Menstrual Dates Research Articles

Forecasting of Menstruation using a Calendar-based Method based on a Web Application

Accurately predicting menstrual dates is valuable for women, yet it poses a significant challenge, particularly for those with irregular cycles. This study introduces a web application that utilises a calendar-based method to predict upcoming menstrual dates while offering additional features such as tracking past periods, logging symptoms, and providing personalised health advice. Using the software development life cycle approach, the critical contribution of this work is the development of a user-friendly tool that not only aids in menstrual tracking but also highlights the limitations of calendar-based predictions, especially for women with irregular cycles. Our findings suggest that while the method provides accurate predictions for women with regular cycles, it is less reliable for those with irregular cycles due to its dependence on a fixed cycle length range. This study underscores the need for more adaptive models to improve prediction accuracy for a broader population.

Folic acid supplements and perinatal mortality in China.

Periconceptional use of multivitamins containing folic acid prevents external major birth defects, especially neural tube defects. We aimed to explore the effects of maternal folic acid supplementation alone on perinatal mortality with or without external major birth defects plus neural tube defects. From the China-US Collaborative Project for Neural Tube Defects Prevention, we identified 222, 303 singleton pregnancies with detailed information on periconceptional folic acid use, defined as folic acid supplementary before the last menstrual date until to the end of the first trimester. Perinatal mortality included stillbirths after 20 weeks' gestation and early neonatal deaths within 7 days of delivery. Among the fetuses or infants of women who did not take folic acid, the rate of perinatal mortality was 2.99% and 1.62% at least 20 weeks' gestation in the northern and southern regions. Among the fetuses or infants of the women with periconceptional use of folic acid, the rates were 1.85% and 1.39% in the northern and southern region. The estimated relative risk for perinatal mortality [adjusted risk ratio (RR), 0.72; 95% confidence interval (CI), 0.61- 0.85], stillbirth (adjusted RR, 0.78; 95% CI, 0.64-0.96), early neonatal mortality (adjusted RR, 0.61; 95% CI, 0.45-0.82), and neonatal death (adjusted RR, 0.64; 95% CI, 0.49-0.83) in northern China was significantly decreased in association with periconceptional folic acid supplementation. Compared with northern, there was a lesser effect in southern China. Periconceptional intake of 400μg folic acid daily reduces the overall risk perinatal mortality, as well as the risk from external major birth defects and neural tube defects, especially in northern China.

Menstrual hygiene practices of adolescent secondary school girls in rural Anambra communities.

Adolescent girls face numerous challenges which hinder their ability to manage menstruation in a healthy and dignified manner. To examine the menstrual hygiene practices of adolescent girls schooling in rural Anambra communities. Cross-sectional descriptive study. Participants were selected using multistage stratified random sampling technique and interviewed using self-administered semi-structured questionnaire. Data were analysed using Statistical Package for Social Sciences version 22.0. Mean age of all, pre-menarche and post-menarche girls were 14.7 ± 1.84, 12.8 ± 1.09 and 15.1 ± 1.73 years, respectively. About 46% of the pre-menarche girls had not received any information on menstruation. Common sources of initial menstruation information were mother (87.3%), school (52.2%) and peers (20.0%). Among the 1091 (85.0% (1091/1283)) post-menarche girls, last menstrual period, last menstrual period duration and cycle length could not be recalled by 53.9%, 34.4% and 39.3%, respectively. Majority (98.3%) who could recall last menstrual period had a cycle length of ⩽30 days and the mean duration of menses was 4.4 ± 0.84 days. Disposable sanitary pad was mostly (60%) cited as recommended product, but cloth/rags (40.6%) or tissue paper (32. 3%) were predominantly used. Majority (88.6%) took their bath ⩾twice/day, 50.9% changed sanitary product ⩽twice/day while 72.5% exhibited poor hand washing. Sanitary products were mostly discarded by burning (45.4%). Fifty-one percent could not change in school predominantly due to lack of functional toilets/changing rooms (84.2%) while 72.5% of those who changed did so in bushes or unused spaces. Challenges faced during menstruation include restriction from holy places (38.9%), waist pain (74.9%), blood stains (36.1%) and lack of money to buy pad (27.0%). Factors significantly associated with using commercial pads were age (p = 0.047), class (p = 0.006), mother's educational status (p < 0.001), social class (p < 0.001), ability to recall last menstrual period date (p = 0.029) or duration (p = 0.001). Menstrual hygiene management was unsatisfactory among studied adolescents. Continuous education of adolescent girls on menstrual hygiene management and advocacy for adequate menstrual hygiene management support are imperative.

Maternal obesity and childhood asthma risk: Exploring mediating pathways.

Growing evidence for the effect of maternal obesity on childhood asthma motivates investigation of mediating pathways. To investigate if childhood body mass index (BMI), gestational weight gain (GWG) and preterm birth mediate the association of maternal obesity on childhood asthma risk. We used electronic medical records from mother-child pairs enrolled in Kaiser Permanente Northern California integrated healthcare system. Children were followed from their birth (2005-2014) until at least age 4 (n = 95,723), age 6 (n = 59,230) or age 8 (n = 25,261). Childhood asthma diagnosis at each age was determined using ICD-9/10 codes and medication dispensings. Prepregnancy BMI (underweight [<18.5], normal [18.5-24.9], overweight [25-29.9], obese [≥30] kg/m2) were defined using height and weight measurements close to the last menstrual period date. Child's BMI (Centers for Disease Control and Prevention BMI-for-age percentiles: underweight [<5th], normal [5th-85th], overweight [85th-95th], obese [>95th]) were obtained using anthropometric measurements taken the year preceding each follow-up age. GWG (delivery weight-prepregnancy weight) was categorised based on Institutes of Medicine recommendations (inadequate, adequate, excessive). Implementing first causal inference test (CIT) then causal mediator models (to decompose the natural direct and indirect effects), we examined the potential mediating effect of childhood BMI, GWG, and preterm birth on the association between prepregnancy BMI (continuous and categorical) and childhood asthma. Overall, risk of childhood asthma increased as prepregnancy BMI increased (age 4 risk ratio: 1.07, 95% confidence interval: 1.04, 1.09, per 5 kg/m2 increase in BMI; similar for age 6 and 8). CIT identified childhood BMI and preterm birth, but not GWG as potential mediators. Causal mediation models confirmed childhood BMI, but not preterm birth, as having a partial mediating effect. Results were similar for age 6 and 8, and when continuous mediators (instead of binary) were assessed. Childhood overweight/obesity has a modest mediating effect on the association between prepregnancy BMI and childhood asthma.

Effect Of a Gym Ball Exercise Program on Dysmenorrhea in Nursing Students of a Selected College in Mangaluru, India: A Quasi-experimental Study

Introduction: Dysmenorrhoea is one of the leading causes of school absenteeism among adolescent girls. Many women have menstrual cramps before and during their menstrual periods. For some women, the discomfort is merely annoying. Methods used to relieve dysmenorrhea include; exercise, a healthy diet, and yoga. Objective: This study aims to evaluate the effect of a gym ball exercise program on dysmenorrhea in nursing students from a selected college in Mangaluru, India. Materials and Methods: This is a quasi-experimental study on 52 eligible nursing students (26 in the exercise group and 26 in the control group). A pre-test assessment was done in both groups to assess the level of dysmenorrhea by using the numerical pain rating scale. The gym ball exercise was performed in the exercise group for 3 weeks prior to their predicted menstrual date, three times a week, each for 45 minutes. The post-test assessment was done on the first day of their menstruation and followed up one month later to assess the sustainability of the effect of the exercise. To analyze the data, inferential statistics, including chi-square test, Fisher’s exact test, Wilcoxon signed rank test, and Mann-Whitney U test were used. Results: The participants had moderate to severe pain. They had regular menstrual cycles lasting for 28-30 days, with a menstrual duration of 3-6 days, and moderate bleeding. The level of dysmenorrhea in the exercise group was lower (2.69±1.15) than in the control group (4.77±1.75) in the post-test phase. The mean level of dysmenorrhoea in the follow-up phase was 3.08±1.74 and 4.35±1.79 in the exercise and control groups, respectively. A significant difference was found between pre-test and follow-up pain scores (P=0.001) and between post-test and follow-up pain scores (P=0.001). Mann-Whitney U test results showed a significant difference between the two groups in the post-test (P=0.001) and follow-up phases (P=0.001). Conclusion: The four-week gym ball exercise program is effective in reducing the intensity of dysmenorrhea in nursing students.

Using simple clinical and ultrasound variables to develop a model to predict first trimester pregnancy viability

IntroductionEarly prediction of pregnancies destined to miscarry will allow couples to prepare for this common but often unexpected eventuality, and clinicians to allocate finite resources. We aimed to develop a prediction model combining clinical, demographic, and sonographic data as a clinical tool to aid counselling about first trimester pregnancy outcome. Material and methodsThis is a prospective, observational cohort study conducted at Queen Charlotte’s and Chelsea Hospital, UK from March 2014 to May 2019. Women with confirmed intrauterine pregnancies between 5 weeks and their dating scan (11–14 weeks) were recruited. Participants attended serial ultrasound scans in the first trimester and at each visit recorded symptoms of vaginal bleeding, pelvic pain, nausea and vomiting using validated scoring tools. Pregnancies were followed up until the dating scan (11–14 weeks). Univariate and multivariate analyses were performed to predict first trimester viability. A model was developed with multivariable logistic regression, variables limited by feature selection, and bootstrapping with multiple imputation was used for internal validation. Results1403 women were recruited and after exclusions, data were available for 1105. 160 women (14.5 %) experienced first trimester miscarriage and 945 women (85.5 %) had viable pregnancies at 11–14 weeks’ gestation. The average gestational age at the initial visit (calculated from the menstrual dates) was 7 + 1 weeks (+/-12.2 days). A multivariable logistic regression model was developed to predict first trimester viability and included the variables: mean gestational sac diameter, presence of fetal heart pulsations, difference in gestational age from last menstrual period and from mean sac diameter on ultrasonography, current folic acid usage and maternal age. The model demonstrated good performance (optimism-corrected area under curve (AUC) 0.84, 95 % CI 0.81–0.87; optimism-corrected calibration slope 0.969). ConclusionWe have developed and internally validated a model to predict first trimester viability with good accuracy prior to the 11–14 week dating scan, which now needs to be externally validated prior to clinical use.

Machine learning for accurate estimation of fetal gestational age based on ultrasound images

Accurate estimation of gestational age is an essential component of good obstetric care and informs clinical decision-making throughout pregnancy. As the date of the last menstrual period is often unknown or uncertain, ultrasound measurement of fetal size is currently the best method for estimating gestational age. The calculation assumes an average fetal size at each gestational age. The method is accurate in the first trimester, but less so in the second and third trimesters as growth deviates from the average and variation in fetal size increases. Consequently, fetal ultrasound late in pregnancy has a wide margin of error of at least ±2 weeks’ gestation. Here, we utilise state-of-the-art machine learning methods to estimate gestational age using only image analysis of standard ultrasound planes, without any measurement information. The machine learning model is based on ultrasound images from two independent datasets: one for training and internal validation, and another for external validation. During validation, the model was blinded to the ground truth of gestational age (based on a reliable last menstrual period date and confirmatory first-trimester fetal crown rump length). We show that this approach compensates for increases in size variation and is even accurate in cases of intrauterine growth restriction. Our best machine-learning based model estimates gestational age with a mean absolute error of 3.0 (95% CI, 2.9–3.2) and 4.3 (95% CI, 4.1–4.5) days in the second and third trimesters, respectively, which outperforms current ultrasound-based clinical biometry at these gestational ages. Our method for dating the pregnancy in the second and third trimesters is, therefore, more accurate than published methods.

Menstrual Phase and Menopausal Status Classification of Benign Breast Tissue Using Hormone-Regulated Gene Expression and Histomorphology: A Validation Study.

The validation of breast cancer risk biomarkers in benign breast samples (BBS) is a long-sought goal, hampered by the fluctuation of gene and protein expression with menstrual phase (MP) and menopausal status (MS). Previously, we identified hormone-related gene expression and histomorphology parameters to classify BBS by MS/MP. We now evaluate both together, to validate our prior results. BBS were obtained from consenting women (86 premenopausal, 55 postmenopausal) undergoing reduction mammoplasty (RM) or contralateral unaffected breast (CUB) mastectomy. MP/MS was defined using classical criteria for menstrual dates and hormone levels on the day of surgery. BBS gene expression was measured with reverse transcription quantitative polymerase chain reaction (RT-qPCR) for three luteal phase (LP) genes (TNFSF11, DIO2, MYBPC1) and four menopausal genes (PGR, GREB1, TIFF1, CCND1). Premenopausal samples were classified into LP or non-LP, using published histomorphology parameters. Logistic regression and receiver-operator curve analysis was performed to assess area under the curve (AUC) for prediction of MP/MS. In all 131 women, menopausal genes plus age>50 years predicted true MS [AUC 0.93, 95% confidence interval (CI) 0.89, 0.97]. Among premenopausal women, high TNFSF11 expression distinguished non-LP from LP samples (AUC 0.80, 95% CI 0.70, 0.91); the addition of histomorphology improved the prediction nonsignificantly (AUC 0.87, 95% CI 0.78, 0.96). In premenopausal subsets, addition of histomorphology improved LP prediction in RM (AUC 0.95, 95% CI 0.87, 1.0), but not in CUB (0.84, 95% CI 0.72, 0.96). Expression of five-gene set accurately predicts menopausal status and menstrual phase in BBS, facilitating the development of breast cancer risk biomarkers using large, archived sample repositories.

Pregnancy and neonatal safety outcomes of timing of initiation of daily oral tenofovir disoproxil fumarate and emtricitabine pre-exposure prophylaxis for HIV prevention (CAP016): an open-label, randomised, non-inferiority trial

The safety of tenofovir disoproxil fumarate and emtricitabine as pre-exposure prophylaxis (PrEP) in pregnant women not living with HIV is uncertain. We aimed to compare pregnancy and neonatal outcomes in women exposed and not exposed to PrEP during pregnancy. In this single-site, open-label, randomised, non-inferiority trial in Durban, South Africa, we evaluated pregnancy and neonatal outcomes in pregnant women aged 18 years or older, not living with HIV, and at 14-28 weeks' gestation at the time of enrolment. Eligible participants were randomly assigned (1:1) using a computer-generated permuted block (block size of ten) randomisation list to immediate initiation or deferred initiation of PrEP until breastfeeding cessation. Participants in the immediate PrEP group received a monthly supply of once daily oral tenofovir disoproxil fumarate 300 mg and emtricitabine 200 mg. Participants in the deferred PrEP group received standard of care for HIV prevention. The primary outcomes were the occurrence of preterm live birth (<37 weeks gestational age) and very preterm birth (<34 weeks gestational age) determined by menstrual dating, low birthweight (<2500 g), very low birthweight (<1500 g), stillbirth (≥20 weeks gestational age), and small for gestational age (birthweight less than the tenth percentile). Post-natal safety outcomes will be reported elsewhere. We used binomial regression models to estimate risk differences and two-sided 90% CIs. Immediate PrEP was non-inferior to deferred PrEP if the upper bound of the 90% CI of the risk difference was less than the upper predefined non-inferiority margin for preterm birth (7·5%), very preterm birth (2·6%), low birthweight (5·5%), very low birthweight (1·2%), stillbirth (1·0%), and small for gestational age (3·7%). All outcomes were analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT3227731. Between Sept 25, 2017, and Dec 6, 2019, we screened 693 women, of whom 540 were randomly assigned to immediate PrEP (n=271) or deferred PrEP (n=269). The median gestational age was 19 weeks (IQR 15-23 for immediate PrEP and 16-23 for deferred PrEP). The risk difference between the immediate PrEP group and the deferred PrEP group for preterm birth was -4·7% (90% CI -10·7 to 1·2; immediate PrEP was non-inferior), for very preterm birth was 0·6% (-3·4 to 4·6; upper limit exceeded the non-inferiority margin), for low birthweight was 2·5% (-1·6 to 6·6; upper limit exceeded the non-inferiority margin), for very low birthweight was 0% (-1·4 to 1·4; upper limit exceeded the non-inferiority margin), for stillbirth was 1·2% (-1·5 to 3·8; upper limit exceeded the non-inferiority margin), and for small for gestational age was 0·9% (-1·2 to 2·9; immediate PrEP was non-inferior). In our study, PrEP was not associated with preterm birth or small for gestational age infants. Our data support the use of tenofovir disoproxil fumarate and emtricitabine in pregnancy and our reassuring findings can be used to allay safety concerns among pregnant women. South African Medical Research Council and Gilead Sciences.

Development and Validation of ICD-10-CM-based Algorithms for Date of Last Menstrual Period, Pregnancy Outcomes, and Infant Outcomes.

Validation studies of algorithms for pregnancy outcomes based on International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes are important for conducting drug safety research using administrative claims databases. To facilitate the conduct of pregnancy safety studies, this exploratory study aimed to develop and validate ICD-10-CM-based claims algorithms for date of last menstrual period (LMP) and pregnancy outcomes using medical records. Using a mother-infant-linked claims database, the study included women with a pregnancy between 2016-2017 and their infants. Claims-based algorithms for LMP date utilized codes for gestational age (Z3A codes). The primary outcomes were major congenital malformations (MCMs) and spontaneous abortion; additional secondary outcomes were also evaluated. Each pregnancy outcome was identified using a claims-based simple algorithm, defined as presence of ≥ 1 claim for the outcome. Positive predictive values (PPV) and 95% confidence intervals (CI) were calculated. Overall, 586 medical records were sought and 365 (62.3%) were adjudicated, including 125 records each for MCMs and spontaneous abortion. Last menstrual period date was validated among maternal charts procured for pregnancy outcomes and fewer charts were adjudicated for the secondary outcomes. The median difference in days between LMP date based on Z3A codes and adjudicated LMP date was 4.0 (interquartile range: 2.0-10.0). The PPV of the simple algorithm for spontaneous abortion was 84.7% (95% CI 78.3, 91.2). The PPV for the MCM algorithm was < 70%. The algorithms for the secondary outcomes pre-eclampsia, premature delivery, and low birthweight performed well, with PPVs > 70%. The ICD-10-CM claims-based algorithm for spontaneous abortion performed well and may be used in pregnancy studies. Further algorithm refinement for MCMs is needed. The algorithms for LMP date and the secondary outcomes would benefit from additional validation in a larger sample.

Assessment of the Effectiveness of Aerobic Exercise Versus Billig’s Exercise Among Nursing Students with Dysmenorrhoea in Selected Nursing Colleges in Bangalore

Introduction Dysmenorrhea afflicts millions of women all over the world and is considered the most common gynecological condition in women regardless of age and nationality. The notion that exercise is effective in preventing and treating symptoms has prevailed for many years and led to the promotion of anecdotal belief that exercise is beneficial. Behavioral interventions such as exercise may not only reduce dysmenorrhoea but also eliminate or reduce the need for medication to control menstrual cramps and other associated symptoms. Objectives 1. To assess the perceived levels of pain among dysmenorrhoeic students of Group-A and Group-B before intervention. 2. To assess the perceived levels of pain among dysmenorrhoeic students of Group-A and Group-B after intervention. 3. To evaluate the effectiveness of aerobic exercise in Group-A and Billigrsquos exercise in Group-B. 4. To compare the effectiveness of aerobic exercise Group-A and Billigrsquos exercise Group-B among nursing students with dysmenorrhea. 5. To determine the association of the perceived levels of pain after intervention in aerobic exercise group Group-A and Billigrsquos exercise group Group-B with their selected demographic variables.Methodology The design used in this study was true experimental pre-test post-test research design. The selected settings for the study were nursing students of SJB and RajaRajeshwari College of Nursing Bangalore. The total number of students at SJB College was around 180 and at RajaRajeswari College of Nursing was around 200. Among them 85-95 students in each college were suffering with dysmenorrhoea. Investigator had selected 30 subjects using lottery method from each college. On Day-1 demographic questionnaire checklist and numerical pain scale were used to collect the data. On the same day aerobic exercise was taught for subjects in Group-A at SJB College of Nursing and Billigrsquos exercise for Group-B subjects at RajaRajeswari College of Nursing using computer assisted instruction method. The phone numbers of participants were collected to maintain contact with them. Investigator maintained a record of their menstrual dates and contacted them over phone to remind and motivate them to do exercise during the time of menstruation. The post-test scores were collected once they attained the menstrual cycle and performed the exercise.Results The mean post test scores were calculated in each group and the lsquotrsquo value was calculated. Since the computed lsquotrsquo 5.6 was greater than lsquotrsquo value lsquotrsquo 58 1.96 at 0.05 level it infers the post test score of aerobicnbspnbspexercise group as 12.857 and that for Billigrsquos exercise group as 12.26. Hence it can be concluded that aerobic exercise was as effective as Billigrsquos exercise.Conclusion Aerobic exercise and Billigrsquos exercise can reduce pain in those suffering with dysmenorrhoea and are effective.

Ultrasound measurement of fetal kidney length in the second and third trimester of pregnancy and its correlation with gestational age

Aims: To measure the fetal kidney length in the second and third trimesters of pregnancy and correlate it with the gestational age and other routine fetal parameters. Methods: This prospective cross-sectional study includes 250 pregnant women presented in the Nobel Medical College for ultrasound examination from the period of July 2021 to June 2022. Gestational age was estimated based on the last menstrual date and ultrasonogram. Routine fetal parameters and mean fetal kidney length were measured. The correlation between gestational age, fetal kidney length, and routine fetal parameters was studied. Results: The mean gestational age according to ultrasound and last menstrual period were 35.5 ± 3.4 weeks and 35.2 ± 3.2 weeks respectively. The mean fetal kidney length was 36.8 ± 4.02mm. There was a very strong positive correlation between gestational age and fetal kidney length (r=0.921, p =0.001). Compared to the routine fetal parameters, adding fetal kidney length improved the effectiveness in predicting gestational age. (R2 =0.918 vs. R2 =0.936) Conclusion: Fetal kidney length can be added to the other standard parameters to improve the prediction of gestational age.

Correlation of Placental Thickness with Gestational Age and Other Fetal Parameters Among Pregnant Women: A prospective cross-sectional study from North India

Background: Placental thickness is the lone parameter that can predict gestational age without relying on the foetus. For many years, the last menstrual period (LMP) date has been used to calculate the foetus gestational age; but, as shown by the studies, approximately 56 percent of females can recall the last menstrual period date with absolute precision. This forgetting might not have a big impact on an uncomplicated pregnancy, but in complicated pregnancies, proper foetal gestational age data is vital. In order to determine the relationship between placental thickness and foetal age and other growth parameters, this study was carried out.Methods: Between July 22, 2021, and July 22, 2022, the Department of Anatomy at Santosh Medical College and Hospital in Ghaziabad, Uttar Pradesh, India, worked with the Departments of Radiology and Obstetrics &amp; Gynaecology on this prospective cross-sectional study. The convenient sampling technique was used to enrol the study subjects, and during the first five months of study, 254 ANC subjects with gestational ages between 11 and 20 weeks were included in the study. The pregnant subjects were examined by USG machine for gestational age (GA), and placental thickness (PT). The analysed data were represented as frequency, percentages, mean, median standard deviation (SD), minimum and maximum values.Results: Among enrolled pregnant subjects, the most common placenta positions were anterior (42.6%) and posterior (30.1%). Between the time of enrolment in the study (1.61±0.26 cms), the first follow-up visit (2.62±0.07 cms), and the second follow-up visit (3.35±0.26 cms), the mean placental thickness significantly increased. A very significant association (r=0.746) was found between gestational age and placental thickness in the Pearson correlation analysis of subjects between 31 and 40 weeks of gestation. Similar to this, a very significant correlation (r=0.965) was found between gestational age and foetus gestational weight.Conclusion: In our study during the first, second, and third trimesters of pregnancy, there was a significant linear association between placental thickness, gestational age, and other foetal parameters. Statistics was found to support the relationship.

Association of lifetime lactation and age at natural menopause: a prospective cohort study.

The aim of this study was to examine the association between duration of lifetime lactation and age at natural menopause. In this prospective cohort study, we analyzed parous premenopausal women in the multiethnic Study of Women's Health Across the Nation who were followed approximately annually for 10 years (1995-2008). Lifetime lactation was defined as the duration of breastfeeding across all births in months. Age at natural menopause was defined as age in years after 12 consecutive months of amenorrhea after the final menstrual period for no other reported cause. We used Cox proportional hazard models to analyze time to natural menopause with age as the underlying time scale. Multivariable models controlled for education, race/ethnicity, parity, smoking, body mass index, and oral contraceptive use. Among 2,377 women, 52.6% experienced natural menopause during follow-up and reported a valid final menstrual period date. The small, crude association between lifetime lactation up to 24 months and later age at natural menopause attenuated to nonsignificance in adjusted models (6 months: adjusted hazard ratio [AHR], 0.96; 95% confidence interval (CI), 0.87-1.06; 12 months: AHR, 0.95; 95% CI, 0.82-1.11; 18 months: AHR, 0.96; 95% CI, 0.82-1.13; 24 months: AHR, 0.99; 95% CI, 0.84-1.16). Duration of lifetime lactation was not associated with age at natural menopause after controlling for sociodemographic characteristics.

P-351 Medical treatment for missed abortion- difference in gestational age based on menstrual dating and on ultrasound criteria, and the correlation to failure

Abstract Study question Does the difference in gestational age based on menstrual dating and on ultrasound criteria correlate with failure rate of medical treatment in missed abortions? Summary answer In missed abortions, the difference in gestational age based on menstrual dating and on ultrasound is inversely correlated with failure rate of medical treatment. What is known already A number of factors have been reported as predictors for Misoprostol treatment failure, including assisted reproductive treatment, primigravity, and vaginal bleeding prior to treatment. Increased rates of failure with medical management were also reported with delaying treatment after diagnosis. Study design, size, duration This was a retrospective cohort study. Overall, 778 patients who underwent medical treatment with Misoprostol for missed abortion at our institute, between 07/2015 and 12/2020 were included. Participants/materials, setting, methods Inclusion criteria were either anembryonic gestation or embryonic death, as long as pregnancy age, as measured by transvaginal sonography , correlated with 12 weeks gestation or less. Exclusion criteria included incomplete or septic abortions, multiple pregnancies, and cases that had either irregular period, missing data, or were lost to follow up. The primary outcome was treatment failure, defined as any need for surgical intervention (elective or emergency Dilation &amp; curettage, or operative hysteroscopy). Main results and the role of chance Five hundred and eighty two patients (74.9%) had successful medical treatment, while 196 (25.1%) required surgical intervention. The gestational age based on menstrual dating and on ultrasound difference (in weeks) was 2.6±1.4 in the success group and 3.1±1.6 in the failure group (p &amp;lt; 0.001). On multivariant regression analysis, gestational age based on menstrual dating and on ultrasound difference was found to be independently correlated with treatment failure (aOR=1.24, CI 95% (1.01-1.51), p = 0.03). Limitations, reasons for caution We did not analyze long term consequences, such as the amount of bleeding, and time to future fertility. Moreover, patients who were treated at our institute may have been diagnosed and treated for treatment failure in neighboring hospitals and hence lost to follow-up. Wider implications of the findings The current study has shown that the difference between gestational age based on menstrual dating and on ultrasound is directly corelated with medical treatment failure. This data should be taken into account when counseling patients regarding the optimal treatment for first trimester missed abortion. Trial registration number not applicable

P-494 A survey of women’s experiences, behaviours and attitudes of using period tracker applications (apps)

Abstract Study question What are women’s experiences, behaviours and attitudes to ovulation and period prediction when using a period tracker app? Summary answer Some women altered their behaviour in response to ovulation prediction and some felt stressed in response to their period arriving earlier or later than predicted. What is known already Period tracker apps are designed to help women track and predict menstrual cycle dates and symptoms. The majority of period tracker apps predict the date a woman is ovulating and the date of her period. Several studies have shown that ovulation cannot be accurately predicted using menstrual cycle dates, and many apps assume that women ovulate on day 14 of their cycle whereas recent large studies have shown this to be closer to days 16/17. With regards to the prediction of the first day of the period, reports have shown that period tracker apps do not always correctly predict this. Study design, size, duration We conducted an anonymous, online survey using multiple choice and open-ended questions on Qualtrics software. The survey was live for 19 days, from 30th June – 20th July 2021 and was promoted using the social media of authors 1 and 3 (Twitter, Instagram, Facebook and Linkedin). The qualitative data was analysed thematically. Participants/materials, setting, methods The inclusion criteria was that participants had to be using or had previously used a period tracker app, be able to read English and have access to the online survey. Main results and the role of chance From 375 total responses, 330 complete responses were analysed, giving a completion rate of 88.0%. Respondents were aged between 14-54, with a mean age of 26.0 (±7.81). When asked what was the best thing about using the app, 29.7% (98/330) respondents selected ‘To know when I’m ovulating’. The majority of respondents sexual activity was not influenced by their app’s predicted dates (65.5%, 216/330). However, a total of 17.0% (56/330) of respondents stated that it was, with 10.9% (36/330) stating they avoided having sex on fertile days predicted by the app. Respondents were asked if their period ever started earlier than the app predicted; 54.9% (189/330) said it had and 72.1% (238/330) said it had started later than predicted. When asked how they felt if their period arrived earlier or later than expected, thematic analysis of responses when periods started earlier revealed 4 themes: feeling unaffected, being frustrated/unprepared, feeling anxious/stressed, and feeling confused/intrigued. Thematic analysis when their period arrived later than expected revealed 6 themes: anxious/concerned about pregnancy, disappointed about pregnancy, seeking advice/informing healthcare professionals, thoughts about the menopause, feeling unaffected and being better prepared. Limitations, reasons for caution All surveys have a selection bias. The survey was only promoted on social media of two of the authors. As the survey was in English, the women who answered the survey were mainly UK residents who were highly educated. Wider implications of the findings Period tracker apps need to be clearer of their intended use and reliability, especially for period and ovulation prediction. Inaccurate predictions can affect the users’ health and behaviour. This study calls for period tracker app companies to update their apps to provide transparency about their intended use and capabilities. Trial registration number NA

A Prospective Cohort Study of Seasonal Variation in Spontaneous Abortion

Up to 30% of pregnancies end in spontaneous abortion, yet few risk factors have been identified. Examining seasonal patterns in risk of spontaneous abortion can generate new hypotheses regarding environmental and lifestyle determinants. We used data from Pregnancy Study Online-a preconception cohort study of pregnancy planners from the United States and Canada-to examine seasonal variation in spontaneous abortion risk. We enrolled 12,197 women during 2013 to 2020, 6104 of whom reported a conception within 12 months of enrollment. On follow-up questionnaires, participants reported date of spontaneous abortion and weeks gestation at time of loss. We used periodic regression to estimate two aspects of seasonal occurrence: peak/low ratio-a measure of intensity of seasonal variation-and peak timing. We examined season at risk (from the date of each gestational week) in relation to spontaneous abortion; in a secondary analysis, we examined season of conception in relation to spontaneous abortion. We controlled for seasonal patterns in attempt initiation via month the pregnancy attempt began. Almost 20% of women experienced spontaneous abortion. Risk was highest in late August, with a peak/low ratio of 1.3 (95% confidence interval [CI] = 1.1, 1.6). This seasonal pattern was evident almost exclusively for spontaneous abortion at <8 weeks since the last menstrual period date (peak/low ratio = 1.4; 95% CI = 1.2, 1.8), and associations were stronger among women living in the Southern and Midwestern United States. Environmental or lifestyle factors more prevalent in late summer may be associated with increased risk of early spontaneous abortion.

Transcriptomics of receptive endometrium in women with sonographic features of adenomyosis

BackgroundWomen with uterine adenomyosis seeking assisted reproduction have been associated with compromised endometrial receptivity to embryo implantation. To understand the mechanisms involved in this process, we aimed to compare endometrial transcriptome profiles during the window of implantation (WOI) between women with and without adenomyosis.MethodsWe obtained endometrial biopsies LH-timed to the WOI from women with sonographic features of adenomyosis (n=10) and controls (n=10). Isolated RNA samples were subjected to RNA sequencing (RNA-seq) by the Illumina NovaSeq 6000 platform and endometrial receptivity classification with a molecular tool for menstrual cycle phase dating (beREADY®, CCHT). The program language R and Bioconductor packages were applied to analyse RNA-seq data in the setting of the result of accurate endometrial dating. To suggest robust candidate pathways, the identified differentially expressed genes (DEGs) associated with the adenomyosis group in the receptive phase were further integrated with 151, 173 and 42 extracted genes from published studies that were related to endometrial receptivity in healthy uterus, endometriosis and adenomyosis, respectively. Enrichment analyses were performed using Cytoscape ClueGO and CluePedia apps.ResultsOut of 20 endometrial samples, 2 were dated to the early receptive phase, 13 to the receptive phase and 5 to the late receptive phase. Comparison of the transcriptomics data from all 20 samples provided 909 DEGs (p<0.05; nonsignificant after adjusted p value) in the adenomyosis group but only 4 enriched pathways (Bonferroni p value < 0.05). The analysis of 13 samples only dated to the receptive phase provided suggestive 382 DEGs (p<0.05; nonsignificant after adjusted p value) in the adenomyosis group, leading to 33 enriched pathways (Bonferroni p value < 0.05). These included pathways were already associated with endometrial biology, such as “Expression of interferon (IFN)-induced genes” and “Response to IFN-alpha”. Data integration revealed pathways indicating a unique effect of adenomyosis on endometrial molecular organization (e.g., “Expression of IFN-induced genes”) and its interference with endometrial receptivity establishment (e.g., “Extracellular matrix organization” and “Tumour necrosis factor production”).ConclusionsAccurate endometrial dating and RNA-seq analysis resulted in the identification of altered response to IFN signalling as the most promising candidate of impaired uterine receptivity in adenomyosis.

Association of Serum Prolactin Level with Preeclampsia

Introduction:Preeclampsia is a potentially fatal disorderof pregnant women; it remains an important cause of maternal mortality throughout the world. More than 50,000 maternal deaths occur worldwideeach year. Various researchers of different countries suggested an association of increase level of serumprolactin in preeclamptic patient. Estimation of serum prolactin level in pregnancy may be helpful in diagnosis of preeclampsia. Objective: Theobjective of the study is to observe the association of serum prolactin level with severity of preeclampsia. Materials and Methods: This cross-sectionalstudy was conducted from March 2020 to February 2021 in the Department of Laboratory Medicine, Department of Fetomaternal Medicine and Obstetrics and Gynecology, BSMMU and Dhaka Medical College Hospital, Dhaka. Fifty diagnosed patients of preeclampsia who fulfilled the inclusion and exclusioncriteria were selected as study population. At the same time 50 normal pregnant women were taken in another group. In both groups gestational age was calculated from last Menstrual date and confirmed by early ultrasound which wasdone at &lt;14 weeks. Then serum prolactin level was calculated. Results: The mean serum prolactin level was 226.56±81.23 µg/L in mild and 394.53±78.75 µg/L in severe preeclampsia. The difference was statistically significant (p=0.001) between two groups.In ROC analysis cut off value of serum prolactin level was 118 μg/L.The area under curve (AUC) of serum prolactin was 0.923 (95% CI; 0.869-0.978). Spearman’s rank correlation coefficient test showed significant positive correlation (r=0.719,p=0.001) between serum prolactin level with severity of preeclampsia. This finding of the study revealed that serum prolactin level was increased with preeclampsia and was positive correlation with severity. Conclusion: Because of significantsensitivity and specificity, serum prolactin level maybe used as an important tool to diagnose preeclampsia and its severity.

A predictive model for next cycle start date that accounts for adherence in menstrual self-tracking.

ObjectiveThe study sought to build predictive models of next menstrual cycle start date based on mobile health self-tracked cycle data. Because app users may skip tracking, disentangling physiological patterns of menstruation from tracking behaviors is necessary for the development of predictive models.Materials and MethodsWe use data from a popular menstrual tracker (186 000 menstruators with over 2 million tracked cycles) to learn a predictive model, which (1) accounts explicitly for self-tracking adherence; (2) updates predictions as a given cycle evolves, allowing for interpretable insight into how these predictions change over time; and (3) enables modeling of an individual's cycle length history while incorporating population-level information.ResultsCompared with 5 baselines (mean, median, convolutional neural network, recurrent neural network, and long short-term memory network), the model yields better predictions and consistently outperforms them as the cycle evolves. The model also provides predictions of skipped tracking probabilities.DiscussionMobile health apps such as menstrual trackers provide a rich source of self-tracked observations, but these data have questionable reliability, as they hinge on user adherence to the app. By taking a machine learning approach to modeling self-tracked cycle lengths, we can separate true cycle behavior from user adherence, allowing for more informed predictions and insights into the underlying observed data structure.ConclusionsDisentangling physiological patterns of menstruation from adherence allows for accurate and informative predictions of menstrual cycle start date and is necessary for mobile tracking apps. The proposed predictive model can support app users in being more aware of their self-tracking behavior and in better understanding their cycle dynamics.