Pregnancy Decisions Research Articles

Pola Komunikasi Keluarga dalam Penerimaan Diri Perempuan dengan Kehamilan Tidak Diinginkan

The facts show that Self-Acceptance of Unwanted Pregnancy occurs a lot, especially because sexual relations are increasingly considered normalized by today's teenagers. Among the factors that encourage unwanted pregnancies to occur is communication between the couple and their environment. Therefore, this research aims to determine the Communication Patterns in the Family and Environment in Self-Acceptance of Unwanted Pregnancy Decisions in Premarital Relationships. This research is qualitative research with a phenomological approach. As informants for this research were 3 people who were perpetrators of unwanted pregnancies, 1 person from the perpetrator's family, and 1 child and adolescent psychology counselor in the city of Bandung. The results of the research state that in making decisions in conditions of Unwanted Pregnancy, everything happens in conditions that can cause good or bad thinking. The communication that occurs starts from the woman's side to ask her partner for responsibility and then tells the woman's family. So in this action, there were several different responses that the female perpetrators received from their partners. So with the differences in responses that occur, in the end the decisions and conditions that occur are also different.

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...

A multicenter multinational study to evaluate different aspects of the relationship between MS and pregnancy

BackgroundTo investigate the pregnancy-related issues in females with multiple sclerosis (MS) from Turkiye, Egypt, Kuwait, and Iran. Methods1692 pregnancies of 701 females with MS were evaluated in this retrospective multicenter, international project. Demographics, clinical features, pregnancy outcomes, relapses, effects of exposure to disease-modifying drugs on pregnancy and fetus, and worries about pregnancy decisions were investigated. Results85.9 % of females were diagnosed with relapsing-remitting multiple sclerosis. The mean age was 39.0 ± 9.0 years (min 20, max 68). The mean EDSS score was 2.26 ± 1.8. The number of conceptions was inversely correlated with the level of education with significance (p<0.05). Among the concerns related to pregnancy, 31.7 % pertain to disability progression, 14.4 % are associated with relapses, and 7.3 % involve the cessation of treatment. Additionally, 82.3 % of females with MS experienced no relapses during both pregnancy and the postpartum period. Most of the relapses (22.9 %) occurred in the postpartum period. Higher EDSS scores were detected in patients who have higher numbers of pre-MS period pregnancies (p= 0.042; r:0.2591). A similar correlation was found between the total number of pregnancies and higher EDSS levels (p=0.003, r:0.2614). Considering the relationship between EDSS score and the number of pregnancies after MS diagnosis, no significance was found (p = 0.595). The age at first pregnancy did not affect the onset age of MS. Significant positive correlation was found between the age of onset and the total number of pregnancies and pre-MS pregnancies. As the number of pregnancies increased, the disease onset was at a later age (correlation = 0.4258). ConclusionPresence of pre-MS pregnancies increased the age of onset of MS and caused more disability. The reduction in the number of pregnancies following the diagnosis of MS was related with a consistent hesitancy among patients in this regard.

Fetal Brain MRI Abnormalities in Pyruvate Dehydrogenase Complex Deficiency.

Pyruvate dehydrogenase complex deficiency (PDCD) is a disorder of mitochondrial metabolism that is caused by pathogenic variants in multiple genes, including PDHA1. Typical neonatal brain imaging findings have been described, with a focus on malformative and encephaloclastic features. Fetal brain MRI in PDCD has not been comprehensively described. The aims of this study were (1) to further characterize the fetal brain MRI findings in PDCD using comprehensive fetal imaging and genetic testing and (2) to determine whether markers of diagnosis of PDCD could be identified on prenatal imaging. Fetuses with a diagnosis of PDCD related to a genetic etiology that had undergone fetal MRI were included. Fetuses were identified retrospectively from local databases of 4 fetal diagnostic clinics within tertiary pediatric health care centers. Electronic medical records were reviewed retrospectively: demographics, maternal and pregnancy history, fetal outcomes, and neonatal outcomes (if available) were reviewed and recorded. Fetal and neonatal imaging reports were reviewed; source fetal and neonatal brain MRI scans were reviewed by a single pediatric neuroradiologist (J.W.S.) for consistency. Genetic testing strategies and results including variant type, zygosity, inheritance pattern, and pathogenicity were recorded. Deidentified data were combined and reported descriptively. A total of 10 fetuses with a diagnosis of PDCD were included. 8 fetuses had corpus callosum dysgenesis, 6 had an abnormal gyration pattern, 10 had reduced brain volumes, and 9 had cystic lesions. 1 fetus had intraventricular hemorrhages. 1 fetus had a midbrain malformation with aqueductal stenosis and severe hydrocephalus. 6 fetuses imaged in the second trimester had cystic lesions involving the ganglionic eminences (GEs) while GE cysts were not present in the 4 fetuses imaged in the third trimester. Fetuses with PDCD have similar brain MRI findings to neonates described in the literature, although some of these findings are subtle early in pregnancy. Additional features, such as cystic lesions of the GEs, are noted in the second trimester in fetuses with PDCD. These may represent an early diagnostic marker of PDCD, although more data are needed to validate this association. Early diagnosis of PDCD using fetal MRI may inform genetic counseling, pregnancy decision making, and neonatal care planning.

The sufficiency of genetic diagnosis in managing patients with inborn errors of immunity during prenatal care and childbearing.

Individuals with inborn errors of immunity face challenges in fertility, pregnancy, and genetic disorder transmission. Prenatal genetic counseling is crucial, especially in tribal societies with consanguineous unions. Ten families with confirmed inborn errors of immunity were studied, revealing diverse pregnancy decisions: An architect with autosomal dominant STAT-1 gain of function underwent prenatal diagnosis despite initial plans for preimplantation genetic diagnosis. In a consanguineous family, two children died from leukocyte adhesion deficiency type 1 because the father refused prenatal diagnosis. First cousins opted against terminating the second pregnancy, resulting in two children affected by Bruton disease. Another consanguineous couple, with two children afflicted by ataxia-telangiectasia, chose oocyte donation for their third child, ensuring a healthy birth. Recurrent pregnancy loss was observed in a mother subsequently diagnosed with ZAP70 deficiency. A mother with Wiskott-Aldrich syndrome child opted for in vitro fertilization, leading to a healthy birth post-prenatal diagnosis. A misdiagnosis of anaplastic anemia occurred in a family with multiple instances of Wiskott-Aldrich syndrome. A leukocyte adhesion deficiency type 1 case led to parental dissolution due to the father's refusal to acknowledge the condition. In a non-consanguineous couple, the father's diagnosis of TACI deficiency influenced the mother's decision to discontinue pregnancy post-prenatal diagnosis. Genetic diagnosis alone cannot optimize prenatal care for immune dysregulation disorders. Various factors, including patient education, societal norms, ethics, and economics, impact pregnancy decisions. Clinical immunologists must integrate these elements into guidance strategies to enhance patient outcomes.

"Maybe if we weren't in the pandemic, I would have reconsidered": Experiences of abortion care-seeking during the COVID-19 pandemic in Maryland.

To understand the COVID-19 pandemic's impact on abortion care-seeking in Maryland, a state with Medicaid coverage for abortion, high service availability, and laws supporting abortion rights. We conducted semi-structured telephone interviews with 15 women who had an abortion between January 2021 and March 2022 at a hospital-based clinic in a mid-sized Maryland city. We purposively recruited participants with varied pandemic financial impacts. Interview questions prompted participants to reflect on how the pandemic affected their lives, pregnancy decisions, and experiences seeking abortion care. We analyzed our data for themes. All participants had some insurance coverage for their abortion; over half paid using Medicaid. Many participants experienced pandemic financial hardship, with several reporting job, food, and housing insecurity as circumstances influencing their decision to have an abortion. Most women who self-reported minimal financial hardship caused by the pandemic indicated they sought an abortion for reasons unrelated to COVID-19. In contrast, women with economic hardship viewed their pregnancies as unsupportable due to COVID-19 exacerbating financial instability, even when they desired to continue the pregnancy. All participants expressed that having an abortion was the best decision for their lives. Yet, when making decisions about their pregnancy, the most financially disadvantaged women weighed their desires against the pandemic's constraints on their reproductive self-determination. The pandemic changed abortion care-seeking circumstances even in a setting with minimal access barriers. Financial hardship influenced some women to have an abortion for a pregnancy that-while unplanned-they may have preferred to continue.

Trisomy 18: Prenatal Diagnosis and Outcome in a Tertiary Care Fetal Medicine Center in South India

AbstractEdwards' syndrome (trisomy 18) is the second most common aneuploidy known in humans, with an overall incidence of 1 in 6,000 live births. It occurs due to the presence of complete or part of an extra copy of chromosome 18 in all or a few body cells of the affected fetus, and it causes major anomalies in the organ systems. Despite this, an accurate diagnosis is often not made antenatally due to its very varied phenotype and the subtle nature of some of the common and consistent findings associated with this condition. This leads to lapses or delays in cytogenetic confirmation as well as delays in decision regarding termination of pregnancies with this mostly lethal fetal aneuploidy. We describe the prenatal profile of 45 confirmed cases of trisomy 18 at a tertiary fetal medicine unit. The presence of a combination of ultrasound (US) findings described in these cases will help alert sonologists and clinicians to suspect this condition and offer a confirmative cytogenetic test without delay for prenatal diagnosis. This study describes the prenatal diagnostic profile of cytogenetically confirmed trisomy 18 cases in a tertiary fetal medicine center in India. A retrospective analysis of records of 45 prenatally diagnosed trisomy 18 cases at a single tertiary fetal medicine center over a period of 11 years was done. Data were collected to describe maternal demography, indication for evaluation, major and minor US findings (trimester-wise), type of invasive test, and gestational age at diagnosis. Outcomes in terms of pregnancy termination, miscarriage, stillbirth, or livebirth were documented. Presenting at a mean maternal age and gestation age of 31.7 years and 22 + 5 weeks, respectively, 41/45 (91%) fetuses showed major and 40/45 (89%) showed minor US findings with an overall US sensitivity of 100%. The most common major US finding was a cardiac anomaly in 26 (57.8%) patients, while clenched fist with pointing index finger, observed in 17 (37.8%) cases, was the most common minor US finding. Fetal growth restriction (FGR) was noted in 20 (44.4%) patients. After cytogenetic confirmation, 37.8% underwent termination, 17.8% had a fetal demise, and only 11.1% had live birth with the longest survival noted at 5.5 months postnatally. Gender was documented in 13 fetuses with a male-to-female ratio of 0.6. A meticulously performed US examination can detect a combination of anomalies that could alert the sonologist to the possibility of trisomy 18. While the US profile could vary among fetuses, an understanding of the spectrum of the anomalies commonly seen in these fetuses would enable caregivers to reach an early accurate diagnosis, and offer appropriate genetic counseling and pregnancy decisions in these cases.

Noninvasive twin genotyping for recessive monogenic disorders by relative haplotype dosage.

To establish a haplotype-based noninvasive prenatal testing (NIPT) workflow for single-gene recessive disorders that adapt to dizygotic (DZ) twin pregnancies. Twin pregnancies at risk of Duchenne muscular dystrophy, Becker muscular dystrophy, hemophilia B, spinal muscular atrophy, phenylketonuria, and nonsyndromic hearing loss were recruited. For subsequent analysis, capture sequencing targeting highly heterozygotic single nucleotide polymorphism sites was conducted. Paternal-specific alleles were used to calculate the total and individual fetal fractions and determine zygosity. A two-step Bayes Factor model was applied to clarify the complex genomic landscape in the maternal plasma: the first step involved determining whether the twins inherited the same haplotype, and the second step involved estimating their individual genotypes. NIPT results were subsequently confirmed by invasive diagnosis. Nine twin pregnancies were recruited, including five DZ and four monozygotic (MZ) twins. The earliest gestational age was 8+0 weeks, and the minimum fetal fraction was 4.6%. Three twin pregnancies were reported with one affected fetus, while the remaining six were reported without affected fetuses. Two dichorionic diamniotic twin pregnancies were confirmed to be MZ twins. The NIPT results were 100% consistent with those of invasive procedures or diagnostic genetic testing after birth. This study is the first to perform NIPT for single-gene disorders in twin pregnancies and preliminarily confirm its clinical feasibility. Acknowledging the twins' genotypes in the first trimester is valuable as it empowers obstetric care providers and parents to have adequate time for pregnancy management and decision-making.

Decision-making for congenital anomalies diagnosed during pregnancy: a narrative review.

The purpose of this narrative review was to assess the limited literature on fetal anomalies diagnosed in the second trimester of pregnancy and parental decision-making and identify sources of information deemed as facilitators and barriers to medical decisions. This was a literature review of source material and information about fetal anomalies diagnosed in the second trimester of pregnancy, decision-making, decision tools or aids, and sources of information for anomalies. The search string used explored related peer-reviewed publications and systematic reviews between 2007 and 2024. We also reviewed references from publications meeting inclusion criteria. The search was conducted between June 2022 and February 2024. Exclusion criteria included conference abstracts, non-peer reviewed literature, and articles not available in English language. A total of 77 publications were identified by searching multiple databases using a predefined search string. The search encompassed full text articles from 2007 to 2024 and 11 full-text publications were ultimately included in the review. A list of 45 co-occurring keywords was generated from the included texts, with each keyword having a minimum of two co-occurrences. Key themes identified included (1) the role of the clinician and need for development of professional knowledge and empathy surrounding discussion of fetal anomalies with patients; (2) information gathering, with individuals reporting use of multiple strategies to obtain information; while the majority found information satisfying, they preferred more details on diagnosis, long-term outcomes of the fetus/child and management of the pregnancy or termination process; and (3) decision-making, the path and process of how individuals made decisions about the pregnancy including quality of life, future fertility, and seeking other people's experiences. Many factors contribute to an individual's decision-making after a diagnosis of a fetal anomalies diagnosed in the second trimester of pregnancy, ranging from personal beliefs and goals to shared experiences of others and access to care. Understanding how sources of information may be deemed both as facilitators and barriers to different individuals during the decision-making process is important for healthcare providers in order to understand how to most effectively support patients. There is a dearth of information on training healthcare professionals to provide support to patients facing these decisions.

Extending the new era of genomic testing into pregnancy management: A proposed model for Australian prenatal services.

Trio exome sequencing can be used to investigate congenital abnormalities identified on pregnancy ultrasound, but its use in an Australian context has not been assessed. Assess clinical outcomes and changes in management after expedited genomic testing in the prenatal period to guide the development of a model for widespread implementation. Forty-three prospective referrals for whole exome sequencing, including 40 trios (parents and pregnancy), two singletons and one duo were assessed in a tertiary hospital setting with access to a state-wide pathology laboratory. Diagnostic yield, turn-around time (TAT), gestational age at reporting, pregnancy outcome, change in management and future pregnancy status were assessed for each family. A clinically significant genomic diagnosis was made in 15/43 pregnancies (35%), with an average TAT of 12 days. Gestational age at time of report ranged from 16 + 5 to 31 + 6 weeks (median 21 + 3 weeks). Molecular diagnoses included neuromuscular and skeletal disorders, RASopathies and a range of other rare Mendelian disorders. The majority of families actively used the results in pregnancy decision making as well as in management of future pregnancies. Rapid second trimester prenatal genomic testing can be successfully delivered to investigate structural abnormalities in pregnancy, providing crucial guidance for current and future pregnancy management. The time-sensitive nature of this testing requires close laboratory and clinical collaboration to ensure appropriate referral and result communication. We found the establishment of a prenatal coordinator role and dedicated reporting team to be important facilitators. We propose this as a model for genomic testing in other prenatal services.

“At the End of the Day it’s Their choice”: An Exploratory Qualitative Study of Pregnancy Options Counseling

ABSTRACT This study’s purpose was to explore the current models and approaches of pregnancy options counseling across three types of agency settings in a Northeastern state. Additionally, this study aimed to determine if individuals who receive pregnancy options counseling obtained medically factual, non-directive, and non-biased information needed to make informed decisions related to their pregnancy decisions. Using qualitative research methodology, semi-structured interviews were conducted with 10 participants across three different agency settings in one state in the Northeastern United States. Results indicated agencies shared a definition of pregnancy options counseling. Outcomes also suggest agency type impacted how pregnancy options counseling was delivered, as variations were found in education provided to patients. Lastly, the interviews imply no standardized model or training for pregnancy options counselors is currently being used.

Aborsi: Pro Dan Kontra Pada Mahasiswa Fakultas Hukum Universitas Tjut Nyak Dhien Medan

Abortion is a controversial topic in the legal context of many countries. It involves complex ethical and moral debates, as well as legal considerations involving women's reproductive rights and the life status of the fetus. The purpose of this service is to analyze the pro and con arguments in the legal debate about abortion, by considering the legal, ethical and social factors related to the law faculty student environment at Tjut Nyak Dhien University, Medan, North Sumatra. This service uses a descriptive-analytical approach, which involves text analysis. This approach allows identification and analysis of the arguments used by both those for and against the legalization of abortion. In the pro-abortion context, the main argument put forward is the protection of women's reproductive rights, including the right to control their own bodies and the right to pregnancy decisions. On the other hand, those who oppose the legalization of abortion put forward moral and ethical arguments, assuming that fetuses have the same status in life as adult humans. The aim of this service is to provide lessons on the pros and cons of abortion and understanding to students, especially law faculty students at Tjut Nyak Dhien University, in preventing promiscuity between fellow students and the importance of understanding sexual life in everyday interactions.

Prenatal diagnosis of polycystic renal diseases: diagnostic yield, novel disease-causing variants, and genotype–phenotype correlations

BackgroundPolycystic renal disease (PRD) is a frequent congenital anomaly of the kidneys, but research utilizing chromosomal microarray analysis (CMA) and exome sequencing (ES) in PRD fetuses remains sparse, with the majority of studies focusing on the multisystem or genitourinary system. ObjectiveThis study aims to describe the detection rate of detectable genetic causes of fetal PRD at different levels, and novel disease-causing variants and explores genotype-phenotype correlations. Study DesignThis study included 220 fetal PRD from January 2014 to June 2022. Cases were divided into three groups: isolated multicystic dysplastic kidneys (MCDK), non-isolated MCDK, and suspected polycystic kidney disease group. We reviewed data on maternal demographics, ultrasonographic results, CMA/ES results, and pregnancy outcomes. ResultsIn our cohort, CMA identified 19 (8.6%) fetuses carrying chromosomal abnormalities, and the most common CNV was 17q12 microdeletion (7/220, 3.2%). Furthermore, 94 families chose to perform trio-ES testing, and 21 fetuses (22.3%) were found to harbor P/LP variants. For PRD, there was a significant difference in the live birth rate (91/130 vs. 46/80 vs. 1/10, p < 0.001). Among 138 live birth cases, 106 (78.5%) underwent postnatal ultrasound review, of which 95 (89.6%) had a consistent prenatal-postnatal ultrasound diagnosis. ConclusionsTaken together, either for isolated or non-isolated PRD, our data show high detection efficiency for both testing tools. Novel pathogenic variants have expanded the disease spectrum of PRD-associated genes while enriching the genotype-phenotype correlation. Therefore, we consider it feasible to perform CMA + ES testing in fetal PRD. Moreover, prenatal-postnatal ultrasound concordance was greater, while the live birth rate was higher and prognosis was better when known genetic disorders were excluded, showing that genetic testing results significantly influenced pregnancy decisions.

COVID-19 vaccination in pregnancy: ambiguity in decision-making.

Throughout the COVID-19 pandemic, pregnant women/people were identified as an at-risk group of severe COVID-19 disease. Consequently, vaccine uptake among this group became a public health priority. However, the relationship between pregnancy and vaccination decision-making is complex, and the heightened uncertainty and anxiety produced through the pandemic further exacerbated this immunization decision. This study explores COVID-19 vaccination decision-making during pregnancy in Aotearoa New Zealand by using an online story completion survey tool. Ninety-five responses were received and analysed using thematic analysis where ambiguity was a core facet within and across stories. Three ambiguities were identified, including who makes the decision (agential), what the risks are (risk) and how immunity to this threat can be best achieved (immunity). We discuss the implications of this ambiguity and how the strong desire to protect the baby persisted across accounts. The recognition of the rather persistent ambiguity in vaccination decision-making helps conceptualize influencing factors taken into account in a more nuanced manner for further research, public health campaigns and health professionals. Future public health campaigns can consider redistributing responsibility for vaccination decision-making in pregnancy, traverse an either/or perspective of 'natural' and 'artificial' immunity-boosting and consider how risk is perceived through anecdotes and viral immediacy.

Married women’s decision to delay childbearing, and loneliness, severe psychological distress, and suicidal ideation under crisis: online survey data analysis from 2020 to 2021

BackgroundThe COVID-19 pandemic has affected every aspect of our lives, including the decision to become pregnant. Existing literature suggests that infertility and the decision to delay childbearing at a younger age are associated with a lower level of well-being and regrets when women start to desire a baby. Thus, the decision to delay childbearing due to the pandemic could negatively affect the well-being of women. This study focuses on how pregnancy decisions affect the well-being of women during the COVID-19 pandemic.MethodsFrom the Japan COVID-19 and Society Internet Survey, a nationally representative web-based survey, 768 observations of married women aged 18 to 50 years who had the intention of getting pregnant during the pre-pandemic period (conducted in 2020 and 2021) were used. Loneliness, severe psychological distress, and suicidal ideation were used as well-being indicators. For pooled data, a generalised estimated equation (GEE) model was used to estimate how pregnancy decision related to well-being indicators. For a sub-analysis, the sample was divided by the survey year and a Poisson regression model was used.ResultsThe GEE analysis showed an association between delaying childbearing and severe psychological distress, with the prevalence ratio (PR) being 2.06 [95% CI (1.40–3.03)]. Furthermore, loneliness and suicidal ideation that occurred after the beginning of the pandemic were significantly related to the decision to delay childbearing—1.55 [95% CI (1.03,2.34)] and 2.55 [95% CI (1.45–4.51)], respectively. Moreover, these PRs were larger for 2021 compared to 2020.ConclusionDuring the COVID-19 pandemic, approximately one-fifth of married women who had childbearing intentions before the pandemic decided to postpone pregnancy. They exhibited a deteriorated mental health state. Furthermore, the negative associations were larger in 2021 compared to 2020. Loneliness has negative consequences for both mental and physical health, as well as elevated severe psychological distress and suicidal ideation among those who decided to postpone pregnancy. Therefore, the current results should not be overlooked by society.

Pregnancy Decision Making for Women With Mental Health Conditions: The Roles of Distress, Lay Beliefs, and Self-Efficacy

Millions of people face unintended pregnancy each year, including thousands who are living with a mental health disorder, and must decide to terminate the pregnancy, become a parent, or place a child for adoption. While people of various genders, such as nonbinary people and transgender men, also face pregnancy, the current study highlighted the perspectives of women in particular, seeking to understand what unique circumstances may predict their pregnancy decision making in the context of mental health concerns. A sample of 327 women of reproductive age who self-identified as having a mental health condition were asked to consider the hypothetical situation of an unintended pregnancy and completed measures of psychological distress, parenting self-efficacy, and likelihood of choosing abortion. Qualitative data was transformed into two composite lay belief variables (perceived harm from pregnancy and mental health resilience) for inclusion in the model. Indirect effects revealed that psychological distress was related to higher likelihood of choosing an abortion through greater perceived harm from pregnancy and to lower likelihood of choosing an abortion through greater mental health resilience and higher parenting self-efficacy. The findings provide a nuanced view of pregnancy decision making from the perspective of women with mental health concerns.

PENGEMBANGAN PROGRAM EDUKASI KEBIDANAN UNTUK REMAJA TENTANG KESEHATAN REPRODUKSI

Comprehensive sexual education for adolescents is important in efforts to improve their reproductive health. This article presents community service conducted at MA Plus Walisongo, North Lampung, with the aim of developing a midwifery education program that focuses on adolescent reproductive health. Through outreach, counseling, and training, this program aims to increase youth's knowledge and awareness about reproductive anatomy, menstruation, contraception, sexually transmitted infections, pregnancy, and wise decisions in sexual life. The method used involved a comprehensive sex education module, group discussions, and question and answer sessions. The results of this dedication show an increase in youth's knowledge and understanding of reproductive health, as well as increased awareness of safe and responsible reproductive health practices. This program has also succeeded in reducing the risk of teenage pregnancy, unsafe abortion, and transmission of sexually transmitted diseases. In conclusion, this community service makes a positive contribution in improving adolescent reproductive health at MA Plus Walisongo, North Lampung, and emphasizes the importance of accurate, scientific and dignified sexual education as a solution to addressing adolescent reproductive health problems.

Reproductive Autonomy of Women in India: A Socio-legal Analysis

Indian reality pertaining to pregnancy and reproductive justice is different as the traditional values, myths and patriarchal role assumed by the society paves way for undermining the decision-making capacity of the women within a family setup. They are considered subordinate to their male counterparts and are having less power in relationships due to many factors like economic, political, and socio-cultural status and at times, not in a position to protect themselves from gender-based violence. They are considered incapable to decide on their own even in a matter pertaining to their own reproductive choices. The concept of autonomy in healthcare in general has a full-fledged acceptance by the judiciary as it affects the bodily integrity of a person. Likewise, the same idea must be reiterated in the pregnancy decision making, as women are the sole person who undergoes the physical and mental transformation during the process. Women should therefore, have the right to choose when and under what circumstances they should bear a child. So, the interest of the woman is a determinant and she should be mentally prepared to conceive, continue the same and give birth to a child. There are various social and ethical factors that pose a hindrance to pregnancy decision making of women in India. Family and social pressure forms the key factor that knocks upon the decision-making capacity of women.

Analysis of characteristic features in ultrasound diagnosis of fetal limb body wall complex during 11-13+6 weeks.

Limb body wall complex (LBWC) is a fatal malformation characterized by major defects in the fetal abdominal or thoracic wall, visceral herniation, significant scoliosis or spina bifida, limb deformities, craniofacial deformities, and umbilical cord abnormalities (short or absent umbilical cord). Early diagnosis of this condition is of great clinical significance for clinical intervention and pregnancy decision-making. With the rapid development of fetal ultrasound medicine, early pregnancy (11-13+6 wk) standardized prenatal ultrasound examinations have been widely promoted and applied. To explore the value of prenatal ultrasound in the diagnosis of fetal LBWC syndrome during early pregnancy. The ultrasonographic data and follow-up results of 18 cases of fetal LBWC diagnosed by prenatal ultrasound during early pregnancy (11-13+6 wk) were retrospectively analyzed, and their ultrasonographic characteristics were analyzed. Among the 18 fetuses with limb wall abnormalities, there were spinal dysplasia (18/18, 100%), varying degrees of thoracoschisis and gastroschisis (18/18, 100%), limb dysplasia in 6 cases (6/18, 33%), craniocerebral malformations in 4 cases (4/18, 22%), thickening of the transparent layer of the neck in 5 cases (5/18, 28%), and umbilical cord abnormalities in 18 cases (18/18, 100%), single umbilical artery in 5 cases. Prenatal ultrasound in early pregnancy can detect LBWC as early as possible, and correct prenatal evaluation provides important guidance value for pregnancy decision-making and early intervention.

"I mean, I didn't really have a choice of anything:" How incarceration influences abortion decision-making and precludes access in the United States.

To understand how the punitive, rights-limiting, and racially stratified environment of incarceration in the United States (US) shapes the abortion desires, access, and pregnancy experiences of pregnant women, transgender men, and gender non-binary individuals. From May 2018-November 2020, we conducted semi-structured, qualitative interviews with pregnant women in prisons and jails in an abortion supportive and an abortion restrictive state. Interviews explored whether participants considered abortion for this pregnancy; attempted to obtain an abortion in custody; whether and how incarceration affected their thoughts about pregnancy, birth, parenting, and abortion; and options counseling and prenatal care experiences, or lack thereof, in custody. The conditions of incarceration deeply shaped our 39 participants' abortion and pregnancy decisions, with some experiencing pregnancy continuation as punishment. Four themes emerged: (1) medical providers' overt obstruction of desired abortions; (2) participants assuming that incarcerated women had no right to abortion; (3) carceral bureaucracy constraining abortion access; and (4) carceral conditions made women wish they had aborted. Themes were similar in supportive and restrictive states. Incarceration shaped participants' thoughts about pregnancy and their abilities to access abortion, consider whether abortion was an attainable option, and make pregnancy-related decisions. These subtle carceral control aspects presented more frequent barriers to abortion than overt logistical ones. The carceral environment played a more significant role than the state's overall abortion climate in shaping abortion experiences. Incarceration constrains and devalues reproductive wellbeing in punitive ways that are a microcosm of broader forces of reproductive control in US society.