97). There were no differences in paced QRS interval duration (126 ± 13ms vs. 129 ± 17ms; p=0.47) or response between women and men in the FOI group (68% vs. 70.5%; odds ratio: 1.12; p=0.82; 95%CI: 0.41 to 3.07). FOI extended the atrioventricular interval to obtain the best fusion; the atrioventricular intervals tended to require greater extension in men than in women (22 ± 33ms vs. 8 ± 28ms, respectively; p=0.07). Women had a shorter PR interval, which was associated with a shorter QRS interval and better response to CRT. The difference in QRS interval duration and response between men and women did not persist when CRT wasoptimized using fusion with intrinsic conduction (FOI programming).

Automated Breast Density Measurement in Mammography for Cancer Risk Stratification

HomeRadiology: Imaging CancerVol. 3, No. 6 PreviousNext Research HighlightsFree AccessAutomated Breast Density Measurement in Mammography for Cancer Risk StratificationSurrin DeenSurrin DeenSurrin DeenPublished Online:Nov 26 2021https://doi.org/10.1148/rycan.2021219025MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: Breast density (BD) was quantified using automated software and compared with subjective radiologist rating of BD.■ Key Result: Automated software improved discrimination of cancer type and of interval cancers compared with visual assessment by a radiologist.■ Impact: Automated BD measurements from mammograms have the potential to stratify patients undergoing breast cancer screening, reducing false-positive rates and the frequency of unnecessary further tests such as MRI or biopsy.Stratified or risk-based breast cancer screening aims to select the most suitable personalized screening regimen for individual patients by estimating the likelihood of developing cancer and balancing this against the negative impact of unnecessary tests. Risk-based stratification algorithms incorporate BD classified subjectively by a radiologist in Breast Imaging Reporting and Data System.In the retrospective case-control study highlighted here, the authors used a U.K.-based population database, the OPTIMAM Database, to identify screening mammograms with cancer in women aged 47EN_DASH73 years. Cancer-free controls (n = 605) were identified and matched to cancer cases (n = 599) on the basis of age and the imaging equipment used. Automated software (Volpara, version 1.5.1; Volpara Health Technologies) calculated fibroglandular volume (FGV), volumetric BD (VBD), and density grade (DG). This was compared to BD assessed by a blinded radiologist using a visual analogue scale (VAS) from 0 to 100.The relative discriminative ability of FGV, both overall and for individual cancer subtypes, was found to be either equivalent to or greater than that of VAS or VBD, whether using statistical analyses based on logistic regression, receiver operating characteristic curves, or number of cancers included in the highest risk category (highest quartile). FGV provided the steepest risk gradient for all cancers, with an odds ratio (OR) for the highest quartile compared to the lowest quartile of 3.7 (95% CI: 2.5, 5.6). FGV quartile, VBD quartile, and DG also predicted node-positive cancers, and FGV quartile demonstrated the steepest risk gradient for interval (OR, 5.3; CI: 3.1, 9.1; P < .01), node-positive (OR, 4.7; CI: 2.5, 9.0; P < .01), and combined cancers (OR, 4.7; CI: 2.9, 7.8; P < .01).This study suggests that automated FGV may provide a good foundation for stratified breast cancer screening. However, information on several covariates was not collected in this study, necessitating further work to confirm this finding.Highlighted ArticleBurnside ES, Warren LM, Myles J, et al. Quantitative breast density analysis to predict interval and node-positive cancers in pursuit of improved screening protocols: a case-control study. Br J Cancer 2021;125(6):884–892. doi: https://doi.org/10.1038/s41416-021-01466-yHighlighted ArticleBurnside ES, Warren LM, Myles J, et al. Quantitative breast density analysis to predict interval and node-positive cancers in pursuit of improved screening protocols: a case-control study. Br J Cancer 2021;125(6):884–892. doi: https://doi.org/10.1038/s41416-021-01466-y Crossref, Medline, Google ScholarArticle HistoryPublished online: Nov 26 2021 FiguresReferencesRelatedDetailsRecommended Articles Impact of New Technology Adoption on Breast Cancer ScreeningRadiology2018Volume: 290Issue: 3pp. 638-639Age-based versus Risk-based Mammography Screening in Women 40–49 Years Old: A Cross-sectional StudyRadiology2019Volume: 292Issue: 2pp. 321-328MRI Screening Interval in Women with a History of Breast CancerRadiology2021Volume: 300Issue: 2pp. 312-313Fully Automated Volumetric Breast Density Estimation from Digital Breast TomosynthesisRadiology2021Volume: 301Issue: 3pp. 561-568Deep Learning Predicts Interval and Screening-detected Cancer from Screening Mammograms: A Case-Case-Control Study in 6369 WomenRadiology2021Volume: 301Issue: 3pp. 550-558See More RSNA Education Exhibits Let’s Talk about Next-Generation Breast Cancer Screening Programs: How Should We Do? What Should We Use?Digital Posters2020The Impact of New Genetic Mutations Associated with Breast Cancer on Breast MRI ScreeningDigital Posters2020Dense Breast: Is It Really Looking for a Needle in the Haystack? Digital Posters2020 RSNA Case Collection Malignancy on abbreviated screening breast MRIRSNA Case Collection2020Multifocal breast cancerRSNA Case Collection2020Breast density change with hormone replacement RSNA Case Collection2021 Vol. 3, No. 6 Metrics Altmetric Score PDF download

INTERPREGNANCY INTERVAL EFFECT ON PRETERM BIRTH

Identication of modiable and non-modiable risk factors for preterm birth before conception or early in pregnancy may help prevent this complication. Aretrospective analysis of interpregnancy interval in women giving preterm birth in a tertiary health centre was done . All records of obstetric patients, from institutional data centre were examined in detail which included demographic information, reproductive history, maternal characteristics, prenatal care, labor management, maternal complications during pregnancy, delivery, and the puerperium, and neonatal outcomes. In this study , among 112 patients 30 percent were having interpregnancy interval of less than 12 months, 50 percent 12 to &lt; 24 months, 11 percent 24 to 48 months and 9 percent &gt; 48 months. Higher occurrence of short interpregnancy interval &lt;24 months and younger age group &lt;19 years were found in association with preterm births.

Contribution of ultrasonography to the prediction of the induction-delivery interval: The ECOLDIA prospective multicenter cohort study

IntroductionTo evaluate the ability of preinduction ultrasonographic cervical length to predict the interval between induction and delivery in women at term with a Bishop score of 4 to 6 at induction. Study designThis multicenter prospective observational cohort recruited 334 women from April 2010 to March 2014. Inclusion criteria were women with singleton pregnancies at a gestational age ≥37 weeks, with no previous caesarean, a medical indication for induction of labor, and a Bishop score of 4, 5, or 6. All women underwent cervical assessment by both transvaginal ultrasound and digital examination (Bishop score). The induction protocol was standardized. The primary outcome measure was the induction-delivery interval. Hazard ratios (HR) and their 95% confidence intervals (95% CI) were used to assess potential predictors. ResultsMean gestational age at induction was 40.1 weeks, 60.8% of the women were nulliparous, and the cesarean rate was 13.4%. The mean induction-delivery interval was 20.8 h (± 10.6). Delivery occurred within 24 h for 56.9% (n=190) of the women. An ultrasonographic cervical length measurement less than 25 mm (HR=1.50, 95% CI 1.18–1.91, P<0.01) and parity (HR=1.41, 95% CI 1.21–1.65, P<0.01) appeared to predict induction-delivery interval. The cervical length cutoff to reduce the induction-delivery interval was 25 mm. ConclusionA cervical length cutoff of 25 mm was associated with shorter induction-delivery interval in women at term with a Bishop score of 4 to 6.

Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

BackgroundBreast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing treatment time intervals has not been widely investigated. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region.MethodsPubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization’s six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program Quality-Assessment Tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding.ResultsFrom 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence diagnostic and treatment intervals in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost.ConclusionThe present review shows that diagnostic and treatment intervals among women with breast cancer in sub-Saharan Africa are influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.

Cervical ripening with laminaria tents prior to second trimester induction of labor

Background Induction abortion in the second trimester may be favored in some instances, such as in women with compounding medical conditions or when skilled providers are not available. Various methods of pre-induction cervical preparation have been used to shorten the length of induction and decrease the risk of complications. The benefits of cervical preparation with laminaria before D&E have been well studied, but the benefits of laminaria before medical induction are less clear. Objective To determine if overnight cervical preparation with laminaria tents shortens delivery interval in women undergoing 2nd trimester induction of labor (IOL) with misoprostol. Study Design This was a retrospective cohort study comparing overnight intracervical laminaria placement followed by misoprostol to misoprostol alone for 2nd trimester IOL between 1/2000 and 12/2010. Women were excluded if the reason for IOL was preterm labor or preterm premature rupture of membranes or if misoprostol was not used as the primary induction agent. The primary outcome was time from misoprostol administration to delivery. Results 126 women were analyzed including 36 (29%) who received laminaria + misoprostol and 90 (71%) who received misoprostol alone. Women in the laminaria + misoprostol group were significantly older (30 yrs [14–44] vs. 27 yrs [17-43], p = .029). Induction for fetal anomaly (92% vs. 34%, p ≤ .001) and the use of feticide (56% vs. 13%, p ≤ .001) were more common in the laminaria + misoprostol group. The mean time to delivery in the laminaria + misoprostol group was 6 h longer compared to the misoprostol only group; 19 ± 8 h compared to 13 ± 12hrs (p = .007). There was no difference in fetal to placental delivery time (p = .329), total misoprostol dose (p = .182), or length of hospitalization (p = .144) however, significantly more women completed abortion at 24 hrs in the misoprostol alone group (90% vs. 61%, p ≤ .001). Conclusions The use of laminaria tents for overnight cervical preparation does not expedite delivery times in patients undergoing 2nd trimester IOL with misoprostol.

Steroid reference intervals in women: influence of menopause, age and metabolism.

To investigate the impact of age, obesity and metabolic parameters on 13 circulating steroids in reproductive and menopausal age. To define reference intervals (RIs). Cross-sectional. Three hundred and twenty five drug-free, healthy and eumenorrheic women were selected from the general population. Independent relationships of LC-MS/MS-determined steroid levels with age, BMI and metabolic parameters were estimated. Reference sub-cohorts were defined for calculating upper and lower limits in reproductive age, menstrual phases and menopause, and these were compared with limits in dysmetabolic sub-cohorts. Lower androgens, pro-androgens and estrogens, but higher cortisol and metabolites were found in menopausal compared to reproductive age women. Androgens and precursors decreased during reproductive age (P < 0.001-P = 0.002) but not after menopause. 17OH-progesterone decreased with BMI (P = 0.006) and glucocorticoids with waist circumference (P < 0.001P = 0.002) in reproductive age, but increased with triglycerides (P=0.011P=0.038) after menopause. Inverse associations of dihydrotestosterone with BMI (P=0.004) and HDL-cholesterol (P=0.010), estrone with total cholesterol (P=0.033) and estradiol with triglycerides (P=0.011) were found in reproductive age. After menopause, estrone increased with waist circumference (P<0.001) and decreased with insulin resistance (P=0.012). Ovarian steroid RIs were estimated in menstrual phases and menopause. Age- and reproductive status-specific RIs were generated for androgens, precursors and corticosteroids. Lower limits for reproductive age cortisol (P=0.020) and menopausal 11-deoxycortisol (P=0.003) in dysmetabolic sub-cohorts were reduced and increased, respectively, compared to reference limits. Obesity and dysmetabolism differently influence circulating steroids in reproductive and menopausal status. Age, menstrual and menopausal status-specific RIs were provided by LC-MS/MS for a broad steroid panel.

Foley's Catheter with or without Misoprostol in Induction of labor: (Randomised Double Blind Control Study)

Background: Labor induction is the initiation of labor at a viable pregnancy duration by artificial means, and occurs before the spontaneous onset of labor. The goal of labor induction is to achieve a timely and uncomplicated vaginal delivery with minimal adverse effects on the mother or newborn.Aim: This study aimed to compare the efficacy of the use of Foley’s catheter with either misoprostol or placebo to improve induction to delivery interval in women with unfavorable cervix undergoing induction of labor.Materials and Methods: The present study is a randomized double blind controlled study that that was conducted at Maternity Hospital of Ain-Shams University. The study included 100 candidates on 4 equal goups :50 nulliparas randomized into 2 groups and 50 multiparas randomized into 2 groups. Each group underwent labor induction by Foley's catheter and Misoprostol or placebo.Results: Labor stages were significantly shorter in combined group than in Foley's group, but no significant difference in third stage. Oxytocin duration and total dose were significantly lower in combined group. No significant difference among studied groups regarding mode of delivery or fetal or maternal complications.Conclusion: Combined Foleys catheter and misoprostol provides a shorter duration of cervical ripening, less oxytocin required with no added complications compared to Foley’s catheter alone.