AJOG global reports最新文献

{"title":"Real-world clinical burden of patients presenting with vaginitis symptoms in the United States","authors":"Justin Chen , Jenny Tse , Liucheng Shi , Mindy M. Cheng , Rebecca Lillis , Aimee M. Near","doi":"10.1016/j.xagr.2025.100504","DOIUrl":"10.1016/j.xagr.2025.100504","url":null,"abstract":"<div><h3>Background</h3><div>While vaginitis is a leading cause of primary care visits among women with a gynecologic-related diagnosis, there are limited contemporary data on the healthcare burden. This study describes the real-world healthcare resource utilization (HCRU) of patients presenting with vaginitis symptoms in the United States (US) at symptom presentation and over long-term follow-up.</div></div><div><h3>Methods</h3><div>This retrospective study utilized IQVIA’s Longitudinal Prescription (LRx) and Medical Claims (Dx) databases to capture patients presenting with vaginitis symptoms from January 1, 2018 to September 30, 2022. The date of the first diagnosis code for vaginitis or related symptoms was considered the first clinical presentation (“index visit”). Healthcare visits, diagnostic testing, and treatments were assessed for patients at presentation (index date +2 days) and 12-month follow-up, stratified by pregnancy status at index. In a subset of patients with linkage to IQVIA Ambulatory EMR – US (AEMR), multivariable models were used to evaluate associations between insurance type, patient characteristics, diagnostic test(s) performed at presentation, and HCRU outcomes (subsequent vaginitis-related healthcare visits and ≥2 vaginitis treatment dates) over follow-up.</div></div><div><h3>Results</h3><div>A total of 18,745,351 people were documented with vaginitis symptoms or vaginitis in the study selection window, of which 4,000,615 patients met all selection criteria for analysis: 3,787,354 were not pregnant and 213,261 had evidence of pregnancy. About one-fourth (23.8%) of the non-pregnant cohort and half (47.6%) of the pregnant cohort had claims for at least 1 diagnostic test at symptom presentation, with traditional methods being most commonly used (44.1% and 36.4% for non-pregnant and pregnant patients, respectively), followed by direct probe (20.0% and 24.1%), and lastly nucleic acid amplification test (NAAT) panel (including bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis; 6.6% and 8.3%). Despite low diagnostic testing rates, 50.1% of the non-pregnant and 60.9% of the pregnant cohort received prescribed vaginitis treatment, most frequently metronidazole or fluconazole, and 28.8% of the non-pregnant and 30.9% of the pregnant cohort had subsequent vaginitis-related visits within 12 months. Among both the non-pregnant and pregnant cohorts, patients with Medicaid insurance had significantly higher odds of repeat healthcare visits and ≥2 treatment dates during follow-up relative to patients with commercial insurance.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that vaginitis poses a high clinical burden in the US, possibly attributed to low diagnostic testing rates, use of tests with poor performance, and high rates of empiric treatment. There is an unmet need for rapid, accurate vaginitis diagnostic testing at the point-of-care to reduce empiric prescribing and improve diagnostic and treatm","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100504"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-inflicted chronic laparoscopic wounds in endometriosis—unveiling major depressive disorder: a case report","authors":"Maryanne Mwangi MBCHB, MMED Obstetrics and Gynecology,&nbsp;Charles Muteshi MBCHB, MMED Obstetrician and Gynecologist and Fertility Specialist","doi":"10.1016/j.xagr.2025.100484","DOIUrl":"10.1016/j.xagr.2025.100484","url":null,"abstract":"<div><div>To our knowledge, there are no reported cases in literature of adolescents with endometriosis with major depressive disorder that manifested as chronic laparoscopic wounds. Major depressive disorder in patients with endometriosis is a common occurrence, but self-directed violence is rare. We present the case of an adolescent female with chronic pelvic pain who was treated with medical management that proved ineffective. She then underwent laparoscopic excision of endometriosis. After surgery, she continued to experience oozing of a brown colored discharge from the primary umbilical port site, and it became a chronic nonhealing wound with associated pelvic pain. Four months later, she underwent re-exploration of the umbilical wound and laparoscopy. Subsequently, she had multiple and frequent hospital visits including ward admissions. The laparoscopic wounds remained as flesh wounds for 11 months despite multidisciplinary treatment, including care from a plastic surgeon. Patient was seen by a psychiatrist and a diagnosis of major depressive disorder was made. She was started on antidepressants, and subsequently, the wounds healed. This case report discussed a young adolescent female who underwent surgical treatment for endometriosis but who presented with a cryptic manifestation of major depressive disorder- chronic postlaparoscopic wounds. This case illustrates the need for early recognition of nonreproductive complications of endometriosis and timely multidisciplinary involvement.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100484"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends and clinical characteristics associated with pregnancy-related acute kidney injury in England: a population-based cohort study","authors":"Lisiane F. Leal PhD ,&nbsp;Kristian B. Filion PhD ,&nbsp;Robert W. Platt PhD ,&nbsp;K.S. Joseph MD, PhD ,&nbsp;Laura A. Magee MD, FRCPC, MSc, FACP, FRCOG ,&nbsp;Kate Bramham MRCP ,&nbsp;Anne-Marie Côté FRCPC, CSPQ ,&nbsp;Azar Mehrabadi PhD","doi":"10.1016/j.xagr.2025.100493","DOIUrl":"10.1016/j.xagr.2025.100493","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have reported an increase in pregnancy-related acute kidney injury, but the underlying reasons and patient characteristics associated with this trend are incompletely understood.</div></div><div><h3>Objective</h3><div>To describe temporal trends and identify clinical characteristics associated with pregnancy-related acute kidney injury in England.</div></div><div><h3>Study design</h3><div>This population-based cohort study included all live birth and stillbirth pregnancies to persons aged 15 to 45 years, between 1998 and 2017, using general practitioner practices in England linked to hospitalization data. The outcomes were overall acute kidney injury, postpartum acute kidney injury, severe acute kidney injury, and pulmonary oedema. Adjusted risk ratios were estimated for each 5-year period using Poisson regression models.</div></div><div><h3>Results</h3><div>Among 324,124 pregnancies (4.3% ≥ 40 years, 44.1% nulliparous), acute kidney injury increased from 2.9 to 11.2 per 10,000 pregnancies from 1998–2002 to 2013–2017. Severe acute kidney injury increased from 15.9 to 18.5 per 100,000 pregnancies from 1998–2007 to 2008–2017, while pulmonary oedema decreased from 16 to &lt;5 events per 100,000 pregnancies. Acute kidney injury incidence increased markedly among women with hypertensive disorders and the adjusted risk ratio (aRR) for acute kidney injury among those with hypertensive disorders (vs those without) increased from 1.7 (95% confidence interval [CI] 0.4–8.1) in 1998–2002 to 4.5 (95% CI 2.6–7.7) in 2013 to 2017. There was no notable change in postpartum acute kidney injury among those with postpartum hemorrhage and the aRR for the association of postpartum hemorrhage with acute kidney injury decreased from 18.4 (95% CI 4.3–79.0) in 1998–2002 to 2.5 (95% CI 0.9–6.1) in 2013 to 2017. Few (&lt;5) cases of acute kidney injury occurred among pregnancies with sepsis.</div></div><div><h3>Conclusions</h3><div>There was a marked rise in pregnancy-related acute kidney injury, particularly in last 5 years of the study. The steady rise among those with hypertensive disorders suggests ongoing vigilance is required to ensure optimal care. An investigation of other potential causes or changes in case ascertainment is also warranted given the rise in acute kidney injury among those without hypertensive disorders of pregnancy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100493"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased prevalence of parvovirus B19 infection among pregnant women in central Italy and genomic analysis","authors":"Alessandra Amendola PhD ,&nbsp;Cesare Ernesto Maria Gruber PhD ,&nbsp;Giuseppina Liuzzi MD ,&nbsp;Martina Rueca ,&nbsp;Sara Belladonna ,&nbsp;Antonella Giancotti MD ,&nbsp;Enrico Girardi MD ,&nbsp;Fabrizio Maggi MD","doi":"10.1016/j.xagr.2025.100514","DOIUrl":"10.1016/j.xagr.2025.100514","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;During 2024, the number of pregnant women who tested positive for parvovirus B19 in central Italy significantly increased. Genome sequence analysis of parvovirus B19 detected in blood samples of pregnant women revealed the co-circulation of 2 distinct clusters belonging to genotype 1, with nucleotide differences in both nonstructural and VP1 and VP2 proteins. The European Centre for Disease Prevention and Control declares a considerable increase in parvovirus B19 infections among children, pregnant women, and blood donors across most European nations from late 2023.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This study aimed to evaluate the positivity rate of parvovirus B19 infections among Italian pregnant women attending the maternal-fetal infection prevention outpatient care facility at the National Institute for Infectious Diseases Lazzaro Spallanzani of Rome for routine evaluation of maternal-fetal infections.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;Blood samples from 139 pregnant women were analyzed for parvovirus B19 infection according to the physician’s request: parvovirus B19 immunoglobulin M and immunoglobulin G antibodies and/or parvovirus B19 DNA. Among these samples, 8 positive for parvovirus B19 DNA were subjected to target amplicon sequencing and whole-genome reconstruction. For phylogenetic analysis, all parvovirus B19 complete genome sequences were collected, and multisequence alignment was performed to develop the best tree model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A sharp increase in parvovirus B19 circulation among Italian pregnant women occurred, starting from the end of 2023. During the first 9 months of 2024, requests for diagnosis of parvovirus B19 infection continued to increase significantly, and 46% of the samples analyzed in the first 9 months of the year were positive for parvovirus B19 infection. Phylogenetic analysis showed that all viruses detected belonged to parvovirus B19 genotype 1 and were clustered in 2 separate phylogenetic groups: one similar to the PP818758 genome sequence from France in 2024 and one similar to the KM393165 genome sequence from the United States in 2013. In addition, whole-genome sequence alignment revealed nucleotide mutations that caused amino acid changes, distinguishing the National Institute for Infectious Diseases clusters from similar sequences: the F8L, R54K, and F517S substitutions in the nonstructural gene of the viral genome for cluster 1 and the C298S, E195D, and T456S mutations in the nonstructural, VP1, and VP1 + VP2 genes for cluster 2. Furthermore, the C298S mutation was observed for the first time, as this mutation has never been detected in any other parvovirus B19 genome sequences submitted to international databases.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;Since the beginning of 2024, Italy, similar to many European countries, has been experiencing an epidemic of parvovirus B19 infection among pregnant women, with a positivity rate increasi","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100514"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of regular prophylaxis with a plasma-derived von Willebrand factor/factor VIII concentrate with a 1:1 activity ratio in reducing heavy menstrual bleeding in girls/women with von Willebrand disease","authors":"Csongor Kiss ,&nbsp;Zoltan Boda ,&nbsp;Claudia Djambas Khayat ,&nbsp;Ana Boban ,&nbsp;Leonid Dubey ,&nbsp;Robert F. Sidonio Jr","doi":"10.1016/j.xagr.2025.100501","DOIUrl":"10.1016/j.xagr.2025.100501","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Heavy menstrual bleeding is the dominant symptom in girls/women with von Willebrand disease (VWD), affecting ∼80 to 90%. Female patients with VWD are typically diagnosed later than males, despite the disproportionate impact of heavy menstrual bleeding. Although heavy menstrual bleeding has a substantial impact on patients, it is commonly undertreated in part because of the potential multifactorial causes in young girls/women, imprecise definition, and exclusion of this bleeding type as an indication for prophylaxis in previous studies. The WIL-31 study showed that prophylaxis with wilate (a plasma-derived von Willebrand factor/factor VIII concentrate with a 1:1 activity ratio) is highly efficacious in reducing bleeding rates in adults and children with VWD of all types. The impact of wilate prophylaxis on heavy menstrual bleeding was evaluated as an exploratory endpoint since it was not included as part of the primary endpoint.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective(s)&lt;/h3&gt;&lt;div&gt;To investigate the efficacy of regular prophylaxis with wilate in reducing the incidence of heavy menstrual bleeding in girls/women with VWD who had previously been treated on-demand.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study design&lt;/h3&gt;&lt;div&gt;WIL-31 (NCT04052698) was a prospective, non-controlled, international, multicenter Phase 3 trial that enrolled male/female patients, aged ≥ 6 years old with VWD. Prior to entering the WIL-31 study, all patients received on-demand treatment with a von Willebrand factor-containing product during a 6-month, prospective, observational, run-in study (WIL-29). Patients in WIL-31 received wilate prophylaxis 2–3 times per week at a dose of 20–40 IU/kg for 12 months. Prophylaxis was not tailored to time with menstruation. Heavy menstrual bleeding was defined as any menstrual bleed that impeded the ability to perform daily activities during menstrual periods. Criteria for heavy menstrual bleeding included changing pads more frequently than hourly, menstrual bleeding lasting 7 or more days, or the presence of clots &gt; 1 cm, combined with a history of flooding or a Pictorial Blood Assessment Chart score ≥ 185.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 33 patients evaluated in the study, 14 (42%) were female, of whom 5 (15%) were of childbearing age (13–43 years old). One of these had VWD type 1, the other 4 had VWD type 3. Prophylaxis with wilate reduced the mean annualized heavy menstrual bleeding rate by 75% compared with on-demand treatment (2.4 vs 9.7 in WIL-31 and WIL-29, respectively). During 6 months of on-demand treatment, all 5 female patients experienced at least 1 heavy menstrual bleed, whereas during 12 months of prophylaxis, 3 (60%) experienced no heavy menstrual bleeding episodes. During on-demand treatment, 5 patients experienced 26 heavy menstrual bleeding episodes, 3 (12%) of which required additional treatment. Under prophylaxis, 2 patients experienced 12 heavy menstrual bleeding episodes, of which only 1 (8%) impeded dai","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100501"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of expanded prenatal screening among consanguineous couples of Afghan descent","authors":"Noura Osman MSc ,&nbsp;Laila Rhee MSc ,&nbsp;Nina Boe MD ,&nbsp;Herman Hedriana MD ,&nbsp;Krishna Singh MD","doi":"10.1016/j.xagr.2025.100503","DOIUrl":"10.1016/j.xagr.2025.100503","url":null,"abstract":"<div><h3>Objective</h3><div>The American College of Medical Genetics recommends extensive carrier screening among consanguineous couples, yet limited information is available regarding its performance among specific populations. We describe the potential utility of a large expanded carrier screening panel (&gt;500 genes) for Afghan couples with consanguinity.</div></div><div><h3>Method</h3><div>A retrospective chart review was conducted of all patients who reported consanguinity and had genetic counseling consultation between 2010 and 2021 at our institution.</div></div><div><h3>Results</h3><div>Thirty-six women of Afghan descent reported consanguinity. Nineteen (53%) did not have known autosomal recessive disease risk (no prior fetus/child with suspected syndrome), 11 (31%) had apparent disease risk (fetus/child with symptoms suggesting syndrome but no specific diagnosis), and six (17%) had known molecular diagnosis for a prior child with a recessive syndrome. Of the six women with known molecular diagnosis for prior child with syndrome, five had known pathogenic variants confirming a genetic disorder, and one had highly suspicious variant of uncertain significance in the family. Among these six, five (83%) could have been identified with a 787-gene prenatal carrier screening panel.</div></div><div><h3>Conclusion</h3><div>Large, expanded carrier screening panel appears to be an effective method for identifying disorders among consanguineous Afghan couples and should ideally be considered preconceptionally.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100503"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Providers' perceptions of implementing standardized postpartum family planning: a qualitative study of midwives and nurses in Ghana","authors":"Sarita Sonalkar ,&nbsp;Ernest Maya ,&nbsp;Chris Guure ,&nbsp;Arden McAllister ,&nbsp;Dzifa Adimle Puplampu ,&nbsp;Roseline Dansowaa Doe ,&nbsp;Mary Eluned Gaffield ,&nbsp;James Kiarie","doi":"10.1016/j.xagr.2025.100506","DOIUrl":"10.1016/j.xagr.2025.100506","url":null,"abstract":"<div><h3>Background</h3><div>The World Health Organization publishes and maintains evidence-based guidance for the delivery of essential family planning services in the postpartum period<strong>.</strong> Despite significant time and effort in the development of these guidelines in the past decades, a significant unmet need for postpartum family planning persists, exposing an implementation gap. Implementation strategies involving education and infrastructure support can improve family planning uptake and mobile health interventions are a feasible adjunct in improvement of health outcomes.</div></div><div><h3>Objective</h3><div>We sought to understand provider perceptions of feasibility, acceptability, and appropriateness of implementation of the Postpartum Family Planning Package, which involved provider use of the World Health Organization Medical Eligibility for Contraceptive Use Mobile Application with a one-on-one counseling strategy.</div></div><div><h3>Study Design</h3><div>We implemented the Postpartum Family Planning Package at three hospitals in Greater Accra and Eastern Regions, Ghana. We conducted in-depth interviews with 23 providers who used the Postpartum Family Planning Package for at least three months. Study design, data collection, analysis, and interpretation were guided by the Consolidated Framework for Implementation Research. We interpreted data using thematic analysis.</div></div><div><h3>Results</h3><div>Providers indicated that use of one-on-one counseling and the mobile application in hospital-based postpartum care delivery was acceptable, feasible, and appropriate. Respondents described the resultant increased perceived trust between patients and providers as well as more effective and efficient information exchange. Endorsement for the use of the World Health Organization Medical Eligibility for Contraceptive Use Mobile Application by the facility leadership motivated providers to use it. The primary barrier to incorporation of one-on-one counseling was lack of privacy on the postnatal wards.</div></div><div><h3>Conclusion</h3><div>Providers perceived the implementation of the Postpartum Family Planning Package as feasible, acceptable, and appropriate. Creation of private spaces on the postnatal ward for counseling and continued buy-in by the facility leadership would likely enhance the impact of the strategy. Given the widespread use of mobile technology and the continued unmet need for postpartum contraception, we recommend evaluating this strategy in a broad range of settings internationally, including in lower-resource settings.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100506"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144222227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to ‘Evaluating Nigeria's recently announced free cesarean delivery initiative’ [AJOG Global Reports Volume 5, Issue 1, February 2025, 100448]","authors":"Patrick Tobechi Ashinze MBBS ,&nbsp;Jonathan Adeola MBBS ,&nbsp;Victor Mayowa Adeleye MBBS","doi":"10.1016/j.xagr.2025.100518","DOIUrl":"10.1016/j.xagr.2025.100518","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100518"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges to accessing gynecological care for women with disabilities in Almaty, Kazakhstan","authors":"Bakhyt Sultanbekova MD ,&nbsp;Aizhan Raushanova PhD ,&nbsp;Gulmira Otynbekova ,&nbsp;Marzhan Brimzhanova MD, PhD ,&nbsp;Gulnara Bedelbayeva ,&nbsp;Anuar Akhmetzhan","doi":"10.1016/j.xagr.2025.100502","DOIUrl":"10.1016/j.xagr.2025.100502","url":null,"abstract":"<div><h3>Background</h3><div>Globally, 1 in 5 women lives with disability, yet access to healthcare remains a significant challenge, especially in low- and middle-income countries. Despite ongoing efforts to implement inclusive policies, many health systems are not fully equipped to meet the needs of this population. Kazakhstan has taken steps to ensure equal access, however significant barriers persist for people with disabilities. This study specifically examines the obstacles to accessing medical care for women with disabilities in Almaty city, the largest city in Kazakhstan.</div></div><div><h3>Methods</h3><div>This study utilized a qualitative research design, conducting in – depth interviews with women with disabilities and medical staffs in hospitals and primary healthcare settings in Almaty. The interview was structured around 5 key areas of inquiry. Each interview lasted approximately 40 minutes, and informed consent was obtained orally from all participants. Data analysis was performed using Dedoose software.</div></div><div><h3>Results</h3><div>A total of 12 women with disabilities and 30 medical staff participated in the study. Common challenges identified by women included a lack of information regarding pregnancy, reproductive health, and government-funded medical care. Many women also reported discomfort and stigma when seeking medical treatment. From the perspective of healthcare providers, key barriers included inadequate training on how to effectively serve women with disabilities, as well as the need for improvements in medical infrastructure and resources.</div></div><div><h3>Conclusion</h3><div>The lack of specialized resources, infrastructure and financial constraints was identified. However, women emphasized the importance of better informational support and psychological assistance, whereas healthcare staff highlighted the need for enhanced training and skill development.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100502"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous thromboembolism with contraceptive use in females with sickle cell trait","authors":"Angela K. Phillips PhD, APRN ,&nbsp;Candy Wilson PhD, APRN, FAAN ,&nbsp;Anwar E. Ahmed PhD ,&nbsp;Arun Shet MD, PhD ,&nbsp;Margaret Bevans PhD, RN, FAAN","doi":"10.1016/j.xagr.2025.100497","DOIUrl":"10.1016/j.xagr.2025.100497","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Sickle cell trait is the carrier state for sickle cell disease and occurs in 1 in 13 births in Black and African American families. Individuals with sickle cell trait are permitted to serve in the military. Some research studies have shown that individuals with sickle cell trait may be at increased risk for thromboembolic events. Contraceptive use, specifically combined hormonal contraceptives containing both estrogen and progesterone, has been linked to an increased risk of thromboembolic events. No research has been done to determine if there is an increased risk of venous thromboembolism in a population of females with sickle cell trait who do or do not take combined hormonal contraceptives.</div></div><div><h3>OBJECTIVE</h3><div>To determine if women with sickle cell trait who use combined hormonal contraceptives are at higher risk for venous thromboembolism compared with females with sickle cell trait who do not use combined hormonal contraceptives. Given the increased risk of venous thromboembolism in sickle cell trait individuals in the general population, we hypothesized that females with sickle cell trait exposed to combined hormonal contraceptives would experience higher venous thromboembolism rates than unexposed females with sickle cell trait.</div></div><div><h3>STUDY DESIGN</h3><div>Population-based retrospective cohort study of females with sickle cell trait identified from the Military Data Repository to evaluate venous thromboembolism after exposure to combined hormonal contraceptives or without exposure to combined hormonal contraceptives.</div></div><div><h3>RESULTS</h3><div>There were 15,440 unique females aged 18–44 years between 2005 and 2021 who had a diagnosis of sickle cell trait. Approximately 40% of females had an International Classification of Diseases code consistent with a prescription of a combined hormonal contraceptive. Thirty-three (0.2%) of the 15,440 females with sickle cell trait had experienced venous thromboembolism of any type. There was no difference in the prevalence of venous thromboembolism by combined hormonal contraceptive use (yes [0.18%] vs no [0.24%]; <em>P</em>=.454). Being older, married, nonactive-duty military status, smoking, and having a diagnosis of hypertension were associated with a higher prevalence of venous thromboembolism.</div></div><div><h3>CONCLUSION</h3><div>Although there was a small number of venous thromboembolism events, the findings of this study suggest that the use of combined hormonal contraceptives in females with sickle cell trait is not associated with a detectable signal for increased venous thromboembolism risk as an outcome. Given the potential clinical benefit of combined hormonal contraceptives in pregnancy prevention and menstrual regulation in females, the concerns about combined hormonal contraceptive-associated venous thromboembolism in this population with sickle cell trait seem to be minimal.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100497"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}