Treatment Of Women Research Articles

What Recovery Means to Postpartum Women in Treatment for Opioid Use Disorder.

Introduction: Opioid overdose has become a leading cause of pregnancy-associated deaths, particularly in the 1st year postpartum, highlighting the need to better understand how to promote recovery for postpartum women. This mixed-methods study aims to investigate how postpartum women receiving medication for opioid use disorder (MOUD) define recovery and factors associated with recovery progression or inhibition.Methods: Women receiving MOUD 2–6 months postpartum were recruited from an outpatient perinatal addiction clinic. Participants completed electronic measures including the Brief Assessment of Recovery Capital (BARC-10, total score range: 6–60) and semistructured individual interviews. Substance Abuse and Mental Health Services Administration (SAMHSA)'s recovery framework served as the conceptual model for interview guide development. Descriptive statistics were generated for survey responses. A qualitative descriptive approach was used to analyze and report the interview data.Results: On average, participants (n = 8) were 28.6 years old and taking 19.5 mg/day buprenorphine (range 8–24). Fifty percent identified as white and 37.5% as black. All participants identified as currently in recovery, with mean BARC-10 score 52.5 (standard deviation 4.8). Recovery goals included no use of drugs or alcohol (62.5%), being a better partner/spouse (87.5%), and improving finances (87.5%). Interviews generated themes including recovery as transformative, building resilience, and transforming one's health, relationships, and environment through recovery.Conclusions: Participants defined recovery as a dynamic transformative process, including nonabstinence-based goals consistent with SAMHSA domains coupled with reduced substance use. Central to recovery for our postpartum participants was the sense of self reinforced throughout their recovery journey. Women highlighted the key role of MOUD in their recovery process. Findings underscore the need for individualized treatment for postpartum women with opioid use disorder based on their personal goals and will inform development of a validated, gender-informed measure of patient-reported recovery outcomes tailored for this population.

Management of Psychiatric Disorders during the Perinatal Period.

Management of Psychiatric Disorders during the Perinatal Period.

Provider Characteristics Associated with Trust When Caring for Women Experiencing Substance Use Disorders in the Perinatal Period

Women experiencing substance use disorders (SUD) have often reported challenges in their relationships with health care providers during the perinatal period that served as a barrier to care. Establishing trust is an important aspect in forming positive relationships. The purpose of this study was to identify provider characteristics associated with the development of trust when caring for women experiencing SUD during the perinatal period. A systematic search was conducted using the databases of CINAHL, APA PsychINFO, and PubMed along with a manual search of Google Scholar between the years of 2000-2021. Studies were included if they were (1) original qualitative research; (2) published in English; (3) peer reviewed; (4) from the perspective of women experiencing SUD; (5) included descriptions of positive health care interactions between women experiencing SUD in the perinatal period and their health care providers; and (6) conducted in the United States or Canada. The studies were assessed for quality and validity using 10 criteria from the Joanne Briggs Institute critical appraisal checklist for qualitative research. Findings from 21 qualitative studies were synthesized using a thematic synthesis approach and revealed 3 overarching themes that included 7 descriptive subthemes which identified provider characteristics associated with trust. The 7 descriptive subthemes included: developing rapport with women, demonstrating caring behaviors, including women in care, understanding women's SUD treatment efforts, reassuring women, delivering competent care, and educating women. Participants' accounts of trusting interactions with health care providers occurred when providers viewed women approvingly, affirmed their treatment efforts and maternal abilities, and delivered competent care that was knowledgeable of issues associated with SUD. The findings suggest the importance of confronting implicit biases, integrated care, and fostering a stigma-free and trauma-informed working environment.

The Evolution of Gender-and Trauma-Responsive Criminal Justice Interventions for Women

For over five decades, the development of risk classification assessments, corrections-based treatment, and the associated outcome research have been focused on men. Thus, it is no surprise that existing treatment frameworks and correctional policies have been established from a male perspective.

Implementation of the RCOG VTE Risk-Assessment Affects on Postpartum Prophylaxis Treatment in Women with SLE

There is no prospective, validated VTE risk-assessment tool for obstetric patients. The Royal College of Obstetrics & Gynecology (RCOG) proposed a VTE risk-assessment tool specific to this population. In March 2020, our institution transitioned to the RCOG VTE risk-assessment tool, utilizing a multi-pronged approach including department interdisciplinary education, and electronic medical record (EMR) clinical decision support tools. The RCOG VTE tool includes “active” Systemic Lupus Erythematosus (SLE) as a “very high-risk factor,” (3 points) and recommends discharge with pharmacologic VTE prophylaxis for a postpartum score ≥ 2.

Impact of Bladder Wall Thickness on the Outcomes of Antimuscarinic Treatment in Women with Overactive Bladder

Aim: This study aimed to evaluate the effect of bladder wall thickness (BWT) (using transabdominal ultrasound) on the outcomes of antimuscarinic treatment in women with overactive bladder. Methods: A total of 102 female patients with symptoms of OAB were recruited. All patients completed the Overactive Bladder version 8 (OAB-V8) (Arabic validation) and the International Consultation of Incontinence Questionnaire (ICIQ-SF). Patients completed the urodynamic study (UDS) including uroflowmetry and PVR and measures of BWT by transabdominal ultrasound. The patients were classified into 2 major groups: G1 (patients with BWT <5 mm) and G2 (patients with BWT ≥5 mm). The patients were re-evaluated after 3-month medication with solifenacin 10-mg oral tablet. Results: At baseline, the results of OAB-V8 and ICIQ-SF were significantly higher in G2 than G1 (p < 0.001). Regarding UDS, volume at 1st desire to void, volume at strong desire to void, and MBC were significantly higher in group 1 compared to group 2 (p = 0.001). Intravesical pressure at strong desire and patients’ number of DO were significantly increased in G2 (p < 0.05 and p = 0.001, respectively). After treatment, there was an improvement in both groups regarding OAB-V8, ICIQ-SF, bladder volume at 1st desire to void, bladder volume at strong desire to void, bladder volume at DO, MBC, intravesical pressure at strong desire, and the patients’ number with DO (decreased), and these improvements were statistically significant in group 1 compared to group 2 (p < 0.05). Conclusion: BWT showed a significant association with both OAB symptom scores and UDS parameters. The decrease in BWT is associated with a significantly higher response to solifenacin therapy regarding the UDS results.

Pregnancy and Neonatal Outcomes With Levothyroxine Treatment in Women With Subclinical Hypothyroidism Based on New Diagnostic Criteria: A Systematic Review and Meta-Analysis.

BackgroundSubclinical hypothyroidism (SCH) during pregnancy has been associated with multiple adverse maternal and neonatal outcomes. However, the potential benefits of levothyroxine (LT4) supplementation remain controversial. Variations across studies in diagnostic criteria for SCH may, in part, explain the divergent findings on the subject. This study aimed to assess the effect of LT4 treatment on pregnancy and neonatal outcomes among pregnant women who were diagnosed as SCH based on the most recent diagnostic criteria.MethodsWe conducted a systematic review and meta-analysis of the literature published from inception to January 2020. The search strategy targeted the studies on pregnancy and neonatal outcomes following LT4 treatment in women with SCH based on 2017 American Thyroid Association diagnostic criteria. Pooled effect sizes were estimated using fixed and random effect models, according to the absence or presence of heterogeneity which was assessed using the I-squared statistic. Sources of heterogeneity and the stability of results were evaluated through sensitivity analysis.ResultsOf the 2781 identified references, 306 full-text articles were screened for eligibility. Finally, 6 studies including a total of 7955 participants were retained for analysis. Summary effect estimates indicated that pregnant women with SCH treated with LT4 had a lower risk of pregnancy loss [odds ratio (OR) = 0.55, 95% confidence interval (CI): 0.43-0.71], preterm birth (OR=0.63, 95% CI: 0.41-0.98) and gestational hypertension (OR = 0.78, 95% CI: 0.63-0.97) than those in control group.ConclusionLT4 treatment in pregnant women with SCH may reduce the risk of pregnancy loss, preterm delivery and gestational hypertension.

Ethnic inequalities in health intervention coverage among Mexican women at the individual and municipality levels.

BackgroundUsing data from Mexico, the country with the largest indigenous population in Latin America, we describe ethnic inequalities in coverage with women's health interventions at individual and municipal levels.MethodsCross-sectional study using data from the National Health and Nutrition Survey 2018 and the Mexican Intercensal Survey 2015. We selected five outcomes: modern contraceptive use, content-qualified antenatal care (ANCq), and skilled birth attendant (SBA) for women aged 15–49 years; Pap smear test and mammogram among women aged 25-64 and 40-69 years respectively. Municipalities were classified into three groups by the percentage of indigenous population: <10%, 10% – 39%, and ≥40%. We calculated crude and adjusted coverage ratios (CR) and 95% confidence intervals (CI) using Poisson regression.FindingsWomen living in municipalities with indigenous population ≥40% were poorer, less educated, and more rural. Coverage was lower for indigenous than non-indigenous for modern contraceptive use (CR: 0·73; CI 0·65-0·83), ANCq (CR: 0·72; CI 0·62-0·83), SBA (CR: 0·83; CI 0·77-0·90) and undergoing a mammogram (CR: 0·54; CI 0·41-0·71), but not for Pap smears (CR: 0·94; CI 0·83-1·07). Coverage with the five interventions increased as the municipal proportions of indigenous population decreased, both for indigenous and non-indigenous women. Coverage gaps at municipal level tended to be wider than at individual level.InterpretationBoth indigenous and non-indigenous women living in municipalities with high proportions of indigenous people were systematically excluded from reproductive and maternal interventions. Our findings suggest that social and health interventions targeted at the individual level should be complemented by structural interventions in municipalities with high proportions of indigenous people, including strengthening health and social services.

Breastfeeding Intention, Knowledge, and Attitude of Pregnant Women in Treatment for Opioid Use Disorder.

The objective of this study was to describe breastfeeding intention, knowledge, and attitude, and sources of infant feeding information during the prenatal period among a cohort of pregnant women in treatment for opioid use disorder (OUD). Pregnant women who were receiving treatment for OUD and in the third trimester completed a questionnaire that measured demographic characteristics, infant feeding intentions, breastfeeding beliefs and attitudes, and sources of breastfeeding information. Frequency counts and percentages and means and standard deviations were used to describe data. Sixty-five women completed the survey. Three-fourths reported some intention to breastfeeding. While attitudes around breastfeeding were generally positive, less than half of respondents knew the recommendations and infant health benefits of breastfeeding. Prenatal programs for women in treatment for OUD should consider addressing patient-reported concerns and gaps in knowledge regarding the benefits of and recommendation for breastfeeding. · Breastfeeding has unique benefits for mother-infant dyads affected by maternal OUD.. · Breastfeeding decisions are influenced by maternal psychosocial factors (e.g., knowledge and attitudes), however, such factors have not been previously assessed in women in treatment for OUD.. · Results indicate that attitudes around breastfeeding are positive but knowledge gaps exist..

Fidelity Monitoring in the Solution Focused Wellness for HIV (SFWH) Intervention for Women 🇨🇳 🇫🇷 🇩🇪 🇮🇷 🇪🇸

Solution Focused methods are often interpreted by different practitioners with a degree of flexibility and adaptation to specific practice settings (Lehmann &amp; Patton, 2012). This flexibility is one of the features that makes SFBT a very client-centered approach and has been highlighted as one of the key aspects of successful co-construction of desired outcomes with clients (Franklin et al., 2017). This collaborative approach is possible due to SFBT’s utilization of social constructionist principals in the solution-building process (Blundo &amp; Simon, 2015). While encouraging flexibility of implementation of SFBT, identifying the main tenets of the therapy, including specific techniques and mindsets is helpful to researchers who are interested in determining SFBT’s success in certain clinical and research efforts (Lehmann &amp; Patton; Trepper et al., 2012). To help with this process, members of the Solution Focused Brief Therapy Association (SFBTA) created a treatment manual that outlined these major tenants to serve as a guide and to reach a consensus about how to understand and implement SFBT (Trepper et al.). In publishing their SFBT fidelity instrument, Lehmann and Patton recommended that the field of SFBT focus more seriously on the issues of treatment fidelity in SFBT practice and research. However, continued discussion on the topic has been limited in the peer-reviewed, published SFBT literature. To continue this discussion among SFBT researchers and practitioners, the process for planning, monitoring and reporting fidelity to SFBT in the Solution Focused Wellness for HIV Intervention for women (SFWH) will be presented. The SFWH fidelity monitoring process will be explained in the context of both common SFBT fidelity processes and the latest accepted behavioral intervention research guidelines for the fidelity process. Chinese (Simplified) (https://drive.google.com/file/d/1UD7nOPx2NKWISaK59O05-ZwmyjICP2cS/view?usp=drive_link) French (https://drive.google.com/file/d/17ySssPy4xulKhieGCAivuAWNwLSK9c5y/view?usp=drive_link) German (https://drive.google.com/file/d/1CTPsV13qOSb3QTNcjydI_zPvwvLcdZ_V/view?usp=drive_link) Persian (https://drive.google.com/file/d/1DVW0xLQGrm06UCEavBFIkj5jRrrnH3ia/view?usp=drive_link) Spanish (https://drive.google.com/file/d/1LM-8RQN1T6jgFVziInIeSZZsWfiZZWln/view?usp=drive_link)

Women and the Politics of Incivility and Discrimination: Introduction

Women and the Politics of Incivility and Discrimination: Introduction

Treatment of Women with Heavy Menstrual Bleeding with a Combination Therapy of Agnus Castus and Tranexamic Acid - Experiences of a German Single Centre

▪Background:Heavy menstrual bleeding (HMB) is a common gynaecological problem and is the reason for 18-30% of gynaecological visits. In a European study in 4,502 women, 27.2% were diagnosed with HMB (Fraser et al., 2015). On the other hand, HMB is often associated with bleeding disorders (Shankar et al., 2004). The definition of HMB has different perspectives; from a subjective perspective HMB is defined as e excessive menstrual blood loss impacting on women's physical, social, emotional and/or mental quality of life, whereas from an objective perspective it is defined as excessive blood loss >80 ml per cycle (Munro et al., 2012). There are different approaches for treating HMB such as the administration of non-steroidal drugs, Desmopressin, herbal Vitex Agnus Castus (VAC), Tranexamic acid (TXA) or a hormonal therapy; moreover, HMB can also be treated surgically.The aim of this study was to test the efficacy of the specific HMB management used in our center: Women with HMB are treated usually with VAC, which optimizes the relation of estrogen to progesterone in the female body (Yavarikia et al., 2013). VAC can be used without using any hormones (Shahnazi et al, 2016), providing a treatment with a low impact on women's bodies. Additionally, TXA is given during the menstruation due to its antifibrinolytic effect. Furthermore, the “Pictural Blood-Loss-Assessment- Chart” (PBAC Score) is administered to analyze the menstrual blood loss.Methods:Two ad hoc patient-reported questionnaires were developed to test the efficacy of the HMB management in our center The baseline questionnaire includes the following aspects: menarche, duration, regularity, number of sanitary products, pain level, medical background and family history. During the first visit in our center women with HMB filled in the baseline questionnaire. In addition, laboratory tests are done including a comprehensive coagulation test and the examination of iron and hemoglobin levels. Moreover, we presented an application called “My Flow Score” to the patients, which calculates the PBAC score as a result of all entered sanitary products women use during their period. Women are prescribed VAC and/or TXA for the management of their HMB. After four months patients are scheduled for a follow up appointment. At that time they complete the follow-up questionnaire including the following aspects: compliance with the medication or the reason for the non-compliance, health complaints due to the medication, duration of the period, improvement, pain level, PBAC score if the patient did use the APP “My Flow Score” or if not the number of sanitary products. A blood test was taken and the HMB management was adapted to the patients' needs.Results:So far, 100 women with HMB with a median age of 14 years (range 9-50) were enrolled in our study. They had their menarche with a median age of 12 years (range 8-17). Diagnosis of women ranged from iron or folic acid deficiency to different forms of bleeding disorders; with the majority suffering from von Willebrand disease (43/100) followed by iron deficiency (14/100). One fifth of the patients had more than one diagnosis. 1/3 of patients received a treatment for the HMB previously, mainly contraceptives, TXA or VAC. 49% reported anomalies with regard to previous other bleeding; 25.8% had increased hematomas and 19.6% recurrent epistaxis. Most of them reported anomalies already in the family (60.2%). Before treatment women had a median PBAC Score of 169 (range 77-800) and reported a median pain level of 6.5 during menstruation on a scale ranging from 1 (low pain) to 10 (extreme pain). 87/100 women received VCA, of these 75.4% regularly and 85/100 women received TXA, of these 84.6% regularly. 81% of them received a combination of both medicines. Compared to before 28.8% of patients reported shorter duration of menstruation and reduced bleeding with treatment, 11.9% did not experience any improvement; the PBAC score decreased significantly (p<.0001).Conclusions:Although the type of diagnosis in women suffering from HMB had a great variation, these patients had a high disease burden with a relatively high level of pain and a high loss of blood assessed with the PBAC score. Thanks to a combination of VAC and TXA the disease burden in these women could be reduced, especially for the time of menstruation and amount of bleeding. VAC proved to be highly accepted by women due to its low treatment burden. DisclosuresVon Mackensen: University Medical Centre Hamburg-Eppendorf: Current Employment; Sobi: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Sanofi: Consultancy; Novo Nordisk: Consultancy; Biomarin: Speakers Bureau; CSL Behring: Speakers Bureau; Chugai/Roche: Membership on an entity's Board of Directors or advisory committees.

The politics of mobility and empowerment: The case of self‐help groups in India

AbstractWithin the empowerment literature, “freedom of movement” or “mobility” are frequently used as indicators to assess empowerment programmes or whether women have become socially empowered. As women's self‐help groups (SHGs) engaged in saving/lending and livelihood schemes have emerged as the de facto vehicles for women's empowerment over the past two decades, their propensity for increasing women's opportunities for mobility has been an oft‐lauded benefit. This has been especially pronounced as the empowerment agenda's prerogative to collectively transform power structures became co‐opted by a neoliberal focus on fostering responsible financial subjects with entrepreneurial savvy. In this paper, I draw on multi‐year ethnographic research of women's SHG interventions in eastern and central India to critically explore the ways different mobile practices intersect with empowerment goals. I contend it is necessary to examine mobility as more than physical movement and also to analyse it as a meaning‐laden and embodied practice intimately bound up in the neoliberal development agenda. Using this analytic, I find that although newfound mobility is often experienced positively by women, it is far from “free,” and remains embedded in power relations where women continue to engage on unfavourable terms – exemplified in women's inability to leisurely tour/wander. I conclude by reflecting on how empowerment interventions might more productively engage mobility less as a practice of increased economic and political participation and more as a site where women can experiment with new forms of being.

Perceived stress and support preferences during bed rest in twin pregnancies: A cross-sectional online survey

ObjectiveTo identify the most prominent sources of stress, examine correlates of stress, and assess support preferences to inform future interventions among women pregnant with twins who are on bed rest. Materials and MethodsA cross-sectional online survey was administered to pregnant and postpartum women who were recommended bed rest during their twin pregnancy. Total stress while on bedrest was assessed using an adapted version of the Antepartum Hospital Stressors Inventory (AHSI). Bivariate analyses were used to compare total stress scores across participant characteristics using linear regression, Spearman's correlation, and one-way ANOVA. Qualitative content regarding women's bed rest experiences and future intervention preferences was analyzed into themes. FindingsWomen's (N = 104, mean age 30.6 years ± 4.6) most prominent sources of stress while on bed rest included thinking about babies’ health, feeling dependent on others, and feeling uncertain about the outcome. Women who were recommended bed rest earlier in their pregnancy or were recommended both home and hospital bedrest had higher stress scores, while women with monochorionic/monoamniotic pregnancies had lower stress scores. Approximately 64% of women indicated interest in a bed rest support program, with 88% indicating a preference for online support and 70% wanting support from family. Key Conclusions: Women pregnant with twins who are recommended bed rest identify many sources of stress. Our findings suggest a need for stress-management interventions targeting this population.

Patterns of Practice for Adjuvant Treatment of FIGO 1B Grade 3 Endometrial Adenocarcinoma Following Publication of ASTRO 2014 Guidelines for Postoperative Treatment in Women With Early Stage High Risk Endometrial Cancer

In 2014, the American Society for Radiation Oncology (ASTRO) published evidence-based guidelines for the role of postoperative radiation therapy in endometrial cancer. These guidelines were also endorsed by the Society of Gynecologic Oncology (SGO). They strongly recommended that women with grade 3 endometrioid endometrial cancer with deep myometrial invasion) receive pelvic radiation (EBRT) and not vaginal cuff brachytherapy (VCBT) given their increased risk of pelvic recurrence based on high quality evidence. We analyzed patterns of practice before and after this consensus guideline was published.We queried the National Cancer Database to identify all women with either FIGO 1C grade 3 disease from 2004-2009 and FIGO 1B grade 3 disease from 2009-2017 with endometrioid histology who were treated surgically. Patients were then stratified to treatment between 2004-2014 (prior to ASTRO guideline updates) and 2015-2017. Patients were excluded from final analysis if they were metastatic at diagnosis, received palliative-intent radiation, treatment parameters were unknown, or age < 18. Multivariable logistic regression was performed to evaluate for factors associated with receipt of VCBT using clinical and sociodemographic covariates.We identified 6,792 patients with grade 3 endometrioid endometrial carcinoma meeting current FIGO 1B disease classification, diagnosed between 2004 and 2017. Adjuvant radiation was not delivered to 38% of patients identified in the study period, and 26% received both EBRT and VCBT. From 2004-2014, of the patients that received single modality adjuvant radiation, 1168 patients received VCBT only (56%) and 908 received EBRT only (44%). The corresponding numbers for 2015 to 2017 for VCBT and EBRT were 347 (62%) and 217 (38%), respectively. The increase in VCBT utilization in 2015-2017 was statistically significant (P = 0.025). Patients who received VCBT were more likely to receive chemotherapy, be treated at a community cancer center or academic cancer center, or live within 50 miles of the treatment center (all P < 0.01). Racial and sociodemographic factors were not associated with likelihood of receipt of VCBT.Based on ASTRO 2014 guidelines, EBRT is strongly recommended in patients with FIGO 1B/ grade 3 endometrioid endometrial carcinoma. However, the rate of EBRT paradoxically declined in the period after the publication of the guideline. This may be in part due to conflicting data from ongoing trials during that time such as GOG 249 and PORTEC 3. Further investigation is warranted to investigate reasons for these variations in practice.C. Weil: None. F. Lew: None. D.K. Gaffney: Research Grant; NCI. Consultant; NCI. run meetings; NCI.G. Suneja: Research Grant; National Institutes of Health. Honoraria; National Comprehensive Cancer Network. Travel Expenses; National Comprehensive Cancer Network, Radiation Oncology Institute, American Board of Radiology; Radiation Oncology Institute, National Comprehensive Cancer Network, ASTRO.V.M. Williams: Involved in planning the mission and activities for the subcommittee; ARRO Equity and Inclusion Subcommittee.

The Effect of Post-Operative Suppressive Treatment in Women with Endometriosis-Related Infertility

<h3>Study Objective</h3> To evaluate the effect of suppressive therapy on fertility and recurrence when administered after a conservative surgical treatment in women with endometriosis seeking pregnancy and to compare it with an inactive control. <h3>Design</h3> We performed a systematic review with meta-analysis. A search of MEDLINE, Embase and CENTRAL was performed by two independent reviewers from databases' inception until December 6, 2020.Two reviewers extracted data and assessed the risk of bias of the included trials (Cochrane risk-of-bias tool for randomized trials 2). Risk ratios (RR) were pooled by quantitative random effect meta-analysis. Overall strength of evidence was assessed using the GRADE method. <h3>Setting</h3> Included studies were randomized controlled trials. <h3>Patients or Participants</h3> Studies populations included reproductive-age women with endometriosis seeking pregnancy. <h3>Interventions</h3> Post-operative suppressive treatment was compared to an inactive control. <h3>Measurements and Main Results</h3> From 3138 citations, 19 trials (2028 participants) were included. No difference was observed between the treatment and the control group for pregnancy rates (RR 1.15; 95%CI 1.00, 1.32; GRADE moderate), live birth rates (RR 1.05; 95% CI 0.84, 1.32; GRADE low) and anatomical recurrence (RR 0.70; 95% CI 0.46, 1.07; GRADE low). However, when administered for three months or more, suppressive therapy significantly increased pregnancy rates (RR 1.22, 95%CI 1.04, 1.43). Post-operative suppressive therapy was also associated with reduced pain recurrence compared to control (RR 0.65; 95%CI 0.50, 0.84; GRADE moderate). <h3>Conclusion</h3> The effect of suppressive therapy administered after surgical treatment of endometriosis on fertility remains unclear but seems to increase chance of pregnancy when administered for three months or more and to effectively reduce pain recurrence after surgery.

Minimally Invasive Sacrocolpopexy Mesh Exposure Rates with and without Concomitant Total Hysterectomy

Study Objective Determine the risk difference of mesh exposure rates at 1-year following minimally invasive sacrocolpopexy (MISC) with and without concomitant total hysterectomy utilizing lightweight Y-mesh. Design Retrospective cohort, 2016-2019. Setting Single academic institution. Patients or Participants Women who underwent MISC and had 1-year in-office follow-up. Excluded if history of prior mesh augmented prolapse repair or supracervical hysterectomy. Interventions Women who underwent MISC with or without concomitant total hysterectomy were compared. Measurements and Main Results Cohort included 259 women, mean age was 63.6±9.2 years, BMI 27.1 kg/m2, 89% were post-menopausal, 46% sexually active, 18% had a history of prior FPMRS surgery. MISC + total hysterectomy (n=126) v. MISC alone (n=133). The overall rate of mesh exposure was 3/259 (1.2%, 95% CI, 0.2% - 3.4%). All mesh exposures were in the total hysterectomy group, two with absorbable suture, one with permanent suture for graft attachment. The risk difference of mesh exposure was 2.4% (95% CI, -0.5% - 6.9%) for those who underwent MISC + total hysterectomy v. MISC alone and was not significantly different from zero. The NSQIP 30-day complication rate was higher in the total hysterectomy group 14.3% v. 2.3% (p <0.01), however, this difference is attributed to the increased rate of urinary tract infections (total hysterectomy group n=14, post-hysterectomy group n=0). There were no mortalities and 30-day readmission rates did not differ between groups 1.5% v. 1.6% (p = 1.0). Rate of recurrent prolapse, defined as ≥ Stage 2 on clinical examination, was not statistically different between groups, MISC+ total hysterectomy 12.7 % v. MISC alone 21.8 % (p=0.06). There was one reoperation for prolapse, which was in the MISC alone group (isolated posterior repair). Conclusion The rate of mesh exposure one year after MISC with lightweight Y-mesh is low at 1.2%, with no statistically significant difference between those who underwent MISC with or without concomitant total hysterectomy. Determine the risk difference of mesh exposure rates at 1-year following minimally invasive sacrocolpopexy (MISC) with and without concomitant total hysterectomy utilizing lightweight Y-mesh. Retrospective cohort, 2016-2019. Single academic institution. Women who underwent MISC and had 1-year in-office follow-up. Excluded if history of prior mesh augmented prolapse repair or supracervical hysterectomy. Women who underwent MISC with or without concomitant total hysterectomy were compared. Cohort included 259 women, mean age was 63.6±9.2 years, BMI 27.1 kg/m2, 89% were post-menopausal, 46% sexually active, 18% had a history of prior FPMRS surgery. MISC + total hysterectomy (n=126) v. MISC alone (n=133). The overall rate of mesh exposure was 3/259 (1.2%, 95% CI, 0.2% - 3.4%). All mesh exposures were in the total hysterectomy group, two with absorbable suture, one with permanent suture for graft attachment. The risk difference of mesh exposure was 2.4% (95% CI, -0.5% - 6.9%) for those who underwent MISC + total hysterectomy v. MISC alone and was not significantly different from zero. The NSQIP 30-day complication rate was higher in the total hysterectomy group 14.3% v. 2.3% (p <0.01), however, this difference is attributed to the increased rate of urinary tract infections (total hysterectomy group n=14, post-hysterectomy group n=0). There were no mortalities and 30-day readmission rates did not differ between groups 1.5% v. 1.6% (p = 1.0). Rate of recurrent prolapse, defined as ≥ Stage 2 on clinical examination, was not statistically different between groups, MISC+ total hysterectomy 12.7 % v. MISC alone 21.8 % (p=0.06). There was one reoperation for prolapse, which was in the MISC alone group (isolated posterior repair). The rate of mesh exposure one year after MISC with lightweight Y-mesh is low at 1.2%, with no statistically significant difference between those who underwent MISC with or without concomitant total hysterectomy.

Retrospective Analysis of Fondaparinux and Low-Molecular-Weight Heparin in the Treatment of Women With Recurrent Spontaneous Abortion.

BackgroundTo compare the clinical efficacy of fondaparinux and LMWH and provide clinical evidence for the effectiveness of fondaparinux in the treatment of recurrent spontaneous abortion caused by PTS.MethodsA retrospective analysis was conducted for 120 patients diagnosed with a recurrent spontaneous abortion caused by PTS in Qingdao Jinhua Women’s Hospital from March 2019 to April 2020. The patients were divided into two groups: 68 cases in the control group, treated with LMWH, 52 cases in the observational group, treated with fondaparinux. The pregnancy outcomes and adverse reactions between the two groups of recurrent miscarriage patients were compared.ResultsNo significant difference was detected in the general data between the two groups of patients before treatment (P>0.05). In the observational group, the R value was increased, and the α and MA values were decreased after three months of treatment compared to those before treatment (P<0.05). In the control group, the R value was increased, and the MA value was decreased after three months of treatment compared to those before treatment (P<0.05). After treatment, no significant difference was observed in the pregnancy outcome between the two groups (P>0.05). The total adverse reaction rate of the fondaparinux group was lower than that of the LMWH group (P<0.05).ConclusionsIn this study, no significant difference was detected in the pregnancy outcome between fondaparinux and LMWH in the treatment of recurrent spontaneous abortion caused by PTS, but fondaparinux had a low occurrence rate of adverse reactions and high safety.

Mindfulness in Pregnancy: A Brief Intervention for Women at Risk.

The U.S. has the highest rate of preterm birth (PTB), of all developed countries, especially among African American women. Social determinants of health and inequalities in health outcomes are understudied areas. The intersectionality of race and socioeconomic status has been shown to contribute to chronic stress, stress has been shown to be associated with PTB, yet the mechanisms that affect pregnancy outcomes have not been explicit. Mindfulness-based Interventions that address stress reduction during pregnancy may improve quality of life during pregnancy, perhaps enhancing resilience, and be on the pathway to reducing the risk of negative pregnancy outcomes such as PTB. We over-enrolled African American women and those covered by Medicaid to reach women at higher risk for PTB and included women in substance use treatment. Participants were enrolled in a 6-week mindfulness in pregnancy (MIP) intervention at the obstetric clinic. Sociodemographic characteristics and psychosocial assessments were obtained at three time points. We enrolled 35 women who self-identified as: non-white, Medicaid recipients, aged 25-35years, with high school or less education. We found reductions in perceived stress, pregnancy specific stress, trait anxiety and depression and increases in mindfulness that sustained post-intervention at 2 and 7months. Social determinants and stress in particular have been associated with negative birth outcomes. This paper describes a brief intervention and results of MIP tailored to women who have significantly more stress due to race, poverty, homelessness, substance use treatment and other comorbid health risks including PTB.

An Efficacy and Feasibility Analysis of Chinese Patent Medicine Combined With Letrozole in the Treatment of Women With Ovulation Disorders: A Network Meta-Analysis.

Objective: To compare the efficacy of various listed Chinese patent medicines combined with letrozole in the treatment of ovulation disorders using network meta-analysis (NMA). Methods: We conducted a systematic literature search in PubMed, Cochrane Central Register of Controlled Trials, Embase, Chinese Biomedical Literature, China National Knowledge Infrastructure, Wanfang, and VIP Information databases up to June 2020. Randomized controlled trials reporting Chinese patent medicine combined with letrozole for ovulation disorders were included. The Stata 13 and WinBUGS1.43 software were used for data analysis. Results: A total of 24 randomized controlled trials were included, involving 2,318 patients. The results showed that when compared with patients using only letrozole, the ovulation rate was higher in patients using letrozole combined with Kuntai capsules, Fuke Zaizao capsules, Fufang Xuanju capsules, or Dingkun Dan, and Fufan Xuanju capsules showed the greatest improvement; the pregnancy rate was higher in patients using letrozole combined with Kuntai capsules, Fuke Zaizao capsules, or Dingkun Dan; and the endometrial thickness on the day of follicular maturity was greater in patients using letrozole combined with Kuntai capsules, Fuke Zaizao capsules, Fufang Xuanju capsules, Bailing capsules, or Dingkun Dan. In terms of the sequencing of NMA results, Fufang Xuanju capsules combined with letrozole gave the best results in improving the ovulation rate and increasing the endometrial thickness, while Dingkun Dan combined with letrozole achieved the best results for improving the pregnancy rate. Conclusion: Letrozole combined with Chinese patent medicine is more effective than letrozole alone in the treatment of ovulation disorders. Fufang Xuanju capsules is good at improving the ovulation rate and increasing the endometrial thickness. Dingkun Dan is good at improving the pregnancy rate. The appropriate choice of treatment should be made according to the actual clinical situation. This study is registered with the International Prospective Register of Systematic Reviews (CRD42020200603).