Therapeutic advances in reproductive health最新文献

{"title":"Association of vitamin A with gestational diabetes and thyroid disorders in pregnancy and their influence on maternal, fetal, and neonatal outcomes.","authors":"Abdul Qadeer, Muhammad Umer Ishaq, Adnan Safi, Anum Akbar, Sana Asif, Aqsa Komel, Digbijay Kunwar, Syed Mujtaba Azhar Bokhari","doi":"10.1177/26334941241271542","DOIUrl":"10.1177/26334941241271542","url":null,"abstract":"<p><p>Gestational diabetes mellitus (GDM) and thyroid disorders during pregnancy pose significant health concerns, impacting a substantial number of mothers globally. Globally, about 14% of pregnant women develop GDM, while thyroid disorders impact approximately 2%-3%. Both conditions contribute to adverse outcomes, including gestational hypertension, excessive fetal growth, and heightened perinatal morbidity. The central focus of this literature review is to examine the relationship between vitamin A, a crucial fat-soluble micronutrient in fetal development, and the occurrence of GDM and thyroid disorders during pregnancy. The primary research question investigates the association between vitamin A, GDM, and thyroid disorders, analyzing their combined impact on maternal, fetal, and neonatal outcomes. The review underscores the potential of vitamin A to modulate the risk and outcomes of GDM and thyroid disorders during gestation, emphasizing its role in GDM development and resolution and its influence on thyroid function in pregnancy.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115827","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":"Validation of the follicular and ovarian thresholds by an 18-MHz ultrasound imaging in polycystic ovary syndrome: a pilot cutoff for North African patients.","authors":"Taieb Ach, Ayoub Guesmi, Maha Kalboussi, Fatma Ben Abdessalem, Emna Mraihi, Houda El Mhabrech","doi":"10.1177/26334941241270372","DOIUrl":"10.1177/26334941241270372","url":null,"abstract":"<p><strong>Background: </strong>Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrinopathies among young women. Ultrasound evidence of polycystic ovaries is one of its crucial diagnostic criteria.</p><p><strong>Objectives: </strong>Our main objective is to study the contribution of ultrasound data in diagnosing PCOS. In addition, we aim to establish a new cutoff point for the use of ultrasound and to determine its sensitivity as well as its specificity.</p><p><strong>Design: </strong>It was a prospective study, including all patients presenting with clinical hyperandrogenism.</p><p><strong>Methods: </strong>The ultrasound examination of these patients was performed using a novel ultrasound machine (18 MHz) compared to an older ultrasound machine (2 Hz-8 MHz). Inclusion criteria encompassed adult female patients over 18 years presenting symptoms suggestive of PCOS, particularly hyperandrogenism and oligo-anovulation, meeting Rotterdam's diagnostic criteria. Prior to inclusion, assessments were conducted to eliminate other potential causes explaining hyperandrogenism or menstrual disorders in both groups.</p><p><strong>Results: </strong>We examined 92 patients diagnosed with PCOS. Menstrual disorders were the main symptoms, with amenorrhea being more frequent in the PCOS group (G1) (48.9% vs the control group (G2): 11.1%). The follicle number was significantly lower in the control group, as assessed by both ultrasound machines (<i>p</i> < 10^-3). The accuracy of the new ultrasound device was evaluated compared to the old one using the receiver operating characteristic (ROC) curve, revealing a cutoff of 18 follicles (sensitivity of 68.1%, specificity of 100%) and an area under the curve of 0.955. We found a significant difference between the median values of the number of follicles (NF) by both ultrasound machines (18 vs 12). It was positively correlated with an index of r = 0.916. For the volume, it was distinctively higher in G1 (<i>p</i> < 10^-3). ROC curve analysis revealed an ovarian volume cutoff of 9.25 ml with a sensitivity of 48.9% and a specificity of 100%. Both ultrasound machines were positively correlated with an index of r = 0.979 (<i>p</i> < 10^-3).</p><p><strong>Conclusion: </strong>In conclusion, we were able to establish significant correlations between the new and the old ultrasound devices for both the NF and ovarian volume. Our study is distinctive as it represents the first on the African continent to re-evaluate the ultrasound criterion for PCOS.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019862","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":"Women's willingness for cervical cancer screening and associated factors among women attending health services in Addis Ababa, Ethiopia.","authors":"Tangute Demas, Teshale Biku, Tewodros Getinet, Bereket Fantahun, Delayehu Bekele, Negat Woldehawariat, Rahel Muzemir, Martha Shoarega","doi":"10.1177/26334941241253181","DOIUrl":"10.1177/26334941241253181","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer is one of the most common causes of cancer-related morbidity and mortality globally. In developed countries, effective screening programs reduced its burden. However, in Ethiopia, cervical cancer remains a major public health problem despite the screening service being available free of charge.</p><p><strong>Objective: </strong>The aim of this study was to assess women's willingness for cervical cancer screening services and associated factors among women attending health services in Addis Ababa, Ethiopia.</p><p><strong>Design: </strong>An institutional-based, analytic, cross-sectional study was conducted among sexually active women attending health facilities from August to September 2022.</p><p><strong>Methods: </strong>A pretested interviewer-administered questionnaire was used for data collection. Data were analyzed using SPSS version 25. Logistic regression was used to determine different variables' frequencies and associated factors. A <i>p</i> value of <0.05 was considered statistically significant.</p><p><strong>Result: </strong>Four hundred twenty-two women were approached, and 394 (93.4%) met the study inclusion criteria. Study participants had a minimum of 1 and a maximum of 6 sexual partners in their lives. A total of 256 (64.9%) study participants had heard about cervical cancer. Among those who heard about cervical cancer, only 22 (8.6%) had been tested for cervical cancer. Of those who did not receive cervical cancer screening, only 175 (47.0%) are willing to receive cervical cancer screening. Age, religion, marital status, place of residence, educational level, occupation, and hearing about cervical cancer were found to be statistically significant. Women who heard about cervical cancer were 15.2 times more likely to take the test compared to those who never heard about cervical cancer before the study.</p><p><strong>Conclusion: </strong>Women's willingness to be screened for cervical cancer is low despite many of the study participants having more than one partner in their lives and being at risk for cervical cancer. Only a few participants had been screened for cervical cancer. Women who had heard about cervical cancer were more likely to take the screening service compared to those who had never heard it before. This highlights the need to prioritize raising awareness about the benefits of cervical cancer screening services.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11162127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297541","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 the Gulu University Reproductive Health Simulation Training for final year medical students and interns: a before-and-after study.","authors":"Pebalo Francis Pebolo, Jerom Okot, Felix Bongomin, Silvia Awor, Baifa Arwinyo, Sande Ojara, Jimmyy Opee, Ayikoru Jackline, Eric Ssennuni, Simple Ouma","doi":"10.1177/26334941241251967","DOIUrl":"10.1177/26334941241251967","url":null,"abstract":"<p><strong>Background: </strong>Reproductive health emergencies, such as postpartum hemorrhage, contribute significantly to maternal and neonatal morbidity and mortality in Uganda due to knowledge and skills gaps. Medical interns, intern midwives, and nurses are crucial as frontline healthcare workers in responding to these emergencies. Our proposed hands-on strategy involves comprehensive simulation-based training (SBT) to equip these healthcare workers with the essential knowledge to manage common reproductive health emergencies and procedures in the country.</p><p><strong>Objectives: </strong>The study aimed to assess the effectiveness of comprehensive SBT in improving the knowledge of interns and fifth-year medical students on reproductive health emergencies and procedures at Gulu University and its Teaching Hospitals in Uganda.</p><p><strong>Design: </strong>A before-and-after study.</p><p><strong>Methods: </strong>A 4-day SBT was conducted for fifth-year medical students and interns (nurses, midwives, and doctors) at Gulu University Teaching Hospitals, focusing on reproductive health emergencies. Pre- and post-tests with 40 multiple-choice questions were used to evaluate knowledge enhancement, the scores were summarized as medians and interquartile ranges. Paired sample <i>t</i>-tests was used to test the difference in pre- and post-test scores. Independent sample <i>t</i>-tests compared median post-test results between interns and students, with a <i>p</i>-value <0.05 considered significant.</p><p><strong>Results: </strong>A total of 153 participants were enrolled, the majority being males (78.4%, <i>n</i> = 120) and medical students (73.9%, <i>n</i> = 113). Among the 40 interns, 55% (<i>n</i> = 22) were doctors, 30% (<i>n</i> = 12) were midwives, and 15% (<i>n</i> = 6) were nurses. The study participants showed an increase in knowledge, with median post-test scores higher than pre-test scores for all participants [63% (interquartile ranges, IQR: 57-71%) <i>versus</i> 49% (42-54%), with a median difference of 14% (8-23%), <i>p</i> < 0.001].</p><p><strong>Conclusion: </strong>The SBT effectively imparts key knowledge competencies to the interns and fifth-year medical students. We recommend that SBT be included as part of the course units that students should take and for continuous medical education for qualified healthcare workers in resource-limited settings.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11127575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155904","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":"Association between pathological positivity rate of endometriosis, demographics, and concomitant gynecological conditions.","authors":"Daniela Moiño, Papri Sarkar, Maha Al Jumaily, Samantha Malak, Jean Paul Tanner, Emad Mikhail","doi":"10.1177/26334941241242351","DOIUrl":"https://doi.org/10.1177/26334941241242351","url":null,"abstract":"<p><strong>Background: </strong>To date, there remains a paucity of present-day literature on the topic of demographics and the biopsy-proven pathological positivity rate of endometriosis.</p><p><strong>Objective: </strong>The goal of this study was to explore the association between patients' demographics and other concomitant gynecological conditions or procedures and the pathological positivity rate of excision of endometriosis.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>All women >18 years old who underwent laparoscopic surgery for endometriosis at a tertiary care hospital from October 2011 to October 2020. Women were classified into two groups: (1) Study group: women with >80% pathological positivity rate of endometriosis and (2) Control group: women with <80% pathological positivity rate.</p><p><strong>Results: </strong>A total of 401 women were included in the analysis. No difference was noted in the 80% pathological positivity rate based on body mass index [BMI; 68.7% in normal BMI <i>versus</i> 80% in underweight, <i>versus</i> 74.5% in overweight, and 74.1% in obese patients (<i>p</i> = 0.72)]. The percentage of patients reaching 80% pathological positivity of endometriosis was lower in women who had undergone previous laparoscopy for endometriosis compared to surgery naïve women (66.5% <i>versus</i> 76.5%, <i>p</i> = 0.03). In addition, a higher percentage of women who underwent concomitant hysterectomy (83.5% <i>versus</i> 68.8% for non-hysterectomy, <i>p</i> = 0.005) or bilateral oophorectomy (92.7% <i>versus</i> 70.0% for non-oophorectomy, <i>p</i> = 0.002) reached 80% pathological positivity. Women with an associated diagnosis of fibroids (79.7% <i>versus</i> 70.5%) or adenomyosis (76.4% <i>versus</i> 71.7%) were more likely to reach 80% pathological positivity compared to women without any other coexisting pathology; however, the observed differences were not statistically significant. After applying a log-binomial regression model, compared to White non-Hispanics, Hispanic patients were 30% less likely to reach 80% positivity (RR: 0.70, 95% CI: 0.49-1.02), although not statistically significant.</p><p><strong>Conclusion: </strong>No significant racial difference was found when comparing the rates of 80% pathological positivity of suspected endometriosis lesions among groups. Endometriosis pathological positivity rate was unaffected by patients' BMI and the presence of concomitant pathologies. In addition, prior laparoscopic surgery for endometriosis might cause tissue changes that result in a decrease in the observed pathological positivity rate of endometriosis lesions during subsequent surgeries.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11015736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862928","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":"Barriers to fertility preservation access in transgender and gender diverse adolescents: a narrative review.","authors":"Ashni S Nadgauda, Samantha Butts","doi":"10.1177/26334941231222120","DOIUrl":"10.1177/26334941231222120","url":null,"abstract":"<p><p>Fertility preservation (FP) involves the cryopreservation of gametes, embryos, and/or gonadal tissue oocytes, for future use in family building. FP as part of a comprehensive approach to care of transgender and gender diverse (TGD) individuals is an understudied topic. Current evidence indicates that gender affirming therapies may increase the risk for infertility. As a result, TGD individuals, including adolescents, should receive counseling regarding FP prior to beginning gender affirming treatment. Many barriers exist to TGD adolescents receiving FP counseling and undergoing FP if desired. The objective of this narrative review is to summarize the literature regarding the desire for FP in TGD adolescents, the barriers to TGD adolescents in accessing of FP, and to discuss potential interventions for alleviation of such barriers. A literature search using the following Medical Subject Headings search terms: 'transgender persons' and 'fertility preservation' and 'adolescents' was conducted <i>via</i> searching PubMed. Additional articles were located <i>via</i> reference review. Included articles consist of qualitative and quantitative research and society guidelines. Articles from inception to 1st July 2023 were included. The results of the literature search have been summarized into the format of a narrative review. Key barriers to FP for TGD adolescents include inconsistencies in form and timing of counseling, potential worsening of gender dysphoria with FP treatment, high cost of treatment, limited research on FP outcomes, and legal barriers. Intersectionality between gender identity and other forms of minority status can compound these barriers to FP and healthcare in general. Barriers to TGD adolescents accessing FP are significant. Increased research is needed upon methods to mitigate these barriers. Solutions include increasing uniformity and timing of FP counseling by varying health care providers, advocacy efforts to mitigate legal and financial barriers, increased research efforts in FP outcomes, and increased cultural competency in clinics offering FP care to TGD adolescents.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10826369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139643540","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":"Comparison of efficacy between levonorgestrel intrauterine system and dienogest in adenomyosis: a randomized clinical trial.","authors":"Satish Choudhury, Saubhagya Kumar Jena, Subarna Mitra, Biswa Mohan Padhy, Sudipta Mohakud","doi":"10.1177/26334941241227401","DOIUrl":"10.1177/26334941241227401","url":null,"abstract":"<p><strong>Background: </strong>Medical management of adenomyosis is an emerging perspective in modern gynecology. Though levonorgestrel intrauterine system (LNG-IUS) and dienogest (DNG) effectively relieve symptoms in adenomyosis, neither has been approved for the same indication. Our study aims to compare the efficacy and safety of these progestins in treating adenomyosis.</p><p><strong>Objective: </strong>To study the efficacy and safety of LNG-IUS <i>versus</i> DNG in patients with symptomatic adenomyosis.</p><p><strong>Design: </strong>Open-labeled, parallel, single-centered, randomized clinical trial.</p><p><strong>Methods: </strong>Patients with adenomyosis-associated pain with or without abnormal uterine bleeding were randomly allocated to either LNG-IUS group or DNG group. The primary outcome was a reduction in painful symptoms after 12 weeks of treatment measured by visual analog scale (VAS) score. Changes in menstrual blood loss (MBL), improvement in quality of life (QoL), and adverse drug reactions were also analyzed.</p><p><strong>Results: </strong>The VAS score significantly decreased from baseline in both groups. The baseline and post-treatment VAS scores in the LNG-IUS group were 6.41 ± 1.07 and 3.41 ± 1.04 (<i>p</i> = <0.001) and in the DNG group, were 6.41 ± 0.95 and 3.12 ± 1.40 (<i>p</i> = <0.001), respectively. A significantly greater proportion of patients in the LNG-IUS group experienced lighter MBL as compared to the DNG group [27/30 (90%) in the LNG-IUS group <i>versus</i> 17/22 (77.2%) in the DNG group (<i>p</i> = 0.006)]. Both the groups had improvement in QOL scores calculated by the World Heath Organisation QOL scale (WHOQOL BREF) questionnaire; however, it was more pronounced in the DNG group [(28.76 ± 30.47 in the LNG-IUS group <i>versus</i> 48.26 ± 44.91 in the DNG group (<i>p</i> = 0.04)]. Both the agents were safe as there were no reported major adverse drug reactions.</p><p><strong>Conclusion: </strong>DNG can be an effective and safe alternative to LNG-IUS for the medical management of adenomyosis.</p><p><strong>Trial registration: </strong>The trial was prospectively registered at the clinical trial registry - India (CTRI) vide CTRI number CTRI/2020/05/025186.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10812097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139572304","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":"Ethnic disparities in the incidence of gynecologic malignancies among Israeli Women of Arab and Jewish Ethnicity: a 10-year study (2010-2019).","authors":"Roie Alter, Adiel Cohen, Paul-Adrien Guigue, Raanan Meyer, Gabriel Levin","doi":"10.1177/26334941231209496","DOIUrl":"10.1177/26334941231209496","url":null,"abstract":"<p><strong>Background: </strong>Ethnic disparities in healthcare outcomes persist, even when populations share the same environmental factors and healthcare infrastructure. Gynecologic malignancies are a significant health concern, making it essential to explore how these disparities manifest in terms of their incidence among different ethnic groups.</p><p><strong>Objective: </strong>To investigate ethnic disparities in the incidence of gynecologic malignancies incidence among Israeli women of Arab and Jewish ethnicity.</p><p><strong>Design: </strong>Our research employs a longitudinal, population-based retrospective cohort design.</p><p><strong>Method: </strong>Data on gynecologic cancer diagnoses among the Israeli population from 2010 to 2019 was obtained from a National Registry. Disease incidence rates and age standardization were calculated. A comparison between Arab and Jewish patients was performed, with Poisson regression models being used to analyze significant rate changes.</p><p><strong>Results: </strong>Among Jewish women, the age-standardized ratio (ASR) for gynecologic malignancies decreased from 288 to 251 (<i>p</i> < 0.001) between 2014 and 2019. However, there was no significant change in the ASR among Arab women during the same period, with rates going from 192 to 186 (<i>p</i> = 0.802). During the study period, the incidence of ovarian cancer decreased significantly among Jewish women (<i>p</i> = 0.042), while the rate remained stable among Arab women (<i>p</i> = 0.102). A similar trend was observed for uterine cancer. The ASR of CIN III (Cervical Intraepithelial Neoplasia Grade 3) in Jewish women notably increased from 2017 to 2019, with an annual growth rate of 43.3% (<i>p</i> < 0.001). A similar substantial rise was observed among Arab women, with an annual growth rate of 40.5% (<i>p</i> < 0.001). In contrast, the incidence of invasive cervical cancer remained stable from 2010 to 2019 among women of both ethnic backgrounds.</p><p><strong>Conclusion: </strong>Our findings indicate that Arab women in Israel have a lower incidence rate of gynecologic cancers, warranting further investigation into protective factors. Both ethnic groups demonstrate effective utilization of cervical screening.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10757790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139076101","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":"Refusal of the hospitalization: a distressed dilemma in obstetric practice.","authors":"Canan Unal, Erdem Fadiloglu, Murat Cagan, Gunel Ziyadova, Esra Kaya, Atakan Tanacan, Mehmet Sinan Beksac","doi":"10.1177/26334941231216531","DOIUrl":"10.1177/26334941231216531","url":null,"abstract":"<p><strong>Background: </strong>Pregnant women are a special population in which hospitalizations are more recommended due to physiological changes mimicking pathologies and medico-legal concerns.</p><p><strong>Objectives: </strong>We aimed to assess the obstetric outcomes of expectant mothers who were admitted to the obstetrics emergency outpatient clinic and declined the hospitalization advised by doctors. Additionally, we examined the appropriateness of physicians' recommendations.</p><p><strong>Design: </strong>We have retrospectively evaluated the patients admitted to the 'Obstetric Emergency Outpatient Clinic' and refused hospitalization between 1 January 2019 and 31 December 2019.</p><p><strong>Methods: </strong>Cases were classified into three groups based on the trimester, considering the substantial variation between complaints and complications in each trimester. The complaints of pregnant women were categorized as psychosocial causes, obstetric complications, maternal systemic complaints, and suspicion of labor. We evaluated the compatibility of the hospitalization decision with the pregnancy outcome of patients.</p><p><strong>Results: </strong>A total of 958 pregnant women were included in the study. Leading causes for admissions were obstetric complications, maternal systemic complaints, and suspicion of labor in first, second, and third trimesters, respectively. Psychosocial causes were mostly observed in the second trimester. Readmission to the hospital within a week was highest in the third trimester group. According to pregnancy outcomes, 12.5% (94/753) of our recommendations were appropriate in all trimesters.</p><p><strong>Conclusion: </strong>Obstetricians seem overcautious in managing obstetric patients and willing to offer hospitalization more often than the actual requirements.</p>","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10752054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049905","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":"Treatment modalities for poor ovarian responders.","authors":"Federica Di Guardo,&nbsp;Nicola Pluchino,&nbsp;Panagiotis Drakopoulos","doi":"10.1177/26334941221147464","DOIUrl":"https://doi.org/10.1177/26334941221147464","url":null,"abstract":"Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). The term poor ovarian response (POR) was first introduced by the Bologna Criteria (BC), as a condition which includes at least two of the following features: advanced maternal age (⩾40 years), a previous POR with ⩽3 oocytes retrieved after conventional stimulation and/or an abnormal ovarian reserve test [i.e. antral follicle count (AFC) < 7 or anti-Müllerian hormone (AMH) < 1.1 ng/ml]. In the case of non-advanced maternal age and normal ovarian reserve test, POR is defined when a patient reports two episodes of POR following maximal ovarian stimulation.1 Although the BC represented a milestone in the field of in vitro fertilization (IVF),2 criticism about its substantial heterogeneity of the population may have prevented its widespread use in clinical practice. In this regard, a recent re-evaluation of these criteria has been proposed by the Poseidon Group (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number)3 in order to overcome limitations of the BC. Some of the weaknesses of the BC are the ambiguity in defining risk factors, its substantial heterogeneity, the lack of accounting for oocyte quality, and other factors that can be associated with a low ovarian reserve.4–6 In this view, the Poseidon Group classification has been developed to better stratify the ‘low-prognosis patient’ by considering (1) qualitative and numerical parameters (e.g. expected aneuploidy rate and patient’s age); (2) ovarian reserve indicators (AFC and/or AMH); and (3) ovarian response to previous stimulation cycle, including four subgroups of patients: [Group 1: women younger than 35 years with AFC ⩾ 5 and AMH ⩾ 1.2; Group 2: women of age ⩾ 35 with AFC ⩾ 5 and AMH ⩾ 1.2; Group 3: women younger than 35 years old with AFC < 1 and AMH < 1.2 ng/ml; Group 4: ⩾35 with AFC < 1 and AMH < 1.2 ng/ml].","PeriodicalId":75219,"journal":{"name":"Therapeutic advances in reproductive health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/64/10.1177_26334941221147464.PMC9880576.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10590510","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}