AJOG global reports最新文献

{"title":"Acute Sheehan syndrome following massive postpartum hemorrhage due to vulvar hematoma","authors":"","doi":"10.1016/j.xagr.2024.100399","DOIUrl":"10.1016/j.xagr.2024.100399","url":null,"abstract":"<div><div>Acute Sheehan syndrome appearing within 6 weeks postpartum is a rare form of hypopituitarism caused by postpartum hemorrhage. A 37-year-old Japanese woman experienced a vulvar hematoma after spontaneous labor at 40 weeks gestation, leading to massive postpartum hemorrhage (estimated total blood loss of 3,000 mL). Despite successful cesarean delivery and hematoma drainage, she presented 28 days postpartum with anorexia, fatigue, and hyponatremia after initial recovery. MRI revealed a swollen pituitary gland with subacute hemorrhage, confirming the diagnosis. Hormonal replacement therapy with levothyroxine, hydrocortisone, estrogen, and progesterone was initiated. This is the first reported case of acute Sheehan syndrome following a vulvar hematoma, a condition typically not considered a risk factor for this syndrome. The case highlights the importance of considering rare complications like acute Sheehan syndrome in patients with massive postpartum hemorrhage, even when the pathogenesis is clinically common, such as vulvar hematomas.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoughts and opinions about fertility preservation and family building from the transgender community—an interview-based approach","authors":"","doi":"10.1016/j.xagr.2024.100398","DOIUrl":"10.1016/j.xagr.2024.100398","url":null,"abstract":"<div><h3>Background</h3><div>When considering the significant prevalence of transgender and gender nonconforming individuals, it is imperative that physicians work to understand the unique needs of this population including paths to family building and fertility preservation.</div></div><div><h3>Objective</h3><div>To understand the thoughts and opinions about fertility preservation and family building within the transgender community.</div></div><div><h3>Study design</h3><div>Survey-based study and qualitative study at a single, large hospital-affiliated fertility center. A 16-question survey followed by a 30-minute virtual interview was utilized. Forty-three participants completed the survey and were used for quantitative analysis, and 40 audio files were used for qualitative analysis.</div></div><div><h3>Results</h3><div>The average age of participants was 27.0±7.3 years old. The majority of participants were assigned female at birth (70.7%); however, most participants’ gender identities were transgender (54.8%) or nonbinary (47.6%). The average age at which participants realized they were transgender and disclosed their identity to a friend, or partner, was 16.2±7.0 (range 3–30) and 20.1±5.6 (range 11–33), respectively. The average age that participants disclosed their gender identity to their parents, siblings, or other family was 22.4±5.9 (range 12–35). Five categories were utilized to summarize the experiences and opinions of the participants: family building and parenthood goals, influences of family background/partner on parenthood goals, awareness and knowledge about fertility preservation, barrier to family building, and recommended healthcare provider communication and education. Sixteen participants (40.0%, <em>n</em>/<em>N</em>=16/40) were interested in having children in the future, 18 (45.0%, <em>n</em>/<em>N</em>=18/40) were unsure/dependent on their partner, and 6 (15.0%, <em>n</em>/<em>N</em>=6/40) were not interested in having children. Of those interested in having children (<em>n</em>/<em>N</em>=16/40), the majority wished to utilize adoption to build their family (68.8%, <em>n</em>/<em>N</em>=11/16). Nine participants (22.5%, <em>n</em>/<em>N</em>=9/40) reported that fertility preservation was never discussed. Most participants agreed that gender dysphoria, cost, inadequate counseling, and improvements in healthcare knowledge about transgender individuals were key influences on their opinions about pursuing fertility preservation or parenthood.</div></div><div><h3>Conclusion</h3><div>Transgender individuals want to build families, and the majority consider adoption the preferred method. There are still transgender individuals who are not counseled about fertility preservation. It is imperative the healthcare system continues to improve the education of healthcare providers about management and care of transgender individuals to provide the best care for this vulnerable population.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the RHOA/ROCK pathway in the regulation of myometrial stages throughout pregnancy","authors":"","doi":"10.1016/j.xagr.2024.100394","DOIUrl":"10.1016/j.xagr.2024.100394","url":null,"abstract":"<div><h3>Background</h3><div>Controlling uterine contractile activity is essential to regulate the duration of pregnancy. During most of the pregnancy, the uterus does not contract (i.e., myometrial quiescence). The myometrium recovers its contractile phenotype at around 36 weeks (i.e., myometrial activation) through several mechanisms. The RHOA/ROCK pathway plays a vital role in facilitating muscular contractions by calcium sensitization in humans. Yet, the role of this pathway during different myometrial stages, including quiescence, has not been elucidated.</div></div><div><h3>Objective</h3><div>we aimed to study the role of the RHOA/ROCK pathway in the regulation of the different myometrial stages throughout pregnancy. Specifically, we hypothesized that the inhibition of the components of the RHOA/ROCK pathway play an important role in maintaining uterine quiescence.</div></div><div><h3>Study design</h3><div>Myometrial samples were obtained from pregnant individuals who underwent cesarean section. Pregnant individuals who delivered preterm without labor (myometrial quiescence), preterm with labor (nonphysiological myometrial stimulation), term not in labor (activation), and term in labor (physiological myometrial stimulation) were included. The mRNA and protein expression of RHOA, ROCK I, ROCK II, RND1-3, and ROCK activity through pMYTP1 were evaluated.</div></div><div><h3>Results</h3><div>We found that the human myometrium constitutively expressed RHOA/ROCK pathway components throughout pregnancy. No changes in the components of the RHOA/ROCK pathway were found during quiescence. Moreover, the RHOA protein and ROCK activity increased in the myometrium during labor, supporting the hypothesis that this pathway participates in maintaining the contractile activity of the myometrium. This study provides insight into the role of the RHOA/ROCK pathway in controlling myometrial contractile activity during pregnancy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guillain-Barré syndrome in pregnancy: a case report and review of the literature","authors":"","doi":"10.1016/j.xagr.2024.100396","DOIUrl":"10.1016/j.xagr.2024.100396","url":null,"abstract":"<div><div>Guillain-Barré syndrome represents a heterogeneous group of immune-mediated peripheral neuropathies that are characterized by various clinical manifestations. Reporting this clinical case emphasizes the rarity of Guillain-Barré syndrome, the diagnostic challenges faced by healthcare providers, and the risk of delayed diagnosis for both the mother and fetus. A 34-year-old pregnant woman at 33 weeks of gestation presented to the inpatient ward complaining of paresthesia in the lower and upper limbs, muscle pain, balance disturbances, moderate headache, nausea and vertigo, general weakness, and pronounced fatigue. The patient had experienced an acute viral respiratory infection 4 weeks before presenting to the hospital. The patient was admitted to the intensive care unit with a preliminary diagnosis of acute viral respiratory infection and nasopharyngitis. The patient's condition worsened dynamically, manifesting bulbar syndrome (swallowing problems), paresthesia of the anterior abdominal wall, reduced perception of fetal movements, numbness of the tongue, and low fever (37.2°C). A diagnosis of acute inflammatory demyelinating polyradiculopathy (Guillain-Barré syndrome) was established. Despite treatment, the neurologic symptoms worsened. The paravertebral radicular type pains were difficult to manage with administered analgesic therapy, and there was a progression of the bulbar syndrome. Treatment with intravenous immunoglobulin was initiated. Consequently, it was recommended by the multidisciplinary council to perform an emergency cesarean delivery, in the interest of the mother and fetus. Guillain-Barré syndrome is a rare condition that occurs during pregnancy and requires thorough evaluation, prompt multidisciplinary assessment, and individualized management of delivery to improve maternal and fetal prognosis.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using machine learning to predict the risk of developing hypertensive disorders of pregnancy using a contemporary nulliparous cohort","authors":"","doi":"10.1016/j.xagr.2024.100386","DOIUrl":"10.1016/j.xagr.2024.100386","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive disorders of pregnancy (HDP) are significant drivers of maternal and neonatal morbidity and mortality. Current management strategies include early identification and initiation of risk mitigating interventions facilitated by a rules-based checklist. Advanced analytic techniques, such as machine learning, can potentially offer improved and refined predictive capabilities.</div></div><div><h3>Objective</h3><div>To develop and internally validate a machine learning prediction model for hypertensive disorders of pregnancy (HDP) when initiating prenatal care.</div></div><div><h3>Study Design</h3><div>We developed a prediction model using data from the prospective multisite cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) among low-risk individuals without a prior history of aspirin utilization for preeclampsia prevention. The primary outcome was the development of HDP. Random forest modeling was utilized to develop predictive models. Recursive feature elimination (RFE) was employed to create a reduced model for each outcome. Area under the curve (AUC), 95% confidence intervals (CI), and calibration curves were utilized to assess discrimination and accuracy. Sensitivity analyses were conducted to compare the sensitivity and specificity of the reduced model compared to existing risk factor-based algorithms.</div></div><div><h3>Results</h3><div>Of 9,124 assessed low risk nulliparous individuals, 21% (n=1,927) developed HDP. The prediction model for HDP had satisfactory discrimination with an AUC of 0.73 (95% CI: 0.70, 0.75). After RFE, a parsimonious reduced model with 30 features was created with an AUC of 0.71 (95% CI: 0.68, 0.74). Variables included in the model after RFE included body mass index at the first study visit, pre-pregnancy weight, first trimester complete blood count results, and maximum systolic blood pressure at the first visit. Calibration curves for all models revealed relatively stable agreement between predicted and observed probabilities. Sensitivity analysis noted superior sensitivity (AUC 0.80 vs 0.65) and specificity (0.65 vs 0.53) of the model compared to traditional risk factor-based algorithms.</div></div><div><h3>Conclusion</h3><div>In cohort of low-risk nulliparous pregnant individuals, a prediction model may accurately predict HDP diagnosis at the time of initiating prenatal care and aid employment of close interval monitoring and prophylactic measures earlier in pregnancy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000807/pdfft?md5=1d72d5b9a6a289e9fc9dc49b95536460&pid=1-s2.0-S2666577824000807-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferences for induction of labor methods in India: a qualitative study of views and experiences of women, clinicians, and researchers","authors":"","doi":"10.1016/j.xagr.2024.100389","DOIUrl":"10.1016/j.xagr.2024.100389","url":null,"abstract":"<div><h3>Background</h3><p>Induction of labor (IOL) is an increasingly common intervention, but experiences and preferences of induction methods are under-researched particularly in low -and middle-income countries. Understanding these perspectives is important to improve the childbirth experience.</p></div><div><h3>Objective</h3><p>To explore the experiences and preferences of IOL methods for women, clinicians, and researchers in the “Misoprostol or Oxytocin for Labour Induction” (MOLI) study.</p></div><div><h3>Study Design</h3><p>This qualitative study was based in two government hospitals in the city of Nagpur, India—one tertiary referral hospital and one women's hospital. Fifty-three semi-structured interviews with women before and after induction (between days 1 and 5 postnatal), with women recruited to the “Misoprostol or Oxytocin for Labour Induction (MOLI)” randomized controlled trial (NCT03749902). Eight focus group discussions with doctors, nurses, and trial research assistants before and during trial delivery were conducted. Thematic analysis was conducted using the Framework approach.</p></div><div><h3>Results</h3><p>Four themes emerged: (1) <em>IOL methods,</em> (2) <em>impact of the study,</em> (3) <em>IOL and childbirth as one small part of the wider experiences in life</em>, and (4) <em>key moments in the childbirth experience.</em> For women, the safety of their baby was more important than any IOL method. Clinicians had apprehensions over misoprostol use which could affect protocol implementation; they reported that changing perception is difficult as usual practice feels “comfortable.” Women wanted to share their experiences and reported key moments during childbirth including vaginal examinations, “trying for normal,” bearing the pain, waiting, and relationships with staff.</p></div><div><h3>Conclusion</h3><p>Women did not have a strong preference for the IOL method and viewed childbirth positively when maternal and neonatal outcomes were good. Labor pain, vaginal examinations, a normal birth, and interactions with staff impacted women's experiences.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000832/pdfft?md5=e76f967d42d729e7b9d67da589f19285&pid=1-s2.0-S2666577824000832-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new classification method for gestational diabetes mellitus: a study on the relationship between abnormal blood glucose values at different time points in oral glucose tolerance test and adverse maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus","authors":"","doi":"10.1016/j.xagr.2024.100390","DOIUrl":"10.1016/j.xagr.2024.100390","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Gestational diabetes mellitus (GDM) can lead to various adverse pregnancy outcomes for both mothers and infants, including gestational hypertension, premature rupture of membranes, preterm birth, macrosomia, large for gestational age (LGA) infants, and neonatal hypoglycemia. Previous studies have mainly focused on the overall risk of GDM for adverse maternal and neonatal outcomes, but there has been limited research specifically investigating the relationship between different patterns of abnormal oral glucose tolerance test (OGTT) results and adverse maternal and neonatal outcomes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;The study aimed to analyze the maternal and neonatal outcomes among GDM women with different OGTT patterns and to explore a new classification method capable of stratifying GDM into high-risk (GDM-HR) and low-risk subtypes based on OGTT results.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;We conducted a retrospective cohort study at the Women's Hospital, School of Medicine, Zhejiang University, spanning from November 1, 2015, to April 30, 2018. During the study period, a total of 3268 cases of GDM were enrolled. Based on the results of the OGTT, these GDM cases were classified into 7 subtypes, and the composition ratio of each subtype and their maternal and neonatal outcomes were analyzed. Innovatively, we proposed to categorize GDM-HR (characterized by elevated fasting blood glucose [FBG] levels, including T0, T0+1, T0+2, and T0+1+2) and low-risk GDM (GDM-LR, without elevated FBG, including T1, T2, and T1+2) and compared the maternal and neonatal outcomes between the two subtypes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;(1) In this cohort of 3268 GDM cases, the composition ratios of the 7 GDM subtypes were as follows: T0 (7.9%, &lt;em&gt;n&lt;/em&gt;=260), T1 (24.2%, &lt;em&gt;n&lt;/em&gt;=791), T2 (27.4%, &lt;em&gt;n&lt;/em&gt;=897), T0+1 (5.4%, &lt;em&gt;n&lt;/em&gt;=175), T0+2 (1.7%, &lt;em&gt;n&lt;/em&gt;=56), T1+2 (26.2%, &lt;em&gt;n&lt;/em&gt;=855), and T0+1+2 (7.2%, &lt;em&gt;n&lt;/em&gt;=234). (2) GDM subtypes with elevated FBG levels (GDM-HR) exhibit more severe adverse prognostic outcomes compared to those without elevated FBG levels (GDM-LR). (3) Multiple logistic regression analysis revealed that compared to the GDM-LR group, the GDM-HR group showed increased fetal birth weight (by approximately 150 grams), and had higher rates of cesarean section (adjusted odds ratio [aOR]: 1.45, 95% confidence interval [CI]: 1.19–1.76), hypertensive disorders of pregnancy (aOR: 1.78, 95% CI: 1.35–2.35), preterm birth (aOR: 1.59, 95% CI: 1.17–2.16), macrosomia (aOR: 2.66, 95% CI: 2.07–3.43), LGA infants (aOR: 2.46, 95% CI: 2.05–2.97), and neonatal hypoglycemia (aOR: 2.00, 95% CI: 1.37–2.91). Partial correlation analysis shows a positive correlation between fetal birth weight and FBG levels, with &lt;em&gt;r&lt;/em&gt;=0.222, &lt;em&gt;P&lt;/em&gt;&lt;.001. Multiple linear regression indicates that for every 1 mmol/L increase in FBG, the fetal weight is estimated to increase by approximately 188 grams.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusio","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000844/pdfft?md5=1025a5f3dc6b0bf91c2ed312380a72b7&pid=1-s2.0-S2666577824000844-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in sensor-based health metrics during and after pregnancy: descriptive data from the apple women's health study","authors":"","doi":"10.1016/j.xagr.2024.100388","DOIUrl":"10.1016/j.xagr.2024.100388","url":null,"abstract":"<div><h3>Background</h3><p>While it is known that vital signs and behaviors change during pregnancy, there is limited data on timing and scale of changes for sensor-derived health metrics across pregnancy and postpartum. Wearable technology provides an opportunity to understand physiologic and behavioral changes across pregnancy with greater detail, more frequent measurements, and improved accuracy. The aim of this study is to describe changes in physiologic and behavioral sensor-based health metrics during pregnancy and postpartum in the Apple Women's Health Study (AWHS) and their relationship to demographic factors.</p></div><div><h3>Methods</h3><p>The Apple Women's Health Study is a digital, longitudinal, observational study that includes U.S. residents with an iPhone and Apple Watch. We evaluated changes from pre-pregnancy through delivery and postpartum for sensor-derived health metrics. Minimum required data samples per day, week and overall were data element specific, and included 12 weeks prior to pregnancy start, and 12 weeks postpartum for pregnancies lasting between 24 and 43 weeks.</p></div><div><h3>Findings</h3><p>A total of 757 pregnancies from 733 participants were included. Resting heart rate (RHR) increased across pregnancy, peaking in the third trimester (pre-pregnancy median RHR 65.0 beats per minute [BPM], interquartile range [IQR] 60.0–70.2 B.M. third trimester median RHR 75.5 B.M. IQR 69.0–82.0 B.M., with a decrease prior to delivery and nadir postpartum (postpartum median RHR 62.0 B.M. IQR 57.0–66.0 B.M.. Heart rate variability (HRV) decreased from pre-pregnancy (39.9 milliseconds, IQR 32.6–48.3 milliseconds), reaching a nadir in the third trimester (29.9 milliseconds, IQR 25.2–36.4 milliseconds), before rebounding in the last weeks of pregnancy. Measures of activity, such as exercise minutes, stand minutes, step count and Cardio Fitness were all decreased in each trimester compared to pre-pregnancy, with their nadirs postpartum. Total sleep duration increased slightly in early pregnancy (pre-pregnancy 7.2 hours, IQR 6.7–7.7 hours; 1st trimester 7.4 hours, IQR 6.8–7.9 hours), with the lowest sleep duration postpartum (6.2 hours, IQR 5.4–6.8 hours).</p></div><div><h3>Interpretation</h3><p>Resting heart rate increased during pregnancy, with a decrease prior to delivery, while heart rate variability decreased across pregnancy, with an upward trend before delivery. Behavioral metrics, such as exercise and sleep, showed decreasing trends during and after pregnancy. These data provide a foundation for understanding normal pregnancy physiology and can facilitate hypothesis generation related to physiology, behavior, pregnancy outcomes and disease.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000820/pdfft?md5=bb9f818bb446be97362923f386b51539&pid=1-s2.0-S2666577824000820-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142152046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Dilapan S compared to foley balloon in preinduction cervical ripening—a noninferiority trial","authors":"","doi":"10.1016/j.xagr.2024.100387","DOIUrl":"10.1016/j.xagr.2024.100387","url":null,"abstract":"<div><h3>Background</h3><div>The need for induction of labor is increasing in present obstetric practice. The available non-pharmacological methods for cervical ripening at term are Foley balloon and Dilapan-S. With the gaining popularity of Dilapan-S worldwide, there are very few clinical trials conducted in India to evaluate its effectiveness.</div></div><div><h3>Objective</h3><div>To compare the efficacy of Dilapan-S and Foley balloons for pre-induction cervical ripening.</div></div><div><h3>Study design</h3><div>This single-center randomized non-inferiority trial included primi- and multi-gravida women between 37 and 41 weeks of gestation and unfavourable cervix with a Bishop's score between 0 and 2. Using a random number table, patients were assigned to study Group 1 Dilapan-S and to control Group 2 Foley balloon. Dilapan-S or Foley balloon was inserted intracervically and assessed for dilation after 12 hours. Patients with unfavourable dilatation were further provided prostaglandins (PgE 1 and 2) for further augmentation of induction. Primary outcome measures included improvement in Bishop's score, and mode of delivery, followed by time to delivery from intervention, use of other augmentation methods, and maternal and neonatal outcomes.</div></div><div><h3>Results</h3><div>After screening, 296 patients with Bishop score less than 2, (148 in each group) were enrolled in the study. The number of patients who had vaginal delivery was comparable between both groups (<em>p</em>=.72), and so were the maternal outcomes. Two cases of cord prolapse occurred with Foley balloon. Group 2 showed significant improvement in Bishop's score (<em>p</em>&lt;.001), and Group 1 had a significantly higher use of augmentation with PgE1 (<em>p</em>-.01) and PgE2 (<em>p</em>&lt;.001). The number of contractions was significantly lower in Group 1 (<em>p</em>&lt;.001), and contraction intensity was higher in Group 2. There was no significant difference in cesarean delivery for failed induction of labor between the groups (<em>p</em>=.72). Based on the primary outcome measure, Dilapan-S was found to be non-inferior to the Foley balloon.</div></div><div><h3>Conclusion</h3><div>Dilapan-S is non-inferior to Foley balloon in achieving pre-induction cervical ripening in term pregnancies, and therefore Dilapan-S can be suggested as an alternative in clinical practice with minimal risks.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000819/pdfft?md5=11bcf4a70769963288838286133b452d&pid=1-s2.0-S2666577824000819-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnant women's knowledge, attitude, and practice toward physical exercise during pregnancy and its associated factors at Dessie town health institutions, Ethiopia","authors":"","doi":"10.1016/j.xagr.2024.100391","DOIUrl":"10.1016/j.xagr.2024.100391","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Physical exercise consists of planned, repetitive, and intentional movements that reduce the risk of pregnancy-related complications. Worldwide, there is a high rate of physical inactivity during pregnancy, including in Ethiopia, which has detrimental effects on both pregnant women and their developing fetus.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess pregnant women's knowledge, attitude, and practice toward physical exercise during pregnancy and its associated factors among antenatal care attendants at health institutions in Dessie, South Wollo Zone, Amhara Region, Ethiopia, in 2023.</p></div><div><h3>STUDY DESIGN</h3><p>An institutional-based cross-sectional study was conducted among 614 pregnant women receiving antenatal care between January 18, 2023, and February 25, 2023. The study participants were selected using systematic random sampling technique. Data were collected using a pretested, face-to-face interviewer-administered, and semistructured questionnaire. The data were cleaned, coded, and entered into EpiData (version 4.6; <span><span>www.epidata.dk</span><svg><path></path></svg></span>) and analyzed using SPSS (version 25; SPSS Inc, Chicago, IL). Bivariate and multivariate binary logistic regression analyses were performed to identify factors associated with knowledge, attitude, and practice toward physical exercise during pregnancy. Variables with a <em>P</em> value of &lt;.2 in the bivariate analysis were transferred to the multivariate analysis. Finally, the adjusted odds ratio and 95% confidence interval with a <em>P</em> value of &lt;.05 in the multivariate analysis were considered statistically significant.</p></div><div><h3>RESULTS</h3><p>The study found that 56.3% of participants had good knowledge, 51.5% of participants had a favorable attitude, and 32.2% of participants practiced physical exercise during pregnancy. Age, educational level, and heard about physical exercise during pregnancy were positively associated with pregnant women's knowledge and attitude. In addition, age, antenatal care follow-up, no history of abortion, ever done physical exercise before becoming pregnant, and good knowledge were positively associated with pregnant women's practice of physical exercise during pregnancy.</p></div><div><h3>CONCLUSION</h3><p>Our findings indicate that approximately half of the participants had good knowledge and a favorable attitude. However, almost one-third of the participants practiced physical exercise during their pregnancy. It is recommended that antenatal care providers advise pregnant women to strengthen their antenatal care follow-up and offer health education and counseling about the benefits of physical exercise during pregnancy.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000856/pdfft?md5=83cee1bac04de839c387db788ec95869&pid=1-s2.0-S2666577824000856-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142152007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}