Voluntary Termination Of Pregnancy Research Articles

Evidence for HPV DNA in the placenta of women who resorted to elective abortion

BackgroundIt is believed that HPV infection can result in the death of placental trophoblasts and cause miscarriages or preterm birth. In clinical cases of placental villi positive for HPV DNA reported by other authors, contamination is suspected in the act of crossing the cervical canal. We analyzed placental samples of women who resorted to elective abortion obtained by hysterosuction of ovular material, bypassing any contact with the cervical canal and vagina.MethodsWe studied the chorionic villi of the placenta of 64 women who resorted to voluntary termination of pregnancy, in the first trimester. To avoid contamination of the villi by the cervical canal, we analyzed placental samples obtained by hysterosuction of ovular material, bypassing any contact with the cervical canal and vagina. All samples of chorionic villi were manually selected from the aborted material and subjected to research for HPV DNA.ResultsHPV DNA was detected in 10 out of 60 women (16.6%). The HPV DNA identified in the placenta belonged to genotypes 6, 16, 35, 53, and 90.ConclusionThe study shows that papillomavirus DNA can infect the placenta and that placenta HPV infection can occur as early as the first trimester of pregnancy.

Opinion, Attitudes and Level of Knowledge of Obstetrics and Childcare Students at the University of Antofagasta Regarding the Law on Voluntary Termination of Pregnancy

objetivo: Describir la opinión, actitudes y nivel de conocimiento que tienen los estudiantes de Obstetricia y Puericultura de una universidad pública frente a la Ley de Interrupción Voluntaria del Embarazo (IVE). material y método. 308 estudiantes de Obstetricia (Universidad de Antofagasta), a quienes se les solicitó opinión y se les midió conocimientos respecto de Ley IVE implementada recientemente en Chile. La información fue recolectada en cuestionario autoaplicado y procesada en una hoja de cálculo Excel. El resguardo ético se realizó a través de consentimiento informado. resultados. De 235 encuestas recibidas se pudo desprender lo siguiente: en relación con conocimientos sobre la Ley IVE, el total de encuestados sabe que en Chile el aborto es legal solamente en tres causales definidas por la ley y logra identificarlas correctamente. Un 18 % cree que las asignaturas de su carrera les proporcionaron información suficiente respecto de la Ley IVE, mientras que un 66 % dice haberse informado mediante la prensa. En relación con opinión y actitudes frente al aborto, un 42 % se declararía «absolutamente a favor». El 91 % de los encuestados opina que la ley IVE es un avance en políticas públicas para Chile. conclusiones. Estudiantes encuestados demuestran una actitud favorable hacia la interrupción del embarazo cuando concurre alguna de las tres causales. Si bien existen potenciales objetores frente a determinadas causales, la mayor parte del grupo de estudiantes tiene una actitud favorable frente a lo que consideran un avance en políticas públicas para el país.

MO828INTENSIFIED TREATMENT FOR PREGNANCY IN HEMODIALYSIS PATIENTS, ANALYSIS OF 13 CASES: IS THERE A GENDER ADVANTAGE?

Abstract Background and Aims Pregnancy in dialysis patients is rare but challenging for nephrologists and obstetricians, because pregnancy has a significant maternal and fetal risk in these patients. Although intensified hemodialysis is effective to achieve favorable clinical outcomes, the evidence concerning reliable parameters for the optimal dialysis prescription is scarce. Herein, we report the management on hemodialysis and outcome of pregnancies occurring in the B. Braun dialysis network in Russia. Method We performed retrospective analysis of all pregnancy cases in B. Braun dialysis chain in Russia from 2013 to 2020. Cases were reported by the involved Renal Care Centers by a common questionnaire. All patients were treated with B. Braun Dialog+, AV set Dialog +, SolCart bicarbonate cartridge and Xevonta dialyzers. Results 13 pregnancies were reported, all achieved without infertility treatment: 1 was interrupted by voluntary termination of pregnancy, 9 resulted with living birth (6 females and 3 males) after a mean of 24 gestational weeks (7 cesarean and 2 vaginal deliveries), 2 with stillbirth and 1 with spontaneous abortion after 8 gestational weeks. Mothers with positive pregnancy outcome were significantly younger (27.9±5.1 vs. 36.3±5.6 years), without differences in dialysis vintage, previous successful or unsuccessful pregnancies and during follow-up blood pressure was well controlled. Females newborns had borderline significant greater body weight (1.9±0.6 vs. 1.1±0.1 kg, p=0.076). 5 newborns had respiratory distress syndrome, 1 jaundice. Conclusion Prompt increase of treatment frequency and time on high-flux/HDF dialysis were associated with successful pregnancy outcome. Considering that cardiovascular system and endogenous metabolism dynamically alter during pregnancy, various clinical parameters, i.e. body weight and blood pressure, should be closely monitored to modify dialysis settings accordingly. Female gender of the newborn seems to be associated with a better outcome. This study shows the safety of high-flux hemodialysis and hemodiafiltration treatments in pregnancy and the benefit of enhanced prescription in dialysis time and frequency. Acknowledgement The authors express their gratitude to the entire medical multidisciplinary team from B. Braun Russia Renal Care Centers and other local medical institutions directly and indirectly involved in the treatment of each case described.

Dysregulated sexuality and childhood trauma in eating disorders: Psychopathological, biological, and behavioural correlates

IntroductionSexual dysfunction is common in eating disorders (EDs), but its relevance is often overlooked.ObjectivesTo describe different ED clinical subgroups in terms of psychopathology, putative biological correlates, and consequences of dysregulated sexuality, focusing on the role of childhood trauma.MethodsHealthy controls (n=60), binge-purging (n=38), and restricting patients (n=24) were compared (age- and BMI-adjusted ANOVA; Bonferroni post-hoc tests), using total scores of Eating Disorder Examination Questionnaire (EDE-Q), Emotional Eating Scale (EES), SCL-90-R Global Severity Index (GSI), Barratt Impulsiveness Scale (BIS-11), Difficulties in Emotion Regulation Scale (DERS), Childhood Trauma Questionnaire (CTQ), Female Sexual Functioning Index (FSFI), Hypersexual Behaviour Inventory (HBI), and patients’ hormonal profiles (gonadal and pituitary hormones, ghrelin). Self-reported voluntary termination of pregnancy (VTP) and promiscuous sexual activity were recorded. For ED patients (N=62), regression analyses between significant variables and HBI were carried, applying moderation models for different CTQ scores.ResultsTable 1 outlines significant between-group comparisons (°: different from controls; *: different from restricting patients; p<0.05). Binge-purging patients had higher FSH, LH, and ghrelin levels, more VTPs and promiscuity. HBI showed significant correlations with EES, SCL-90-R-GSI, DERS, CTQ, and ghrelin levels. CTQ moderated interactions for DERS and EES (Figure 1).Binge-purgingRestrictingControlsFEDE-Q3.86±1.20°3.41±1.64°0.85±0.8367.32EES40.85±22.74°*16.01±15.8819.87±15.217.01SCL-90-R GSI1.73±0.65°1.27±0.69°0.68±0.4420.32BIS-1162.47±9.91°60.81±8.5657.04±10.044.99DERS106.97±29.15°*83.97±33.1278.14±14.1210.21CTQ55.32±21.06°49.31±10.81°38.02±8.3215.24FSFI17.32±11.89°*11.70±10.98°29.32±7.4524.02HBI28.75±13.89*20.56±3.1226.11±4.904.92ConclusionsDysregulated sexuality is linked to emotion dysregulation and childhood trauma. Binge-purging patients experience adverse behavioural consequences.DisclosureNo significant relationships.

Dorsolumbosacral agenesis: Case report and literature review

Objetives: To report a case of dorsolumbosacral agenesis and to make a systematic review of the literature focused on prenatal diagnosis. Materials and methods: We report a case of a 32year old pregnant woman, with a 30 week pregnanacy, without prenatal care, the fetus is diagnosed with dorsolumbosacral agenesis. The mother request voluntary termination of pregnancy. A systematic review of the literature focused on prenatal diagnosis of thos condiction is performed. Results: We found 50 papers, 6 met the inclusión critiria. Three of them with prenatal diagnosis. In the first case the diagnosis was made at 13 weeks of gestation and termination of preganancy was requested. In the second case corresponded an biamniotic bicorial twin preganancy. One normal feto and one presented dorsolumbosacral agenesis. The diagnosis was made in the second trimester. The pregnancy continued until 34 week of gestation and the affected neonate had perinatal death. The third case, the diagnosis was made at 18 weeks and a male newborn of 2990gr was born at 37 weeks of gestation. Conclusion: Dorsolumbosacral agenesis is a very severe form of caudal regresión syndrome, with only a few cases reportted in the literature. To the best of our knowladge this is the fourth case reported with prenatal diagnosis.

Analysis of recommendations by the Regional Maternal Mortality Commissions involving deaths from induced abortion in the city of Rio de Janeiro, Brazil

Abortion is still a public health problem in Brazil and is among the leading causes of maternal death. Socially vulnerable women have the greatest risk of death from abortion. The Brazilian Ministry of Health determined mandatory investigation of deaths of childbearing-age women with discussion of maternal deaths by Maternal Mortality Committees, aimed at identifying failures in management of cases that led to or determined the deaths. In the city of Rio de Janeiro, this structure is organized in a Municipal Committee and ten Regional Commissions for Prevention and Control of Maternal Mortality. The objective was to analyze the recommendations by the Regional Commissions on deaths from induced abortion. We carried out a descriptive study of recommendations by the Regional Commissions on deaths from induced abortion in women living in the city of Rio de Janeiro from 2011 to 2016. Case selection used the classification of the Guidelines for Epidemiological Surveillance of Maternal Death for deaths from abortion. Recommendations were classified according to two points: "recipients and content" and "performance of abortion and related factors". The recommendations were predominantly technical and biomedical, without correlating the deaths to social, cultural, and economic issues. Taboo topics such as voluntary termination of pregnancy and search for changes in standards that would promote women's right to health were missing. Regional Commissions exercise an important activity and are a step forward in the fight against maternal mortality, but their recommendations only contribute partially to reducing mortality from induced abortion.

A defesa da interrupção voluntaria da gravidez nos cartuns "Abortinho" de Fabiane Langona (2015-2017)

O artigo versa sobre como a defesa da interrupção voluntária da gravidez se tornou um tema abraçado por cartunistas e quadrinistas contemporâneas que se mostram sintonizadas com as demandas feministas, centrando o enfoque na série “Dicas do Abortinho”, criada pela cartunista Fabiane Langona. Na primeira parte do texto, apresento de forma breve três trabalhos pontuais que, com abordagens distintas, discutem tabus, mitos e os riscos inerentes à prática do aborto clandestino: a narrativa autobiográfica em forma de HQ desenhada pela cartunista Cynthia B, publicada na revista Piauí, em 2014; o romance gráfico produzido em 2015, pela artista Leah Hayes; e a reportagem gráfica, escrita em 2016 pela jornalista Joyce Gomes e pela quadrinista Helô D’Angelo, autora dos desenhos. Na segunda parte, analiso especificamente o personagem “Abortinho”, colocando em relevo as estratégias visuais e discursivas empregadas pela cartunista para tratar desse tema como um problema social e político, ainda que tenha gerado uma significativa hostilidade entre leitores e leitoras. Entendo que a reação à série “Abortinho” se deu menos pelo impacto visual que a série produz sobre seus leitores, do que pela densidade que o tema “aborto” carrega, afinal a defesa dos direitos ao corpo e à liberação do aborto consistem nos maiores desafios enfrentados pelos feminismos contemporâneos. Palavras-chave: Aborto. Quadrinhos. Fabiane Langona. Feminismo.

Évaluation de l’éthique des pratiques pharmaceutiques : une revue de la littérature

Ethics are at the heart of pharmacy practice. This is a literature review. The main objective is to carry out a review of studies relating on the evaluation of ethics in pharmacy practice. Documentary research on Pubmed was carried out from 1990 to 2020. All studies relating to pharmaceutical ethics that may be applied to the pharmacy practice in pharmacies or in health establishments and that conducted a qualitative or quantitative evaluation of pharmaceutical ethics (e.g. surveying pharmacists or pharmacy students, using a measurement tool, quantifying or qualifying a perception or behaviour) were included. The studies come mainly from Anglo-Saxon countries (29/38). Studies related to pharmacy practice, mainly target pharmacists (n=27) and pharmacy students (n=16), and more often have a quantitative component of (n=28). The main ethical dilemmas observed dealt with emergency oral contraception (EOC), voluntary termination of pregnancy with drugs, euthanasia, commercial practices of the pharmaceutical industry, refusal to dispense a prescription in a broader context and plagiarism or dishonesty in academic settings. Few studies have been conducted on the review of ethics of pharmacy practices from 1990 to 2020. Pharmacy students and practicing pharmacists are regularly exposed to ethical dilemmas and respond to these dilemmas with due consideration, taking into account six principles, eight values and other factors. Exposure to these dilemmas creates inaction, stress and distress. A few possible solutions have been identified.

The Pregnancy Outcomes Among Newly Arrived Asylum-Seekers in Italy: Implications of Public Health

BackgroundMigration has a significant impact on overall health and pregnancy outcome. Despite the fact that growing volume of migration flows significantly engaging the public health system of European host countries, there is a lack of evidence concerning pregnancy outcomes of newly arrived asylum-seeking women.MethodsData about pregnant asylum seekers hosted in the Italian Reception Centers between the 1 st June 2016 and the 1st June 2018 were retrospectively collected and analysed in the present study. We examined the following pregnancy outcomes: miscarriage, self-induced abortion, voluntary pregnancy termination, live-birth; and studied potentially related socio-demographic factors.ResultsOut of the 110 pregnant women living in the reception centers, 44 (40%) had eutocic delivery, 8 (7.3%) dystocic delivery, 15 (13.6%) miscarriage, 17 (15.5%) self-induced abortion and 26 (23.6%) underwent voluntary pregnancy termination. Nigerian women were at a significantly higher risk of abortive outcomes for voluntary pregnancy termination (p < 0.001), miscarriage (p = 0.049) and self-induced abortion (p < 0.001). Being unmarried was significantly associated with voluntary pregnancy termination and self-induced abortion. Women who chose to undergo unsafe abortion did not result to have significantly lower educational levels, compared to women who preferred medical abortion.ConclusionThis study offers first insights into pregnancy outcomes among asylum-seeking women in Italy. The country of origin and marital status seem to significantly impact on pregnancy outcome. We identified sub-groups of migrant women at increased risk of abortive outcomes, and highlight the need to improve care in order to promote migrant women’s reproductive health.

Who Is Best to Test? A Systematic Review of Chlamydia Infections in Switzerland.

In many countries, community pharmacies provide sexual-health-related services to limit the spread of sexually transmitted infections (STIs), including chlamydia testing. To identify suitable target groups for pharmacy-based chlamydia testing in Switzerland, we aimed to assess chlamydia prevalence, identify risk groups, and delineate screening strategies. We conducted a systematic literature search up to December 2019 in PubMed, EMBASE, and Web of Science, according to the PRISMA guidelines, using as keywords “chlamydia”, “screening”, and “Switzerland”. Two researchers screened the title, abstract, and full-text article and assessed the methodological quality. The literature search generated 108 hits, and nine studies were included. Chlamydia prevalence ranged between 0.8 and 12.8%. Most frequently affected were undocumented women undergoing voluntary termination of pregnancy (12.8%, 95% CI: 8.4–18.9), HIV-positive men who have sex with men (10.9%, 95% CI: 9.2–17.6), and adult offenders (6.5%, 95% CI: 3.2–9.0). Systematic screening was suggested for the first two risk groups and women suffering a miscarriage. To conclude, chlamydia infections are prevalent in Switzerland, but the identified risk groups are difficult to reach for a pharmacy-based testing service. More studies are needed to identify suitable target groups, including customers seeking sexual health services, particularly emergency contraception users who already receive counselling for STIs at community pharmacies.

Maternal Obesity Affects the Glucose-Insulin Axis During the First Trimester of Human Pregnancy.

Background and objective: The maternal glucose-insulin axis is central for metabolic adaptations required for a healthy pregnancy. Metabolic changes in obese mothers in early pregnancy have been scantly described. Here we characterized the glucose-insulin axis in the first trimester of human pregnancy and assessed the effect of maternal obesity and fat mass.Methods: In this cross-sectional study, maternal blood samples (N = 323) were collected during voluntary pregnancy termination (gestational age 4+0–11+6 weeks) after overnight fasting. Smokers (N = 198) were identified by self-report and serum cotinine levels (ELISA). Maternal BMI (kg/m2) and serum leptin (ELISA) were used as proxy measures of obesity and maternal fat mass, respectively. BMI was categorized into under-/normal weight (BMI < 25.0 kg/m2), overweight (BMI 25.0–29.9 kg/m2) and obese (BMI ≥ 30.0 kg/m2), and leptin in tertiles (1st tertile: leptin < 6.80 ng/ml, 2nd tertile: leptin 6.80–12.89 ng/ml, 3rd tertile: leptin > 12.89 ng/ml). ISHOMA insulin sensitivity index was calculated from glucose and C-peptide (ELISA) serum concentrations. Analyses of covariance including multiple confounders were performed to test for differences in glucose, C-peptide and ISHOMA between gestational age periods, BMI and leptin groups. C-peptide and ISHOMA were log-transformed before analyses.Results: At weeks 7–9, fasting glucose and C-peptide levels were lower (P < 0.01 and P < 0.001, respectively) and insulin sensitivity higher (P < 0.001) than at weeks 4–6. Glucose levels were not significantly different between BMI or leptin categories. In contrast, C-peptide increased by 19% (P < 0.01) between the normal weight and the overweight group and by 39% (P < 0.001) between the overweight and obese group. In the leptin groups, C-peptide increased by 25% (P < 0.001) between the 1st and 2nd leptin tertile and by 15% (P < 0.05) between the 2nd and 3rd leptin tertile. ISHOMA decreased with higher BMI and fat mass. ISHOMA decreased by 18% (P < 0.01) between the normal weight and the overweight group and by 30% (P < 0.01) between the overweight and the obese group. In the leptin groups, ISHOMA decreased by 22% (P < 0.001) between the 1st and 2nd leptin tertile and by 14% (P < 0.05) between the 2nd and 3rd leptin tertile.Conclusions: At the group level, fasting glucose, C-peptide and insulin sensitivity dynamically change in the first trimester of human pregnancy. Maternal obesity is associated with higher C-peptide and lower insulin sensitivity at all periods in the first trimester of human pregnancy, while glucose is unaltered. These findings have implications for the timing of early gestational diabetes mellitus risk screening.

Rate of Voluntary Termination of Unwanted Pregnancy among Undergraduate Students in a Tertiary Institution in North Central, Nigeria

Termination of unwanted pregnancies especially if unsafely procured contributes significantly to maternal deaths. This study was designed to determine the rate of voluntary termination of unwanted pregnancies among undergraduate students. It was a cross-sectional study of female university undergraduates. A self administered pre-tested questionnaire was used to elicit information on socio-demographic variables, sexual activities, unwanted pregnancies and voluntary termination. SPSS software version 25.0 was used for analysis. Frequency tables were generated and Chi square was used as a test of statistics. Four hundred and thirty one respondents were studied out of which 304(70.5%) of them have been sexually exposed. The modal age of initiation of sexual intercourse was 20 years. Most 177(58.2%) has had one sexual partner while 127(41.8%) had multiple sexual partners. The major motivation for sexual activity was found to be pleasure 60.5%, financial reasons 18.1%, peer pressure 9.2 %, and 12.2% gave no reason. At least one-third 119(39.1%) has had an unwanted pregnant in the past and 63(52.9%) were induced. Among the induced abortions most 32(50.8%) had termination done more than once while 31(49.2%) had it done once. As high as 96.1% were aware of contraceptives and 69.6% had ever used a method in the past .There was statistically significant relationship between unwanted pregnancy and contraceptive usage (p=0.001).The rate of voluntary termination of unwanted pregnancies (52.9%) was high with associated low contraceptive usage. Unrestricted reproductive health information and care should be made accessible and available to these young people.

Prenatal diagnosis of congenital heart defects and voluntary termination of pregnancy

The prenatal diagnosis of an isolated congenital heart defect is a matter of concern for parents. The decision of whether to terminate the pregnancy according to the different types of congenital heart defects has not been investigated yet. This study aimed to evaluate the frequency of voluntary termination of pregnancy after the prenatal diagnosis of a congenital heart defect in a tertiary care center. This was a retrospective study of patients who were referred to our center from January 2013 to December 2019, underwent fetal echocardiography, and were counseled by a perinatologist and a pediatric cardiologist. The following data were collected: prenatal diagnosis, including genetic testing; gestational age at diagnosis; and outcome of pregnancy. The diagnoses were stratified retrospectively according to the type of congenital heart defect and its severity (low complexity, moderate complexity, and high complexity) by a perinatologist and a pediatric cardiologist. Of 704 women who received a diagnosis of fetal congenital heart defect, 531 (75.4%) were seen before 23 weeks' gestation, which is the upper limit imposed for the termination of pregnancy by the Italian legislation. Congenital heart defects were apparently isolated in 437 of 531 cases (82.3%). Overall, 108 of 531 patients (20.3%) requested a termination of pregnancy. The rate of termination of pregnancy was found to vary according to the severity of congenital heart defects: low complexity, 0%; moderate complexity, 12.1%, and high complexity, 33.2% (P<.001). The presence or absence of associated anomalies or the ethnicity of the couples was not found to have an influence on women's decisions. In our population, the decision to terminate a pregnancy after the diagnosis of a fetal congenital heart defect is influenced by the surgical complexity of the congenital heart defect itself. However, most patients, including those with the most severe forms of congenital heart defect, decided to continue the pregnancy.

Defining ambulatory care sensitive conditions for adults in Portugal

BackgroundAmbulatory Care Sensitive Conditions (ACSCs) are health conditions for which adequate management, treatment and interventions delivered in the ambulatory care setting could potentially prevent hospitalization. Which conditions are sensitive to ambulatory care varies according to the scope of health care services and the context in which the indicator is used. The need for a country-specific validated list for Portugal has already been identified, but currently no national list exists. The objective of this study was to develop a list of Ambulatory Care Sensitive Conditions for Portugal.MethodsA modified web-based Delphi panel approach was designed, in order to determine which conditions can be considered ACSCs in the Portuguese adult population. The selected experts were general practitioners and internal medicine physicians identified by the most relevant Portuguese scientific societies. Experts were presented with previously identified ACSC and asked to select which could be accepted in the Portuguese context. They were also asked to identify other conditions they considered relevant. We estimated the number and cost of ACSC hospitalizations in 2017 in Portugal according to the identified conditions.ResultsAfter three rounds the experts agreed on 34 of the 45 initially proposed items. Fourteen new conditions were proposed and four achieved consensus, namely uterine cervical cancer, colorectal cancer, thromboembolic venous disease and voluntary termination of pregnancy. In 2017 133,427 hospitalizations were for ACSC (15.7% of all hospitalizations). This represents a rate of 1685 per 100,000 adults. The most frequent diagnosis were pneumonia, heart failure, chronic obstructive pulmonary disease/chronic bronchitis, urinary tract infection, colorectal cancer, hypertensive disease atrial fibrillation and complications of diabetes mellitus.ConclusionsNew ACSC were identified. It is expected that this list could be used henceforward by epidemiologic studies, health services research and for healthcare management purposes. ACSC lists should be updated frequently. Further research is necessary to increase the specificity of ACSC hospitalizations as an indicator of healthcare performance.

Aborto legal o aborto desigual: penalización del aborto a la luz de la ley de identidad de género

Existe una incoherencia jurídica entre los artículos del código penal que penalizan la interrupción voluntaria del embarazo, y el principio de igualdad consagrado en el artículo 16 de la Constitución Nacional Argentina. Dicha incoherencia no resulta evidente per se, sino que es posible descubrirla teniendo en cuenta, por un lado, la Ley N°26.743 de Identidad de Género, y además que quienes son penalizadas por abortar en el Código Penal Argentino son las mujeres. Partiendo de esas bases normativas, se desarrollará un análisis en global, para evaluar cómo unas se relacionan con otras y a partir de ello elaborar una conclusión respecto de su vigencia, aplicabilidad, y problemáticas.

Prenatal screening diagnosis and management in the era of coronavirus: the Sardinian experience.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new coronavirus, was first identified in December 2019 in Wuhan, China and spread rapidly, affecting many other countries. The disease is now referred to as coronavirus disease 2019 (COVID-19).The Italian government declared a state of emergency on 31st January 2020 and on 11th March World Health Organization (WHO) officially declared the COVID-19 outbreak a global pandemic. Although the COVID-19 incidence remained considerably lower in Sardinia than in the North Italy regions, which were the most affected, the field of prenatal screening and diagnosis was modified because of the emerging pandemic. Data on COVID-19 during pregnancy are so far limited. Since the beginning of the emergency, our Ob/Gyn Department at Microcitemico Hospital, Cagliari offered to pregnant patients all procedures considered essential by the Italian Ministry of Health. To evaluate the influence of the COVID-19 pandemic on the activities of our center, we compared the number of procedures performed from 10th March to 18th May 2020 with those of 2019. Despite the continuous local birth rate decline, during the 10-week pandemic period, we registered a 20% increment of 1st trimester combined screening and a slight rise of the number of invasive prenatal procedures with a further increase in chorionic villi sampling compared to amniocentesis. Noninvasive prenatal testing remained unvariated. The request for multifetal pregnancy reduction as a part of the growing tendency of voluntary termination of pregnancy in Sardinia increased. The COVID-19 pandemic provides many scientific opportunities for clinical research and study of psychological and ethical issues in pregnant women.

P1470PREGNANCY IN HEMODIALYSIS: EXPERIENCE OF HEMODIALYSIS CENTERS IN SOUTHERN TUNISIA DURING 34 YEARS

Abstract Background and Aims Women with chronic kidney disease are much less likely to become pregnant and pregnany has always been considered as a challenging event both for the mother and the fetus. The challenge is harder in patients undergoing dialysis. The main objective of our work is reporting our experience of pregnancy’s cases in hemodialysis centers in southern Tunisia. Method It was a retrospective study looked at 25 spontaneous pregnancies in 19 patients treated with periodic hemodialysis in different hemodialysis centers in southern Tunisia over a period of 34 years. All pregnancies were spontaneous and are counted even spontaneous or voluntary abortions during the 1st and 2nd trimester of pregnancy Results The maternal age at the onset of pregnancy was, on average, 35.63 years ± 5.62 (between 23 and 44 years). Our study included 19 patients from southern Tunisia, 6 of them belonged to the governorate of Medenine. Hypertension was present in 7 patients (37%). The average duration of hemodialysis before conception is 4.56 years ± 3.55 (1 - 17 years). Seven patients (37%) had residual diuresis of: 1 liter per 24h in 2 cases, 500ml per 24h in other cases and the rest of the patients were anuric. All our patients were anemic before pregnancy with a mean hemoglobin level at 8 ± 1.54 g / dl (5.1 - 10.6 g / dl) with erythropoietin use in 12 (48%), folate in 11 cases (44%), intravenous iron in 11 cases (44%) and transfusion in 6 cases (24%).In our series, the average urea level was 22.19 ± 4.29 mmol / L .The urea level was lower or equal to 20 mmol / L in 8 cases (42%) and greater than 20 mmol / L in 11 cases (58%). Among the 25 pregnancies, 16 (64%) resulted in the birth of a live child: 4 intra-uterine malformations, 4 early abortions and one voluntary termination of pregnancy. There were 2 deaths within 28 days after birth. Pregnancy was considered a success if it resulted in the birth of a newborn surviving at least 28 days. Thus, the success rate was estimated at 56%. Among the maternal complications, hypertension was the most frequently complication (35% of cases). There were 2 cases of hemorrhage’s delivery as obstetrical complication. Among fetal complications, prematurity was frequent and was present in 15 cases (60%): 10 cas (40%) of average prematurity, 4 cases (16%) of great prematurity and 1 case (4%) of extreme immaturity. Hydramnios was found in 3 cases (16%). Intra-uterine growth retardation was found in 13 cases (52%) and 6 cases of death (24%) were described. Conclusion Pregnancy during chronic end stage renal failure is rare but possible. The chance of giving birth to a live child has increased in parallel with advances in hemodialysis techniques and early weight-bearing. Thus, a successful pregnancy in woman on dialysis requires collaboration among nephrologists, dialysis unit staff and obstetricians.

Influence of the detection of parent-of-origin on the pregnancy outcomes of fetuses with copy number variation of unknown significance

The widespread application of high-resolution chromosome detection technology in clinical practice has identified many variants of unknown significance (VOUS) in prenatal diagnosis. The purpose of this study was to prospectively analyze the chromosomal results of parents and the follow-up information of pregnancy outcomes of prenatal samples with VOUS, so as to determine the influence of the detection of parent-of-origin on the pregnancy outcomes of fetuses with VOUS. The present study analyzed amniotic fluid samples obtained from women with different risk indications between February 2017 and December 2018. The samples were subjected to copy number variation sequencing, and detection of parent-of-origin was suggested in cases of samples with VOUS. The pregnancy outcome was followed up. In a total of 14073 amniotic fluid samples, 729 cases of VOUS were detected (5.2%, 729/14073) and 721 cases were followed up successfully. Among the 721 cases, 525 patients agreed to detect the parent-of-origin (72.8%, 525/721). It was revealed that the VOUS in 460 of the fetuses were hereditary (87.6%, 460/525). The percentages of abnormal pregnancy outcomes (included pregnancy loss, fetal pathological abnormality, preterm delivery, neonatal death, birth defects) in the inherited, de novo, and refusal to detect the parent-of-origin (i.e. unknown origin) groups were 4.3% (20/460), 6.2% (4/65), and 6.6% (13/196), respectively. There was no significant difference among the three groups (P > 0.05). The rate of voluntary termination of pregnancy (TOP) in the unknown origin group was significantly higher than that in the group that had determined the parent-of-origin (14.3% vs 7.4%, P = 0.005). There is currently no evidence that suggests that the proportion of abnormal pregnancy outcomes is higher in fetuses with VOUS than in other fetuses. However, the present study revealed that determining the parent-of-origin affects the decision to undergo voluntary TOP, as the rate of voluntary TOP in the group that refused detection was higher than that in the group that consented.

ACTIVISMO FEMINISTA EN INSTAGRAM. EL CASO DE LA CAMPAÑA NACIONAL POR EL DERECHO AL ABORTO LEGAL SEGURO Y GRATUITO EN ARGENTINA

espanolDurante 2018 la democracia argentina asistio al debate del aborto que hasta ese entonces habia estado excluido de la agenda publica. La Campana Nacional por el Derecho al Aborto Legal Seguro y Gratuito organizo, desde las plataformas digitales, la accion colectiva a favor de la interrupcion voluntaria del embarazo. El objetivo general de la investigacion es describir las estrategias que llevo adelante la Campana, en Instagram, para propiciar el proceso de conversacion digital en torno al aborto. La metodologia utilizada es el clasico analisis de contenido combinado con el web scrapingy diferentes opensoftwares. El estudio se enmarca en los desarrollos teoricos de la tecnopolitica y el ciberactivismo. EnglishDuring 2018, Argentine democracy attended the abortion debate that until then had been excluded from the public agenda. The National Campaign for the Right to Legal, Safe and Free Abortion organized, on digital platforms, collective action in favor of voluntary termination of pregnancy. The main objective of this research is to describe the strategies carried out by the Campaign, on Instagram, to promote the process of digital conversation around abortion. The methodology uses the classic content analysis combined with web scrapping and various open software. The study is framed in the theoretical developments of technopolitics and cyberactivism.

Serum and placental periostin levels in women with early pregnancy loss

ObjectivesPeriostin is secreted from the placenta in the embryonic period and it is emphasized that it may be involved in endometrial implantation. In this study, we aimed to investigate periostin serum levels and placental tissue expression in first trimester pregnancy losses. Study designIn this prospective case-control study, 30 patients who underwent dilatation and curettage with first trimester spontaneous abortion (<10 weeks of gestation) were included in the study group and 30 patients who had voluntary pregnancy termination (<10 gestational weeks) were included in the control group. Serum samples collected from the study and control groups were analyzed usingenzyme-linkedimmunosorbent assay (ELISA), and trophoblastic and decidual tissues were examined using immunohistochemical staining with streptavidin-biotin-peroxidase techniques. ResultsThere were no significant differences between the groups in terms of age, gravida status, parity number, gestational week, and number of previous abortions. In the spontaneous abortion group, the serum level of periostin was significantly lower than in the voluntary termination group (6.56 ± 4.16 pg/mLvs. 9.51 ± 4.52 pg/mL, p = 0.03). There was no significant difference between the two groups in terms of periostin expression in decidual and trophoblastic tissue (p = 0.617, p = 0.274, p = 0.497). ConclusionPeriostin serum levels were significantly reduced in patients with spontaneous pregnancy loss. Periostin can be used as a predictive marker for the success of endometrial implantation.