AJOG global reports最新文献

{"title":"Uterine fibroids with heavy menstrual bleeding stratified by race in a commercial and Medicaid database","authors":"Sanjay K. Agarwal MD, FACOG , Michael Stokes MPH , Rong Chen MA , Cassandra Lickert MD","doi":"10.1016/j.xagr.2024.100412","DOIUrl":"10.1016/j.xagr.2024.100412","url":null,"abstract":"<div><h3>Background</h3><div>Historically, the clinical characteristics and treatment pathways for patients with uterine fibroids and heavy menstrual bleeding have differed between White and Black women.</div></div><div><h3>Objective</h3><div>To provide a contemporary comparison of patient characteristics and treatment patterns among White and Black women with uterine fibroids and heavy menstrual bleeding in the United States.</div></div><div><h3>Study Design</h3><div>This retrospective cohort study included administrative claims data from 46,139 White and 17,297 Black women with uterine fibroids and heavy menstrual bleeding from the Optum Clinformatics database (January 2011–December 2020) and 7353 White and 16,776 Black women from the IBM MarketScan Multi-State Medicaid Insurance database (January 2010–December 2019). Patients were indexed at their initial uterine fibroid diagnosis claim and were required to have a claim for heavy menstrual bleeding and ≥12 months of continuous enrollment pre- and postindex. Patients were followed until the earliest of death, disenrollment, hysterectomy date, or end of study database. Outcomes were stratified by race and included patient demographics, clinical characteristics, pharmacologic treatment patterns, and surgeries/procedures. Pearson's Chi-square test for categorical variables and Student's t-test for continuous data were used to evaluate differences in baseline characteristics. Descriptive statistics were used to characterize treatment pathways for hormonal contraceptive use in women with ≥24 months of follow-up. Kaplan–Meier survival analysis was used to estimate time until hysterectomy, with log-rank testing to assess between-group differences.</div></div><div><h3>Results</h3><div>The mean (standard deviation) duration of follow-up was 44.6 (27.9) and 41.0 (24.9) months in the commercial and Medicaid databases, respectively. Mean (standard deviation) age at uterine fibroid diagnosis was lower for Black than White women in both databases (commercial: 42.3 [6.5] vs 44.4 [6.3] years; <em>P</em><.0001; Medicaid: 39.6 [7.1] years vs 40.2 [7.2] years; <em>P</em><.0001). Anemia was more prevalent in Black vs White women in both databases (commercial: 5.9% [1028/17,297] vs 3.6% [1648/46,139]; <em>P</em><.0001; Medicaid: 7.0% [1180/16,776] vs 4.5% [331/7353]; <em>P</em><.0001). In the commercial database, approximately one-half of women had claims for ≥1 bulk symptom, with no significant differences between groups. In the Medicaid database, significantly more White than Black women had claims for bulk symptoms (77.0% [5665/7353] vs 68.4% [11,477/16,776]; <em>P</em><.0001). Approximately 40% of all patients received hormonal drug therapies as initial treatment, most commonly hormonal contraceptives. However, discontinuation of hormonal contraceptive therapy was nearly universal, with one-half discontinuing within a median treatment duration of ∼5 months. Most women stopped treatment after 1 or","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100412"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578164","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":"Maternal and neonatal outcomes following antenatal corticosteroids in pregnancies complicated by diabetes: a scoping review","authors":"Klea Atallah BBiomed(Hons) ,&nbsp;Serena Moon MD ,&nbsp;I-Lynn Lee MBBS, BMedSc, FRACP, PhD ,&nbsp;Rosalynn Pszczola MBChB, BMedSci(Hons), FRACP ,&nbsp;Joanne M. Said MBBS, PhD, CMFM","doi":"10.1016/j.xagr.2024.100416","DOIUrl":"10.1016/j.xagr.2024.100416","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the current literature surrounding the administration of antenatal corticosteroids in pregnancies complicated by diabetes and summarize the reported neonatal and maternal outcomes in exposed and unexposed groups.</div></div><div><h3>Data sources</h3><div>A systematic search was performed in November 2023 using Ovid Medline and Embase databases to identify relevant studies.</div></div><div><h3>Study Eligibility Criteria</h3><div>Articles that reported on the maternal or neonatal outcomes in pregnancies complicated by pre-gestational or gestational diabetes after exposure to antenatal corticosteroids were included in this review. Articles were excluded if they did not separately report on the outcomes experienced by women with diabetes.</div></div><div><h3>Methods</h3><div>Maternal and neonatal outcomes of interest included neonatal respiratory distress syndrome, neonatal hypoglycemia, and maternal hyperglycemia. Key words in this search included combinations of the terms related to pre-gestational and gestational diabetes, antenatal corticosteroids, respiratory distress syndrome, hypoglycemia, and hyperglycemia. Title and abstract screening was conducted in duplicate.</div></div><div><h3>Results</h3><div>There were 19 studies that met the inclusion criteria. There were 13 studies that presented results pertaining to neonatal respiratory distress syndrome, 14 studies discussed neonatal hypoglycemia and 5 studies discussed maternal hyperglycemia. Only 2 included studies were randomized controlled trials with the remaining 17 studies being observational. There was heterogeneity in clinical settings, study populations, type of corticosteroid administered and timing of administration across the included studies. This review found that there is no clear evidence of beneficial effect of corticosteroid administration on neonatal respiratory outcomes in pregnancies complicated by diabetes. Additionally, there was discrepancy between studies reporting on neonatal hypoglycemia with 6 studies reporting an increased incidence in this outcome after antenatal corticosteroid exposure whilst 4 studies found no difference between exposed and unexposed groups. This review identified a specific gap in the reporting of maternal hyperglycemia following antenatal corticosteroids. The limited number of studies that did report this outcome unanimously reported an increased incidence of maternal hyperglycemia after corticosteroid exposure. The majority of studies had small sample sizes of pregnancies both complicated by diabetes and exposed to corticosteroids and therefore lacked sufficient power to make robust conclusions about the influence of antenatal corticosteroids in this group.</div></div><div><h3>Conclusion</h3><div>This review concludes that there are insufficient data regarding the risks and benefits of antenatal corticosteroid administration in pregnancies complicated by diabetes.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100416"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701333","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":"Exploration of iron deficiency anemia and its associated factors among pregnant women seeking antenatal care in public health facilities of southwestern Ethiopia. A mixed study","authors":"Endale Tamiru Burayu MSc,&nbsp;Bekem Dibaba Degefa MSc","doi":"10.1016/j.xagr.2024.100417","DOIUrl":"10.1016/j.xagr.2024.100417","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Anemia is a major problem in Ethiopia, affecting a large part of the population. Despite the importance of the problem, the causes of anemia, especially iron deficiency anemia, among pregnant women attending antenatal care (ANC) in the study area have been little studied. Therefore, the aim of this study was to investigate iron deficiency anemia and its associated factors in pregnant women seeking antenatal care in public health facilities in Southwest Ethiopia in 2023.</div></div><div><h3>METHODS AND MATERIALS</h3><div>A mixed facility-based cross-sectional study was conducted involving 364 pregnant women from selected health facilities in Ilubabor and Buno Bedele zones. Backward multiple logistic regression was used to analyze the relationship between dependent and independent variables, with statistical significance set at a <em>P</em> value less than .05.</div></div><div><h3>RESULTS</h3><div>In this study, the prevalence of iron deficiency anemia was found to be 21.4%. Several factors have been significantly associated with iron deficiency anemia including; presence of malaria parasite [AOR=15.8, CI=5.1–48.4], presence of Helminthes [AOR=8.1, CI=2.8–23.9], consumption of leafy vegetables less than once a day [AOR=3.4, CI = 1.5–13.3] and not taking iron supplements/consumption [AOR=2.2, CI=1.1–4.4].</div></div><div><h3>CONCLUSION AND RECOMMENDATIONS</h3><div>The overall prevalence of iron deficiency anemia in the study area suggests that, it is a moderate public health problem. In order to improve the nutritional status of women, routine and consistent nutritional advice, the establishment of regular preventive systems and the implementation of feedback mechanisms are recommended.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100417"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701335","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":"Mistreatment in healthcare: peripartum experience in a Tunisian maternity","authors":"Haithem Aloui MD,&nbsp;Hatem Frikha MD,&nbsp;Rami Hammami MD,&nbsp;Amal Chermiti MD,&nbsp;Hassine Saber Abouda MD,&nbsp;Mohamed Badis Channoufi PhD,&nbsp;Abir Karoui PhD","doi":"10.1016/j.xagr.2024.100410","DOIUrl":"10.1016/j.xagr.2024.100410","url":null,"abstract":"<div><h3>Background</h3><div>Mistreatment in healthcare is defined by the set of behaviors, acts, and omissions committed by the healthcare providers on patients. Pregnant women can be exposed to this behavior during pregnancy, childbirth, and the postpartum period. It can have several aspects and affects the women's mental health, social and professional life, and also their newborns and families.</div></div><div><h3>Objective</h3><div>This study was made to estimate the frequency of mistreatment during the peripartum period in a Tunisian maternity unit, determine its impact on the parturient and her entourage, and draw up recommendations for the prevention of this public health problem.</div></div><div><h3>Study Design</h3><div>We conducted a cross-sectional survey in Department C of the Tunis Maternity and Neonatology Center from July 2022 to September 30, 2022. Our questionnaire encompassed verbal and physical abuse, patient information, consent, unprofessional conduct, poor communication, and discrimination.</div></div><div><h3>Results</h3><div>This study included 400 patients. The average age was 29.3+–5.65. Single women represented 12.3% of the cases. Seventy-five percent of women reported having been victims of at least one type of violence during childbirth. Verbal abuse was the most frequent type observed. Eighty-two percent of women reported verbal abuse, while 23.25% underwent physical violence. After the delivery, 391 women (97.8%) stated that the delivery was a source of anxiety and that they were not ready to repeat the experience. Six of them were followed up in psychiatry. Mistreatment was expressed by a lack of information and/or respect for consent, unprofessional conduct, or poor communication between the caregiver and the patient.</div></div><div><h3>Conclusion</h3><div>This study emphasizes the significance of including women in decision-making processes regarding their care. Establishing systematic approaches for providing information and obtaining consent is crucial, ensuring a dynamic approach that promotes women's freedom of choice.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100410"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578081","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":"Timing of cesarean section for prolonged labor in urban Tanzania: A criterion-based audit","authors":"Monica Lauridsen Kujabi MD, PhD ,&nbsp;Natasha Housseine MD, PhD ,&nbsp;Idrissa Kabanda MD ,&nbsp;Rukia Msumi MD ,&nbsp;Luzango Maembe MD ,&nbsp;Mtingele Sangalala MD ,&nbsp;Manyanga Hudson MD ,&nbsp;Sarah Hansen BSc. Med. ,&nbsp;Anna Macha MD ,&nbsp;Brenda Sequeira D'mello MD ,&nbsp;Dan Wolf Meyrowitsch PhD ,&nbsp;Flemming Konradsen PhD ,&nbsp;Andreas Kryger Jensen PhD ,&nbsp;Kidanto Hussein MD, PhD ,&nbsp;Nanna Maaløe MD, PhD ,&nbsp;Thomas van den Akker MD, PhD","doi":"10.1016/j.xagr.2024.100404","DOIUrl":"10.1016/j.xagr.2024.100404","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Similar to many resource-constrained urban settings, cesarean deliveries in Dar es Salaam, Tanzania, have increased rapidly, from 17% in 2015 to 26% in 2022. Alarmingly, at the population level, the increase was not followed by improvements in perinatal outcomes, suggesting the overuse of cesarean delivery. Prolonged labor is the leading cause of women's first cesarean delivery. Therefore, understanding the management of prolonged labor preceding cesarean delivery is crucial for preventing nonmedically indicated cesarean deliveries across Tanzania and globally.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This study aimed to estimate the proportion of cesarean deliveries with a written indication of prolonged labor that was performed in labors with uncomplicated progression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;This study was conducted at 5 urban maternity units in Dar es Salaam, Tanzania, from October 1, 2021, to August 31, 2022. Data were extracted from case files of women who gave birth via cesarean delivery with a written indication of prolonged labor. The timing of cesarean delivery decision was assessed against predefined definitions of prolonged labor at each stage/phase of labor. The proportion of cesarean deliveries performed in cases of uncomplicated progression was calculated. The exclusion criteria included referral to study sites because of prolonged labor or cervical dilatation of &gt;6 cm upon admission, noncephalic presentation, multiple pregnancy, intrauterine fetal death, failed induction of labor, previous cesarean delivery, or other written indications for cesarean delivery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;The overall cesarean delivery rate was 32% (2949/9364). Of first-time cesarean delivery cases, 746 of 1517 patients (47.9%) had a written indication of prolonged labor. Finally, 456 of 746 patients (61.1%) met the inclusion criteria, of which 307 of 456 patients (67.3%) were admitted in the latent phase of labor. In 243 of 456 cesarean deliveries (53.3%) with an indication of prolonged labor, labor was not prolonged. This group included (1) women not being given a trial of labor (78/243 [32.1%]), (2) women in the first stage of active labor not crossing the partograph action line (145/243 [59.7%]), and (3) women in the second stage of labor lasting &lt;1 hour (20/243 [8.2%]). Of note, 78 of 346 women (21.5%) in the first stage of active labor had a labor progression faster than 0.5 cm per hour preceding the decision for cesarean delivery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;Almost half of cesarean deliveries in unscarred uteri were because of prolonged labor. Despite a written indication of prolonged labor, approximately half of the cases did not have prolonged labor. Although care in low-resource settings has traditionally been categorized as “too little, too late,” this study finds care as “too much, too soon” in one of the world's fastest-growing urban areas. This finding highlights th","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100404"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142594149","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":"Screening for pulmonary hypertension in pregnant women with sickle cell disease in sub-Saharan Africa","authors":"Alim Swarray-Deen MD ,&nbsp;Misturah Y. Adana MD, PhD ,&nbsp;Micheal A. Alao MD ,&nbsp;Victoria A.A. Agyen-Frimpong MD ,&nbsp;Adekunle Fakunle PhD ,&nbsp;Deda Ogum-Alangea PhD ,&nbsp;David N. Adjei PhD ,&nbsp;Kwame Yeboah MD, PhD ,&nbsp;Yemi Raheem Raji MD ,&nbsp;Samuel A. Oppong MD ,&nbsp;James A. Ogunmodede MD ,&nbsp;Kolawole Wahab MD ,&nbsp;Kola Okuyemi MD","doi":"10.1016/j.xagr.2024.100413","DOIUrl":"10.1016/j.xagr.2024.100413","url":null,"abstract":"<div><h3>Background</h3><div>Sickle cell disease (SCD) has evolved from a condition predominantly fatal in childhood to a chronic illness impacting many adults, including women of reproductive age. For females with SCD, pregnancy represents one of the greatest health threats, exacerbating existing health challenges and introducing new risks. Despite advancements in healthcare, routine screening for existing complications like pulmonary hypertension (PH) remains inconsistent, particularly in low- and middle-income countries (LMICs), where the prevalence of SCD is highest.</div></div><div><h3>Objective</h3><div>This study aimed to assess the feasibility of screening for PH in pregnant women with SCD in LMICs, with the goal of enhancing maternal health outcomes in this vulnerable population.</div></div><div><h3>Study Design</h3><div>A prospective multi-center feasibility study was conducted from September 2022 to February 2023 at teaching hospitals in Ghana and Nigeria. The study included pregnant women with SCD between 28 and 34 weeks of gestation. Screening for PH utilized a tricuspid regurgitation velocity (TRV) criterion (&gt;2.5 m/s), with adherence to American Society of Echocardiography guidelines. Statistical analysis included descriptive statistics and proportions.</div></div><div><h3>Results</h3><div>Among 3091 pregnant women attending antenatal care, 88 had SCD (2.8%), and 55 were eligible for the study. We recruited 44 participants (mean age 28.9 years, SD 4.8), with 48% (21/44) SS genotype and 52% (23/44) SC genotype. Most participants (95.3%) had normal TRV (&lt;2.5 m/s), with only one showing elevated TRV, successfully referred. Protocol adherence was 100%. Antenatal outcomes showed 95% echo uptake and 95.7% retention to term whilst postnatal echo follow-up was 43.5%. Notably, 27.1% (10/37) of deliveries required neonatal intensive care unit admission, and 18.2% were preterm. The sole participant with PH required intensive care unit care and experienced a preterm delivery with neonatal death on day 5.</div></div><div><h3>Conclusion</h3><div>Screening and referral for PH in pregnant women with SCD in LMICs are feasible but face challenges in early diagnosis, healthcare personnel availability, and postnatal follow-up. Strategic planning is crucial to address these challenges and improve outcomes in this high-risk population</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100413"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658428","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":"Cesarean delivery in a tertiary institution of the Republic of Moldova: analysis using the Robson classification","authors":"Angela Marian-Pavlenco MD, PhD,&nbsp;Irina Siritanu MD,&nbsp;Tatiana Ribac MD,&nbsp;Valentin Friptu MD, PhD","doi":"10.1016/j.xagr.2024.100408","DOIUrl":"10.1016/j.xagr.2024.100408","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>The worldwide increase in the cesarean delivery rate is a major public health concern and cause of significant debate. Although multiple studies have shown that higher cesarean delivery rates may be associated with adverse maternal and perinatal outcomes, the number of cesarean deliveries has been continuously increasing. In the Republic of Moldova, cesarean delivery increased from 15.75% in 2012 to 27.42% in 2022. However, the perinatal mortality remained unchanged at 11.6%. To understand the factors that determine the increasing trend in cesarean delivery and to approach new strategies to reduce unnecessary surgical delivery, a standardized tool is needed to assess and compare cesarean delivery rates.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to assess the changes in the rates and trends of cesarean delivery and to evaluate the contribution of different obstetrical populations to overall cesarean delivery rates in the Municipal Clinical Hospital using the Robson classification.</div></div><div><h3>STUDY DESIGN</h3><div>This was a cohort study conducted at the Municipal Clinical Hospital in Chisinau. The study included 13,882 women who gave birth in 2017, 2019, and 2022 at the Municipal Clinical Hospital. All births were classified into 10 Robson groups, using 6 basic variables (parity, cesarean delivery in medical history, labor onset, number of fetuses, gestational age, and fetal presentation). Statistical data were collected and analyzed using the Epi Info program (version 7.2.1.0; Centers for Disease Control and Prevention, Atlanta, GA).</div></div><div><h3>RESULTS</h3><div>The overall cesarean delivery rate was 20.02% (2779/13,882), with a significant increase from 18.59% (809/4351) to 21.59% (1134/5252) (<em>P</em>=.0003). Approximately one-third (1099/2279 [39.55%]) of all cesarean deliveries were performed before labor onset. The main contributor in all study years was group 5 (957/2779 [34.44%]). The next valuable group that contributed to the overall cesarean delivery rate was group 2 (393/2779 [14.14%]), followed by group 1 (333/2779 [11.98%]).</div></div><div><h3>CONCLUSION</h3><div>The Robson Ten-Group Classification System provides a clear and detailed record of the trends in cesarean delivery. In addition, because of the Robson Ten-Group Classification System's simplicity and exclusivity, it can be implemented in the Republic of Moldova. The main contributors to the overall cesarean delivery rate were women with a previous cesarean delivery (group 5), followed by nulliparous women of group 2 and group 1.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100408"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555040","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":"Rural women's preferences for cervical cancer screening via HPV self-sampling: a discrete choice experiment study in chidamoyo, Hurungwe District, Zimbabwe","authors":"Mathias Dzobo MSc ,&nbsp;Tafadzwa Dzinamarira PhD ,&nbsp;Michael Strauss MSc ,&nbsp;Tivani Mashamba-Thompson PhD","doi":"10.1016/j.xagr.2024.100414","DOIUrl":"10.1016/j.xagr.2024.100414","url":null,"abstract":"<div><h3>Background</h3><div>Cervical cancer screening using HPV self-sampling presents a valuable opportunity to enhance access for underserved and never-screened women in Zimbabwe. However, to ensure the successful implementation of this innovative approach, it is crucial to understand the preferences of key stakeholders, particularly women, with regard to the various components of an HPV self-sampling intervention.</div></div><div><h3>Objective</h3><div>This study aimed to elicit rural women's preferences for HPV self-sampling.</div></div><div><h3>Study design</h3><div>A DCE questionnaire was administered to 215 women in Chidamoyo, Hurungwe Rural District. Women were asked to choose between two hypothetical screening choices defined by education, location of services, supervision of self-sampling, comfort of sampling device, results notification and care after HPV results. Data were analysed using fixed and mixed logistic regression models.</div></div><div><h3>Results</h3><div>Results indicated that the comfort of the sampling device had the most significant impact on women's preferences for HPV self-sampling. Women prioritised facility-based self-sampling, female-supervised self-sampling, and face-to-face education on cervical cancer and screening methods. The methods of results notification and care after HPV results did not significantly impact women's choices. The mixed effects results showed preference heterogeneity in some of the attributes. Interaction analyses suggested that preferences were largely homogenous across the following subgroups: never-screened, previously screened, young and older women. The stratified analysis also showed that preferences were consistent among the four subgroups.</div></div><div><h3>Conclusion</h3><div>Our findings highlight the importance of face-to-face education, comfortable and user-friendly sampling devices, female health worker supervision and health facility-based self-sampling for cervical cancer screening via HPV self-sampling. These insights could guide the design of patient-centric interventions to ensure high uptake and increased screening coverage.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100414"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586774","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":"Pregnancy intentions and outcomes among young married women in Nepal","authors":"Aimee J. Lansdale MS ,&nbsp;Mahesh C. Puri PhD ,&nbsp;Nadia Diamond-Smith PhD","doi":"10.1016/j.xagr.2024.100403","DOIUrl":"10.1016/j.xagr.2024.100403","url":null,"abstract":"<div><h3>Background</h3><div>Approximately 44% of Nepalese women ages 15–49, desiring to avoid pregnancy, do not use modern contraceptives, resulting in an estimated 539,000 unintended pregnancies annually.</div></div><div><h3>Objectives</h3><div>This study aims to investigate the association between young, newly married women's pregnancy intentions and subsequent pregnancies.</div></div><div><h3>Study design</h3><div>Data were collected longitudinally from 200 recently married women ages 18–25 in Nepal. Surveys conducted every six months over 18 months covered various health domains. The study used mixed-effects logistic regression models to account for repeated measurement of correlated data over time. The primary outcome was pregnancy. Pregnancy intention was determined based on responses to, “When would you like to have a child in case you were to have one?” Participants were recategorized into a dichotomous variable for analytical purposes: “Right away” or “Not right away.”</div></div><div><h3>Results</h3><div>A total of 133 participants became pregnant during the study, with sociodemographic characteristics showing minimal differences between pregnant and nonpregnant groups. Women intending to become pregnant right away had significantly higher odds of becoming pregnant (OR, 4.03; 95% CI, 2.51–6.48) after adjusting for covariates. Among those not intending immediate pregnancy, over 70% became pregnant, suggesting potential barriers to achieving reproductive goals.</div></div><div><h3>Conclusions</h3><div>Young, newly married women in Nepal intending immediate pregnancy have higher odds of becoming pregnant. However, a substantial proportion of those hoping to delay pregnancy still experience unintended pregnancies, indicating challenges in meeting reproductive goals. The findings underscore the need for addressing barriers to contraceptive access and societal norms impacting women's reproductive autonomy in Nepal.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100403"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866519","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":"Congenital portosystemic shunts: experience of a tertiary Tunisian referral center","authors":"Bilel Jerbi Dr ,&nbsp;Hajer Chourou Dr ,&nbsp;Rim Ben Aziza Dr ,&nbsp;Omar Jelassi Dr ,&nbsp;Yosra Sdiri Dr ,&nbsp;Wafa Belhadj Ammar Dr ,&nbsp;Samia Kacem Dr ,&nbsp;Nadia Aloui Dr ,&nbsp;Radhouane Achour Dr","doi":"10.1016/j.xagr.2024.100409","DOIUrl":"10.1016/j.xagr.2024.100409","url":null,"abstract":"<div><div>Congenital portosystemic shunt is a rare condition in which communications between the systemic venous circulation and the portal veins drain blood directly into the systemic circulation. Diagnosis may occur from the prenatal period to adulthood. Nevertheless, diagnosing and treating a congenital portosystemic shunt, particularly in the perinatal stage, remain challenging, as multiple complications can occur. This study aimed to describe the clinical characteristics of 3 cases of congenital portosystemic shunts diagnosed during pregnancy or the neonatal period, the diagnostic procedures, and their outcomes. This study reported 3 cases of full-term newborns with a congenital portosystemic shunt diagnosed at neonatal age. Case 1 was antenatally diagnosed with a congenital portosystemic shunt, which was confirmed postnatally via computed tomography and was associated with malformed ductus venosus and hypoplasia of the right portal vein. Cases 2 and 3 were siblings: a boy who had diffuse hemangiomatosis and a congenital portosystemic shunt complicated with severe persistent pulmonary hypertension and a girl who presented with a congenital portosystemic shunt and Kell alloimmunization. Congenital portosystemic shunts can be detected on prenatal ultrasounds during the etiologic workup of one of its complications or may be incidentally identified later in life. Children with congenital portosystemic shunts may develop various biological abnormalities, such as pulmonary hypertension, hypoxemia, encephalopathy, and liver tumors. A multidisciplinary approach and standardized protocols are required to optimize the management of congenital portosystemic shunts and minimize the short- and long-term consequences of congenital portosystemic shunts.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100409"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535958","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}