Desire For Pregnancy Research Articles

Uterine Factor Infertility, a Systematic Review.

Uterine factor infertility (UFI) is defined as a condition resulting from either a complete lack of a uterus or a non-functioning uterus due to many causes. The exact prevalence of UFI is currently unknown, while treatments to achieve pregnancy are very limited. To evaluate the prevalence of this condition within its different causes, we carried out a worldwide systematic review on UFI. We performed research on the prevalence of UFI and its various causes throughout the world, according to the PRISMA criteria. A total of 188 studies were included in qualitative synthesis. UFI accounted for 2.1 to 16.7% of the causes of female infertility. We tried to evaluate the proportion of the different causes of UFI: uterine agenesia, hysterectomies, uterine malformations, uterine irradiation, adenomyosis, synechiae and Asherman syndrome, uterine myomas and uterine polyps. However, the data available in countries and studies were highly heterogenous. This present systematic review underlines the lack of a consensual definition of UFI. A national register of patients with UFI based on a consensual definition of Absolute Uterine Factor Infertility and Non-Absolute Uterine Factor Infertility would be helpful for women, whose desire for pregnancy has reached a dead end.

Tales of Hysteroscopic Evaluation of PPIUD with Missing String in a Tertiary Care Government Hospital

Background: The safety and efficacy of the postpartum intrauterine device (PPIUD) has been documented worldwide with increasing institutional deliveries. It was relative new concept therefore a close observation should be kept on potential complication arising from it. Removal of an IUD can be easily done when the string is visible during speculum examination but the task become challenging when the string no longer visible. Objectives: To evaluate the role of hysteroscopy for removal of PPIUD with missing string. Methods: This descriptive study was conducted in tertiary government hospital over six months from July 2020 to December 2020. PPIUD clients with lost strings were included in this study. Before the procedure complete history about reason for retrieval, duration of insertion, complication related to IUD was recorded. Furthermore, speculum examination & USG was performed then decided for hysteroscopic evaluation and removal. Per-operative location of PPIUD in uterine cavity and any complication & associated pathology encountered were recorded. The size and model of hysteroscope also noted. Results: Thirty one patients were included among them more than two third of PPIUD given following caesarean section (LSCS). Reason for PPIUD removal of most clients due to menstrual irregularities 29% displaced & fragmented CuT on USG 25.8% and desires for pregnancy. Nineteen respondents removed within three years due to complication like irregular menses ,displaced IUD on ultrasonography.. Most of the PPIUD 64.5% in normal location rest of them deviated from normal among those three PPIUD were inverted & tip of the five PPIUD near the external os. Arms of cu-T were embeded in five clients, some difficulties faces to remove those. Polyp were found in two clients with menstrual irregularities. Postoperative outcome of all patients were uneventful. Conclusion: Hysteroscopy is a good modality for the removal of PPIUD with lost strings. J Shaheed Suhrawardy Med Coll 2021; 13(1): 63-67

Survival and pregnancy outcomes of fertility-sparing surgery for ovarian malignant sex cord-stromal tumors: A multicenter retrospective study (176)

<b>Objectives:</b> To assess the survival and pregnancy outcomes of fertility-sparing surgery (FSS) in stage I ovarian malignant sex cord-stromal tumors (MSCSTs). <b>Methods:</b> Inverse Probability of Treatment Weighting (IPTW) was performed between the FSS and radical surgery (RS) groups. The Chi-square test and Kaplan-Meier method were used to compare the categorical variables and disease-free survival (DFS). The binary logistic regression analysis and Cox proportional hazards regression analysis were used to identify risk factors related to pregnancy and DFS. <b>Results:</b> A total of 107 patients were included, of whom 54 (50.5%) women underwent FSS, and 53 (49.5%) women underwent RS. After IPTW, 208 patients were obtained, and all of the covariates were well balanced. After a median follow-up time of 50 months (range: 7-156 months), there was no significant difference of DFS between the two groups in both unweighted cohort (p=0.969) or weighted cohort (p=0.792). In the weighted cohort, stage IC (p=0.014), tumor diameter >8 cm (p=0.003), without staging surgery (p=0.003), and no adjuvant chemotherapy (P <0.001) were the four high-risk factors associated with a shorter DFS. Among 14 patients who had pregnancy desire, 11 (78.6%) women conceived successfully, and the live birth rate was 76.9%. In univariate analysis, only adjuvant chemotherapy (p=0.009) was associated with pregnancy. <b>Conclusions:</b> FSS is safe in stage IA and IC MSCSTs with a satisfactory reproductive outcome on the premise of complete staging surgery.

Fibroids and Fertility: A Comparison of Myomectomy and Uterine Artery Embolization on Fertility and Reproductive Outcomes.

Leiomyomata, or fibroids, are a common gynecological problem affecting many women of reproductive age. Historically, myomectomy is offered to women with symptomatic fibroids who desire to preserve fertility. More recently, uterine artery embolization (UAE) has been explored as another fertility-sparing option. This review aims to provide an in-depth summary of the effects on fertility and reproductive outcomes following myomectomy and UAE for the treatment of symptomatic fibroids. Articles were obtained from PubMed using search terms myomectomy, uterine artery embolization, and fertility, as well as American Society of Reproductive Medicine practice committee reports. References from identified sources were searched to allow for thorough review. While myomectomy and UAE are both fertility-sparing options for women with fibroids, reproductive outcomes following myomectomy are superior to UAE with higher rates of clinical pregnancy and live births and lower rates of spontaneous abortion, abnormal placentation, preterm labor, and malpresentation. Myomectomy should be offered to women with symptomatic submucosal or cavity-distorting fibroids who have a strong desire for a future pregnancy. For women who are not appropriate surgical candidates, UAE can be offered, although detrimental effects on future fertility should be disclosed. A thorough understanding of the efficacy of both myomectomy and UAE, as well as their impact on future fertility, allows for improved counseling when deciding the optimal intervention for women with fibroids who desire future fertility.

Prevalence of preconception risk factors for adverse pregnancy outcome among women from tribal and non-tribal blocks in Nashik district, India: a cross-sectional study

BackgroundAlthough critical, the preconception phase in women’s lives is comparatively ignored. The presence of some risk factors during this phase adversely affects the wellbeing of the woman and the pregnancy outcome. The study objectives were to measure the prevalence of various known risk factors for adverse pregnancy outcome in the preconception period of women and their comparison between blocks.MethodsThis was a community-based cross-sectional study in two tribal and two non-tribal blocks each in Nasik district, Maharashtra, India. The study included married women desiring to conceive within 1 year. Trained Accredited Social Health Activists (field level health worker) collected information from women using a validated interview schedule through house-to-house visits and obtained women’s anthropometric measurements in a standard manner. The study assessed the presence of 12 documented risk factors.ResultsThe study enlisted 7875 women desiring pregnancy soon. The mean age of women was 23.19 (± 3.71) years, and 16% of them were adolescents. Women’s illiteracy was higher in tribal areas than non-tribal (p < 0.001). About two-thirds of women have at least one risk factor, and 40.0% have a single risk factor. The most common risk factor observed was no formal education (44.35%). The prevalence of selected risk factors was significantly higher among women from tribal areas. The mean BMI of women was 19.73 (± 3.51), and a higher proportion (40.5%) of women from tribal areas had BMI < 18.5. Despite being of high parity status (≥ 4), about 7.7% of women from the tribal area and 3% from non-tribal desired pregnancy. Tobacco and alcohol consumption was higher among tribal women. The majority of women consumed meals with family members or husbands. Protein and calorie intake of about 1.4% of women was less than 50% of the recommended daily allowance; however, most of them perceived to have abundant food.ConclusionsHealth risks, namely younger age, illiteracy, high parity, consumption of tobacco, low protein, and calorie intake, were quite prevalent, and the risks were significantly more among women from tribal areas. “Continuum of care” must comprise preconception care inclusive of Behavioral Change Communication, particularly for easily modifiable risk factors and specially for tribal women.

Impact of Infertility on Female Sexual Function

ABSTRACT Introduction Infertility, known to have a negative impact on couples, may cause significant distress in a relationship and can potentially lead to/or exacerbate sexual dysfunction. The physical, psychological, and often financial strains of infertility treatments, with potential failure to achieve the desired pregnancy can all contribute to this stress. Additionally, sex may be seen as becoming a medical or therapeutic act, with loss of spontaneity and pleasure. Hence, infertility and sexual dysfunction can be interlinked. Despite this association, intervention with effective templates of care appears to be limited in addressing this issue. Objective A systematic literature review was done, focusing on female sexual dysfunction due to infertility and on what are available templates of care. Methods A Google Scholar and pub med search were done with keywords “sexual dysfunction,” “infertility,” and “couple.” Results Although there are many studies depicting the correlation between the infertility and sexual dysfunction, templates of management appear to be lacking. Data suggest that infertility is a major contributor to female sexual dysfunction. That is, not only the infertility diagnosis but also the duration of infertility contributes to the sexual dysfunction. Studies have shown the lubrication and orgasm issues are the woman's main concerns. Also, sexual dysfunction is more profoundly impaired in patients with secondary infertility, lower educational level and higher partner education. Conclusions These data suggest that couples undergoing infertility treatment should be evaluated for sexual dysfunction and be offered management during the infertility process. Sexual therapy does not appear to be routinely offered, despite the fact that these patients are at an increased risk of either developing a sexual dysfunction or a sexual dysfunction being exacerbated as a result of infertility as part of the infertility treatment process. Disclosure No

Patient attitudes and preferences for the management of pregnancy of unknown location

ObjectiveTo understand patient attitudes and preferences when faced with the uncertainty of pregnancy of unknown location (PUL).DesignQualitative, interview-based study.SettingUniversity Hosptial.Patient(s)Patients aged >18 years sampled from the emergency department and a subspecialty fertility practice of a university hospital system.Intervention(s)Six to 8 weeks after resolution of a PUL, with an ultimate clinical outcome of either an intrauterine pregnancy, spontaneous abortion, or ectopic pregnancy. Participants underwent either surgical, medical, or expectant management.Main Outcome Measure(s)Thematic analysis of the virtual, semistructured interviews (45–60 minutes in length) conducted with participants to identify commonly expressed priorities was performed.Result(s)Interviews were completed from October 2020 to March 2021 until thematic saturation was achieved (n = 15). Resolution diagnoses included intrauterine pregnancy (26.7%, n = 4), ectopic pregnancy (40.0%, (n = 6), and spontaneous abortion (33.3%, n = 5). Moreover, 66.7% (n = 10) of the patients presented to the emergency department, whereas 33.3% (n = 5) presented to a subspecialty fertility clinic. All had desired pregnancies. Thematic analyses revealed 4 related priorities around PUL management: health of pregnancy; health of self; future fertility; and diagnostic prediction and diagnostic certainty. The relative balance of these priorities was dynamic and evolved throughout the course of management with different outcomes. A second set of themes related to logistical preferences included mental healthsupport, clarity of treatment and next steps, and continuity of care. Interrater reliability was validated with a pooled κ of >0.8. Limitations include that all participants had desired pregnancies, and the experiences of those who experienced different pregnancy outcomes may have been affected by recall bias.Conclusion(s)These data demonstrate novel themes around related priorities in patients with desired pregnancies diagnosed with a PUL previously underappreciated by clinicians. The balance of these priorities evolved throughout management with increasing information and clarity. Continually reevaluating relevant patient priorities and preferences is essential to the comprehensive management of PUL.

Psychological Stress Perceived by Pregnant Women in the Last Trimester of Pregnancy.

Pregnancy is characterized by changes in neuroendocrine, cardiovascular, and immune function. For this reason, pregnancy itself is perceived as a psychological “stress test”. Research to date has focused on stress exposure. The aim of the study was to evaluate the influence of associated factors on the level of stress experienced by pregnant patients. We conducted a prospective study that included 215 pregnant women in the third trimester of pregnancy, hospitalized in the Obstetrics and Gynecology Clinic II in Târgu-Mureș, between December 2019 and December 2021, who were evaluated by the ABS II scale. All patients included in the study filled in a questionnaire that included 76 questions/items, in which all the data necessary for the study were recorded. The results obtained from the study showed that pregnant women in urban areas (53.49%) are more vulnerable than those in rural areas (46.51%), being influenced by social and professional stressors, social determinants playing a critical role in pregnancy and in the newborn. Patients who have had an imminent abortion in their current pregnancy have a significantly higher score of irrationality than those with normal pregnancy, which shows that their emotional state can negatively influence the phenomenon of irrationality. There is a statistically significant association between pregnancy type I (normal pregnancy or imminent pregnancy) and irrationality class (p = 0.0001; RR: 2.150, CI (95%): 1.154–4.007). In the case of women with desired pregnancies, the risk of developing irrationality class IV–V is 4.739 times higher, with the association being statistically significant (p < 0.0001; RR 4.739; CI (95%): 2.144–10.476). The analysis of the obtained results demonstrates the importance of contributing factors and identifies the possibility of stress disorders, occurring in the last trimester of pregnancy, disorders that can have direct effects on maternal and fetal health. We consider it extremely important to carry out evaluations throughout the pregnancy. At the same time, it is necessary to introduce a screening program to provide psychological counseling in the prenatal care of expectant mothers.

Comparison of Pregnancy Preferences Preceding vs Year 1 of the COVID-19 Pandemic

Understanding how the COVID-19 pandemic affected people's desire to avoid pregnancy is essential for interpreting the pandemic's associations with access to reproductive health care and reproductive autonomy. Early research is largely cross-sectional and relies on people's own evaluations of how their desires changed. To investigate longitudinal changes in pregnancy desires during the year before and the first year of the COVID-19 pandemic. In this cohort study, participants reported their pregnancy preferences at baseline and quarterly for up to 18 months between March 2019 and March 2021. An interrupted time series analysis with mixed-effects segmented linear regression was used to examine population-averaged time trends. People were recruited from 7 primary and reproductive health care facilities in Arizona, New Mexico, and Texas. Participants were sexually active, pregnancy-capable people aged 15 to 34 years who were not pregnant or sterilized. Data analysis was performed from September 2021 to January 2022. Continuous time, with knots at the onset of the first (July 1, 2020, summer surge) and second (November 1, 2020, fall surge) COVID-19 cases surges in the Southwest. Preferences around potential pregnancy in the next 3 months, measured using the validated Desire to Avoid Pregnancy (DAP) scale (range, 0-4, with 4 indicating a higher desire to avoid pregnancy). The 627 participants in the analytical sample had a mean (SD) age of 24.9 (4.9) years; 320 (51.0%) identified as Latinx and 180 (28.7%) as White. Over the year before the first case surge in the US Southwest in summer 2020, population-averaged DAP scores decreased steadily over time (-0.06 point per quarter; 95% CI, -0.07 to -0.04 point per quarter; P < .001). During the summer 2020 surge, DAP scores stopped declining (0.05 point per quarter; 95% CI, -0.03 to 0.13 point per quarter; change in slope, P < .001). During the fall 2020 surge, however, DAP scores declined again at -0.11 point per quarter (95% CI, -0.26 to 0.04 point per quarter; change in slope, P = .10). Participants aged 15 to 24 years and those who were nulliparous and primiparous experienced greater declines in DAP score before the summer surge, and greater reversals of decline between summer and fall 2020, than did those who were aged 25 to 34 years and multiparous. These findings suggest that the COVID-19 pandemic onset was associated with the stalling of a prior trend toward greater desire for pregnancy over time, particularly for people earlier in their reproductive lives.

Spontaneous Fertility after Myomectomy for Pregnancy Desire in Reference University Maternities of Benin from 2016 to 2020: Contributing Factors and Pregnancies Outcome

Introduction: Spontaneous fertility after myomectomy for pregnancy desire remains a concern. Objective: Appreciate spontaneous fertility after a myomectomy for pregnancy desire. Methods: This was a descriptive and analytical study to collect retrospective data on cases of myomectomy pregnancy desire realised between 2016 and 2020 in the university maternity wards of Cotonou. All myomectomy records for desire for pregnancy were identified. The post myomectomie fertility related data and the clinical characteristics influencing the occurrence of pregnancy and its outcome after myomectomy were analyzed with regard to the rules of professional conduct and ethics. Results: On 188 myomectomies performed for desire of pregnancy, 102 had been analyzed. The mean age was 34 years ± 5.7. Nulligest and nulliparous were the most numerous in the respective proportions of 39.2% and 71.6%, and 16.7% (n=17) had a history of polymyomectomy. Fertility after myomectomy was observed in 16.7% (n=17) of cases. The mean time to return to fertility (pregnancy) after myomectomy was 27 months. Alcohol addiction (p=0.00), gestality (p=0.01), myoma size (p=0.00) and adenomyosis (p=0.00) had an negative impact on the time to onset pregnancy after myomectomy. Of 17 pregnancies recorded after myomectomy, 11 (64.7%) progressed normally with term delivery and 5 spontaneous abortions (29.4%) were recorded. One (1) pregnancy was ongoing at the time of the survey. Planned caesarean section (n=9) was the most frequent mode of delivery. Eleven (11) newborns were welcomed and the diaper suites were simple. Conclusion: Spontaneous fertility after myomectomy remains low in our series. Factors with a negative impact on fertility must be taken into account.

Do Sociocultural Factors Affect COVID-19 Vaccine Hesitancy Among Pregnant Women? A Hospital-oriented Cross-sectional Study in Türkiye

Purpose: It was aimed to evaluate coronavirus disease-2019 (COVID-19) vaccine hesitancy among pregnant women after the vaccine has been approved for use. Material and Method: This study was a hospital-oriented cross-sectional study. The study universe consisted of 8972 pregnant women. The number of pregnant women included in the study sample was 368. The dependent variable was vaccine hesitancy, whereas the independent variables consisted of the socio-demographic, bio-demographic, and socio-economic characteristics of pregnant women. Chi-square analysis was used for paired comparisons, and logistic regression analysis was used to determine risk factors. Results: The rate of pregnant women who had vaccine hesitancy was 59.5% in this study. Vaccine hesitancy was 2,470-fold (CI: 1,319-4,625) higher in pregnant women who did not have a formal education than those who had a formal education, 8,136-fold (CI: 3,461-19,122) higher in pregnant women who had a living child in the household than those who did not, 1,776-fold (CI: 1,039-3,035) higher in pregnant women who had a wanted pregnancy than those who had an unwanted one and 7,485-fold (CI: 2,894-19,360), 35 age 4,212 (CI:0,436-1,438) higher in pregnant women who were influenced by the social media than those who were not. In addition, it is 0.626 (CI: -0.469 - -0.445) times protective for women under 19 years of age. Conclusion: Low education level, first pregnancy, desire for pregnancy, and being influenced by social media were the risk factors for COVID-19 vaccine hesitancy among pregnant women.

Covid-19 Pandemi Sürecinde Annelerin Bebek Besleme Tutumları ve Bu Tutumları Etkileyen Faktörler: Facebook, Instagram Örneği

Amaç: Bu araştırma Covid-19 pandemi sürecinde annelerin bebek besleme tutumlarını ve etkileyen faktörleri değerlendirmek amacıyla yapılmıştır. Yöntem: Türkiye’de yaşayan 0-6 ay arasında bebeği olan emziren, gönüllü ve iletişim kurulabilen anneler tanımlayıcı tipteki bu araştırmanın örneklemini(n=402) oluşturmuştur. Veriler sosyal ağlar aracılığıyla Google anket formuna eklenen anne tanıtım formu, Iowa Bebek Beslenmesi Tutum Ölçeği, Edinburgh Doğum Sonu Depresyon Ölçeği (EPDÖ) ve Emzirme Öz-yeterlilik Ölçeği (EÖYÖ) kullanılarak toplanmıştır. Bulgular: Araştırma sonucuna göre Iowa Bebek besleme tutumları toplam puanına bakıldığında 64.41±5.50 olduğu bulunmuştur (min=17, max= 85). Annelerin bebek besleme tutumlarını eğitim durumu, öz-yeterlilik düzeyi, eş-evlilik ilişki memnuniyet durumunun etkilediği görüldü. Annelerin mesleği, gebeliği isteme durumu, doğum öyküsü, başka çocuk varlığı, gebeliğinde emzirme ve anne sütü hakkında eğitim alma durumunun ise etkilemediği saptandı(p&amp;gt;0.05). Ayrıca annelerin bebek besleme tutumları ile öz-yeterlilik düzeyi arasında pozitif yönde, depresyon düzeyi ile negatif yönde ilişki olduğu saptandı(p&amp;lt;0.001). Covid- 19 tanısı alan annelerin bebek besleme tutumlarının tanı almayanlara göre daha düşük olduğu bulundu(p&amp;lt;0.05). Sonuç: Pandemi sürecinde anneler anne sütü ile besleme konusunda kararsızdı. Ayrıca annelerin öz yeterlilik düzeyleri arttıkça ve depresyon düzeyleri azaldıkça anne sütü verme tutumlarının arttığı görüldü. Bu doğrultuda pandemi sürecinde gebelik ve postpartum dönemde anneler emzirmenin artırılması konusunda daha fazla izlenmeli ve ruhsal yönden daha fazla desteklenmelidir.

Obstetrical and Fertility Outcomes Following Transcatheter Pelvic Arterial Embolization for Postpartum Hemorrhage: A Cohort Follow-Up Study.

Objectives: Management of severe postpartum hemorrhage (PPH) includes transcatheter pelvic arterial embolization (TAE). Data regarding subsequent fertility and obstetrical outcomes is limited, as most fertility outcomes derive from TAE in uterine fibroma. The purpose of our study was to evaluate the long-term outcomes of patients undergoing TAE, particularly concerning subsequent fertility and following pregnancies. Material and methods: We included 28 patients who underwent TAE for PPH at our institution between 2009 and 2018 in a retrospective cohort study. Data were assessed by reviewing patients’ charts and by contacting the patients. Results: Ten patients had prophylactic balloon occlusion before cesarean section because of anticipated PPH, with planned hysterectomy by placenta increta/percreta. All these patients were excluded from the analysis regarding fertility. 16 (73%) patients reported having regular menstruation after TAE. In total, 11 women had no desire for subsequent pregnancy. Seven of the remaining 11 patients (63.6%) had a total of 13 spontaneous pregnancies, nine of these resulted in miscarriages. Four patients delivered a live baby (36.4%). Two of these (50%) had recurrent PPH and treatment was conservative. Of the patients with infertility (n = 4, 36.4%), two (18.1%) underwent assisted infertility treatment without success. Conclusion: Our study suggests that the fertility of patients undergoing TAE due to PPH is limited. In women who conceive, the risk for first trimester miscarriage as well as recurrent PPH seems to be increased. If this is a consequence of the underlying cause of PPH or the TAE remains unknown. Larger follow-up cohorts are needed. In the meantime, patients who desire pregnancy after TAE should be counseled accordingly.

Long-term quality of life assessment after excisional treatment for cervical dysplasia

We evaluated factors influencing long-term health-related quality of life (HRQoL) after excisional treatments of low- and high grade squamous intraepithelial cervical lesions (SIL) in three groups of women (n = 160): nulliparas interested in reproduction (A), parous women interested in reproduction (B) and women without pregnancy desire (C). The HRQoL was assessed using the disease-specific FACIT-CD and the generic SF36v2 questionnaires. Anxiety and depression were evaluated by Beck’s inventories. After median follow-up of 5 (2–18) years, FACIT-CD total score and the score for Emotional Well-Being (EWB) were significantly lower in group A. The total, EWB and REL (Relationships) scores of FACIT-CD were the highest in group B. Women operated for HSIL demonstrated lower REL quality in comparison to those with LSIL. Neither SF36v2 nor FACIT-CD total scores differed in relation to SIL grade or type of excision. ‘SF36v2 Mental Component Summary Score’ and ‘being parous and interested in fertility’ were independent predictors of disease-specific FACIT-CD score. Impact Statement What is already known on this subject? Long-term consequences of excisional treatments for cervical dysplasia on health-related quality of life (HRQoL) are not well reported. What do the results of this study add? Our study provides data on HRQoL in women treated with large loop excision of the transformation zone (LLETZ) or cold knife conization (CKC) obtained during the longest (median 5 years) follow-up as reported to date. We were able to show that having children and planning further pregnancies positively influenced HRQoL in these patients. In addition, we identified nulliparas with pregnancy desire as psychologically the most vulnerable group within the studied cohort. What are the implications of these findings for clinical practice and/or further research? Even several years after LLETZ or CKC, women may suffer from impaired Emotional Well-Being and reduced HRQoL. Awareness and assessment of these long-term consequences should be part of surveillance after excisional treatments for cervical dysplasia.

What happens when you stop using the combined contraceptive pill? A qualitative study protocol on consequences and supply needs for women who discontinued the combined contraceptive pill in Germany

IntroductionFor more than 60 years, contraceptive pills have been prescribed to mostly healthy biological women. An emerging body of research concerning the possible physiological and psychological side effects of hormonal...

123 Enterobius vermicularis infection and multiple fetal anomalies in early pregnancy – Case report

A 20-year-old patient was hospitalized at week 11 of a naturally occurring, desired pregnancy, with signs of threatening abortion (lower abdominal pain), followed by vomiting and diarrhea. Nuchal translucency, measured at a control ultrasound examination prior to hospitalization, indicated a deviation from normal values, and an expert ultrasound examination was planned to rule out genetic fetal abnormalities. The patient has a history of 3 miscarriages at 6, 10, and 20 weeks of gestation. The patient was previously diagnosed with thrombophilia - mutation for PAI 1 - homozygote.

Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis.

Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis.

Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion.

Objectives: There is a need to hone reproductive health (RH) services for women who sell sex (WSS). The aim of this review was to collate findings on non-barrier contraception, pregnancies, and abortion amongst WSS in Eastern and Southern African (ESA). Methods: A scoping review methodology was employed. Inclusion criteria were: 1) empirical papers from 2) ESA, 3) published since 2010, and 4) addressing WSS in relation to 5) the identified RH issues. Results: Reports of rates of non-barrier contraceptive usage varied from 15% to 76%, of unintended pregnancy from 24% to 91%, and of abortion from 11% to 48%. Cross-cutting factors were alcohol use, violence, health systems problems, and socio-economic issues. Pregnancy desire was associated with having a non-paying partner. Barriers to accessing, and delaying, antenatal care were reported as common. Targeted programmes were reported as promoting RH amongst WSS. Conclusion: Programmes should be contextually relevant, based on local patterns, individual, interpersonal and systemic barriers. Targeted approaches should be implemented in conjunction with improvement of public health services. Linked HIV and RH services, and community empowerment approaches are recommended.

The parent trap: desire for multifetal gestation among patients treated for infertility.

ObjectiveTo evaluate predictors for patient preference regarding multifetal or singleton gestation among women presenting for infertility care.DesignCross-sectional study.SettingAcademic university hospital-based infertility clinic.Patient(s)Five hundred thirty-nine female patients with infertility who presented for their initial visit.Main outcome measure(s)Demographic characteristics, infertility history, insurance coverage, desired treatment outcome, acceptability of multifetal reduction, and knowledge of the risks of multifetal pregnancies were assessed using a previously published 41-question survey. Univariate analysis was performed to assess patient factors associated with the desire for multiple births. Independent factors associated with this desire were subsequently assessed by multivariate logistic regression analysis.Result(s)Nearly a third of women preferred multiples over a singleton gestation. Nulliparity, lower annual household income, older maternal age, marital status, larger ideal family size, openness to multifetal reduction, and lack of knowledge of the maternal/fetal risks of twin pregnancies were associated with pregnancy desire. Older age (OR (95% CI) 1.66 (1.20–2.29)), nulliparity (OR (95% CI) 0.34 (0.20–0.58)), larger ideal family size (OR (95% CI) 2.34 (1.73–3.14)), and lesser knowledge of multifetal pregnancy risk (OR (95% CI) 0.67 (0.55–0.83)) were independently associated with desire.Conclusion(s)A large number of patients undergoing fertility treatment desire multifetal gestation. Although a lack of understanding of the risks associated with higher order pregnancies contributes to this desire, additional individual specific variables also contribute to this trend. Efforts to reduce the incidence of multiples should focus not only on patient education on comparative risks of multiples vs singleton pregnancies but also account for individual specific reservations.

MO031: Long-term safety of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease

Abstract BACKGROUND AND AIMS Tolvaptan, a vasopressin antagonist, is a drug that acts by slowing the progression of autosomal dominant polycystic kidney disease (ADPKD). Its administration is not free of side effects. To assess the long-term safety profile of ADPKD patients treated with tolvaptan. METHOD Retrospective observational study was undertaken of ADPKD patients on treatment with tolvaptan. RESULTS Of the 182 ADPKD patients under follow-up in our hospital, 18% (n = 33) started treatment. Of these, 60.6% (n = 20) were male, with an age of 47.64 ± 8.64 years, a baseline Fg of 65.24 ± 20.14 mL/min, TKVh of 1137.45 ± 667.58 mL and a mean follow-up time of 39.85 ± 10.04 months. A total of 72.7% reached the maximum dose (120 mg), the mean maximum dose reached being 108.18 ± 22.42 mg. At the time of the study, 100% of the patients had reached the maximum dose, the mean time to reach it being 5.8 ± 9.3 weeks. A total of 90.9% (n = 30) presented with side effects: 81.8% (n = 27) aquaretic and 12.1% (n = 4) hepatotoxicity. Others being hypernatremia in 9.1% (n = 3) and hyperuricemia in 24% (n = 8). No other side effects were described. A total of 39.4% (n = 13) of the patients temporarily discontinued treatment after 3.01 ± 2.17 months. The reasons were as follows: aquaretic effects 35.7% (n = 5), hepatotoxicity 35.7% (n = 5), 3.03% desire for pregnancy (n = 1), 3.03% cerebral hemorrhage (n = 1) and 3.03% (n = 1) worsening of renal function. Some 30.76% (n = 4) of the patients restarted treatment at 5.5 ± 6.76 months. Therefore, the treatment discontinuation rate was 27.2%. The profile of patients with side effects were mostly male (60%) with mean age of 46 ± 8.65 years and TKVh of 1829.93 ± 1172.83 mL .The maximum dose reached in these patients was 107 ± 23.2 mg with a mean time to reach it of 6.19 ± 9.7 ± weeks. Patients who had more aquaretic side effects were characterized by better baseline prior to renal function and a greater decrease in GFR throughout follow-up. No differences in TRV variations were observed. CONCLUSION Tolvaptan treatment is shown to be safe in the long term. However the patient profile to receive treatment must be considered given that a high percentage present aquaretic effects. Regarding hepatotoxicity, although it is another potentially serious effect to consider, it is easily managed and reversible in our studied sample.