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Human Reproduction (Oxford, England) Aug 2023What is the anti-Mullerian hormone (AMH) test usage, awareness, and perceived reasons for testing in a representative community sample of women in Australia?
STUDY QUESTION
What is the anti-Mullerian hormone (AMH) test usage, awareness, and perceived reasons for testing in a representative community sample of women in Australia?
SUMMARY ANSWER
: Among women aged 18-55 years, 13% had heard about AMH testing and 7% had had an AMH test, with the top three reasons for testing including due to infertility investigations (51%), considering pregnancy and wanting to understand their chances (19%) or to find out if a medical condition had affected fertility (11%).
WHAT IS KNOWN ALREADY
The growing availability of direct-to-consumer AMH testing has raised concerns about overuse, however as most AMH tests are paid for privately by consumers, data on test usage is not publicly available.
STUDY DESIGN, SIZE, DURATION
National cross-sectional survey of 1773 women, conducted in January 2022.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Females aged 18-55 years were recruited from the representative 'Life in Australia' probability-based population panel and completed the survey online or by telephone. Main outcome measures included if and how participants had heard about AMH testing, whether they had ever had an AMH test, main reason for testing and test access.
MAIN RESULTS AND THE ROLE OF CHANCE
Of the 2423 women who were invited 1773 responded (73% response rate). Of these, 229 (13%) had heard about AMH testing and 124 (7%) had had an AMH test. Testing rates were highest among those currently aged 35-39 years (14%) and associated with educational attainment. Almost all accessed the test through their general practitioner or fertility specialist. Reasons for testing were: part of an infertility investigation (51%), considering pregnancy and wanting to understand chances of conceiving (19%), finding out if a medical condition had affected fertility (11%), curiosity (9%), considering egg freezing (5%), and considering delaying pregnancy (2%).
LIMITATIONS, REASONS FOR CAUTION
Although the sample was large and mostly representative, it was over-represented by people holding a university degree and under-represented by people aged 18-24, however, we used weighted data where possible to account for this. All data were self-reported so there is a risk of recall bias. The number of survey items was also restricted, so the type of counselling women received prior to testing, reasons for declining an AMH test or test timing were not measured.
WIDER IMPLICATIONS OF THE FINDINGS
Whilst most women reported having an AMH test for appropriate reasons, about one third had it for reasons not supported by evidence. Public and clinician education about the lack of utility of AMH testing for women not undergoing infertility treatment is needed.
STUDY FUNDING/COMPETING INTEREST(S)
This project was supported by a National Health and Medical Research Council (NHMRC) Centre for Research Excellence grant (1104136) and Program grant (1113532). T.C. is supported by an NHMRC Emerging Leader Research Fellowship (2009419). B.W.M. reports research funding, consultancy and travel support from Merck. D.L. is the Medical Director of City Fertility NSW and reports consultancy for Organon, Ferring, Besins and Merck. The authors have no other competing interests.
TRIAL REGISTRATION NUMBER
N/A.
Topics: Pregnancy; Humans; Female; Anti-Mullerian Hormone; Cross-Sectional Studies; Infertility; Fertility; Probability
PubMed: 37309652
DOI: 10.1093/humrep/dead111 -
BMJ Medicine 2023To evaluate the association between preconception contraceptive use and miscarriage.
OBJECTIVES
To evaluate the association between preconception contraceptive use and miscarriage.
DESIGN
Prospective cohort study.
SETTING
Residents of the United States of America or Canada, recruited from 2013 until the end of 2022.
PARTICIPANTS
13 460 female identified participants aged 21-45 years who were planning a pregnancy were included, of whom 8899 conceived. Participants reported data for contraceptive history, early pregnancy, miscarriage, and potential confounders during preconception and pregnancy.
MAIN OUTCOME MEASURE
Miscarriage, defined as pregnancy loss before 20 weeks of gestation.
RESULTS
Preconception use of combined and progestin-only oral contraceptives, hormonal intrauterine devices, copper intrauterine devices, rings, implants, or natural methods was not associated with miscarriage compared with use of barrier methods. Participants who most recently used patch (incidence rate ratios 1.34 (95% confidence interval 0.81 to 2.21)) or injectable contraceptives (1.44 (0.99 to 2.12)) had higher rates of miscarriage compared with recent users of barrier methods, although results were imprecise due to the small numbers of participants who used patch and injectable contraceptives.
CONCLUSIONS
Use of most contraceptives before conception was not appreciably associated with miscarriage rate. Individuals who used patch and injectable contraceptives had higher rates of miscarriage relative to users of barrier methods, although these results were imprecise and residual confounding was possible.
PubMed: 37705685
DOI: 10.1136/bmjmed-2023-000569 -
Midwifery Nov 2023The assessment of professional competence is essential to ensure the achievement of competence standards. The goal of this study is to design and implement a...
The assessment of professional competence is essential to ensure the achievement of competence standards. The goal of this study is to design and implement a professional competence test model to make the test unified, comprehensive, and fair. This research was a multimethod, multiphasic study. The first qualitative phase of the nominal group technique was conducted to design the test model with specific guidelines. The second phase was a mixed-method parallel field trial conducted on 161 senior midwifery bachelor students in universities of Iran. The test was conducted following the traditional method in the control group and OMMID model in the intervention group. This model consists of three parts: the MCQs (multiple choice questions), OSCE (objective structured clinical examination), and clinically-oriented tests, which included Mini-CEX (mini-clinical evaluation exercise) and DOPS (direct observation of procedural skills). Data were collected using questionnaires and interviews, and the results were assessed qualitatively and quantitatively. The OMMID model and the associated guideline were designed. Qualitative data analysis resulted in six main themes, including organizing, structure, tension due to change, fairness, unification, and outcome. The OMMID model did not increase students' anxiety and stress and did not decrease their satisfaction. The merits of this model include having a centralized guideline, using multiple evaluation methods, comprehensive evaluation of necessary skills, promotion of fairness, and increased student satisfaction.
Topics: Pregnancy; Humans; Female; Clinical Competence; Educational Measurement; Midwifery; Professional Competence; Students, Nursing
PubMed: 37757699
DOI: 10.1016/j.midw.2023.103831 -
BMC Infectious Diseases Nov 2023Pro-b-type natriuretic peptide (Pro-BNP) is an inflammatory marker that indicates cardiac damage and inflammation. The elevation of this marker in COVID-19 patients can...
BACKGROUND
Pro-b-type natriuretic peptide (Pro-BNP) is an inflammatory marker that indicates cardiac damage and inflammation. The elevation of this marker in COVID-19 patients can be used as a predictive factor in the prognosis of these patients.
METHOD
Our cross-sectional study investigated the evaluation of cardiac diagnostic test findings based on pro-BNP levels in pregnant COVID-19 patients in Sayyad Shirazi Hospital, Gorgan, Iran, in 2020-2022. A hundred and ten pregnant patients diagnosed with COVID-19 infection were evaluated for cardiac diagnostic tests (electrocardiogram (ECG) and echocardiography (Echo)) and pro-BNP levels. Data were analyzed using SPSS 25 software. Chi-square and Student's t-test will be used to test and compare the relationship between variables and compare them. A P-value less than 0.05 is considered statistically significant. The chi-square test was used to compare the ratio of qualitative variables among the groups if the presuppositions of chi-square distribution were established. Otherwise, Fisher's exact test was used.
RESULT
The mean age of participants were 31.06 ± 5.533 years and 49.1% of patients had pro-BNP levels above the cut-off value for predicting an adverse outcome of COVID-19. The mean ± standard deviation of pro-BNP levels in the low group was 46.125 ± 17.523 pg/mL and in the high group was 878.814 ± 1038.060 pg/mL. This study revealed that patients with higher pro-BNP plasma levels had a significant relation between, myocardial infarction (MI), pericardial effusion (PE), urgent Caesarean section (C/S), and mortality. In addition, no significant relation between gravid, trimester, vaccination, arrhythmia, heart block, and valves diseases with high pro-BNP levels was found.
CONCLUSION
The current research showed that pro-BNP levels can be used as a diagnostic and valuable prognostic tool in pregnant women to diagnose cardiac complications by using ECG and Echo.
Topics: Pregnancy; Humans; Female; Adult; Biomarkers; Cesarean Section; Cross-Sectional Studies; Predictive Value of Tests; COVID-19; Prognosis; Diagnostic Tests, Routine; Natriuretic Peptide, Brain; Peptide Fragments; COVID-19 Testing
PubMed: 37957564
DOI: 10.1186/s12879-023-08764-1 -
JMIR Research Protocols Jan 2024Syphilis in pregnancy and congenital syphilis are growing public health issues worldwide. Several factors can influence their occurrence in the population. Therefore,...
BACKGROUND
Syphilis in pregnancy and congenital syphilis are growing public health issues worldwide. Several factors can influence their occurrence in the population. Therefore, understanding the epidemiology of this condition and the factors that influence its occurrence is fundamental for decision-making by clinicians and health managers. However, so far, no systematic review has summarized and analyzed data on the incidence, prevalence, and predictors of these diseases in Brazilian cities, considering different sociocultural, demographic, economic, sanitary, and spatial-temporal characteristics presented across locations.
OBJECTIVE
We propose a systematic review protocol to gather and analyze data on the incidence, prevalence, and risk or associated factors of syphilis in pregnancy and congenital syphilis in Brazil, taking into account different local or regional contexts.
METHODS
Searches will be conducted in CINAHL, MEDLINE, LILACS, Embase, and Web of Science databases. We will include observational studies (ie, cross-sectional, longitudinal, or case-control studies), analyzing the incidence, prevalence, and risk or associated factors of syphilis in pregnancy and congenital syphilis in Brazil from primary data. The diagnosed syphilis will be assessed based on direct pathogen detection tests or through immunological, treponemal or nontreponemal tests, following Brazilian protocols for diagnosing syphilis. The studies are currently undergoing screening in the databases, and after this step, 2 reviewers will perform all identified documents. The Newcastle-Ottawa Scale and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) system will be used to assess methodological quality and quality of evidence of studies, respectively. The Kappa coefficient will assess the agreement between researchers in each study stage. Cochran Q test will assess the heterogeneity among studies. Then, a random-effects meta-analysis will be performed.
RESULTS
Results will be discussed based on subgroup analysis, which is as follows: (1) type of syphilis (in pregnancy or congenital), (2) type of study (case-control and cross-sectional studies for analysis of associated factors and longitudinal studies for risk factors), and (3) contextual factors (ie, region of country, socioeconomic and demographic characteristics, and year of study). This systematic review is expected to be completed by December 2023, and our results will be disseminated through publication in peer-reviewed journals and scientific events.
CONCLUSIONS
This systematic review aims to assist health care managers and professionals in their decision-making to control these diseases in Brazil, considering location heterogeneity. Furthermore, countries with health systems and demographic and socioeconomic contexts similar to those of Brazil may benefit from this information.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/50702.
PubMed: 38175689
DOI: 10.2196/50702 -
Journal of Clinical Medicine Oct 2023(1) Background: Asthma is a very prevalent disease with special characteristics during pregnancy, however, little is known about its relationship to the psychological...
(1) Background: Asthma is a very prevalent disease with special characteristics during pregnancy, however, little is known about its relationship to the psychological wellbeing of women in this period; we aimed to know whether depression and anxiety symptoms are more frequent in asthmatic pregnant women. (2) Methods: Family Apgar (week 20), Edinburgh Postnatal Depression Scale (weeks 20 and 32) and State-Trait Anxiety Inventory (STAI) (week 32) tests were administered to 738 pregnant women (81 asthmatics) in the Nutrition in Early Life and Asthma (NELA) birth cohort. (3) Results: There were no significant differences between asthmatic and non-asthmatic pregnant women in any of the different tests at any of the time points. The mean scores for the different tests and timepoints between asthmatic and non-asthmatic pregnant women were: Apgar 20, 17.9 ± 2.2 vs. 10.0 ± 2.2; Edinburgh 20, 6.7 ± 4.2 vs. 6.9 ± 4.3; Edinburgh 32, 5.9 ± 4.4 vs. 5.6 ± 4.3; and STAI 32, 16.7 ± 8.4 vs. 15.8 ± 8.3. The proportion of pregnant women out of the normal range score for any of the tests and time points was also similar in both populations. (4) Conclusions: asthma is not associated with the psychological wellbeing of pregnant women.
PubMed: 37834979
DOI: 10.3390/jcm12196335 -
Culture, Health & Sexuality Mar 2024This qualitative study conducted between November 2020 and March 2021 in the US state of Mississippi examines the experiences of 25 people who obtained medication...
This qualitative study conducted between November 2020 and March 2021 in the US state of Mississippi examines the experiences of 25 people who obtained medication abortion at the state's only abortion facility. We conducted in-depth interviews with participants after their abortions until concept saturation was reached, and then analysed the content using inductive and deductive analysis. We assessed how people use embodied knowledge about their individual physical experiences such as pregnancy symptoms, a missed period, bleeding, and visual examinations of pregnancy tissue to identify the beginning and end of pregnancy. We compared this to how people use biomedical knowledge such as pregnancy tests, ultrasounds, and clinical examinations to confirm their self-diagnoses. We found that most people felt confident that they could identify the beginning and end of pregnancy through embodied knowledge, especially when combined with the use of home pregnancy tests that confirmed their symptoms, experiences, and visual evidence. All participants concerned about symptoms sought follow-up care at a medical facility, whereas people who felt confident of the successful end of the pregnancy did so less often. These findings have implications for settings of restricted abortion access that have limited options for follow-up care after medication abortion.
Topics: Pregnancy; Female; Humans; Abortion, Induced; Health Facilities; Emotions; Qualitative Research; Mississippi
PubMed: 37211833
DOI: 10.1080/13691058.2023.2212298 -
Archives of Gynecology and Obstetrics Aug 2023The purpose of this study was to identify if switching from intramuscular (IM) to vaginal progesterone compared to staying on IM progesterone after a positive pregnancy...
The association between the type of progesterone supplementation and miscarriage risk in women who have had a positive pregnancy test following embryo transfer: a retrospective cohort study.
PURPOSE
The purpose of this study was to identify if switching from intramuscular (IM) to vaginal progesterone compared to staying on IM progesterone after a positive pregnancy test following embryo transfer (ET) is associated with miscarriage risk.
METHODS
A retrospective cohort study was performed in a private university-affiliated fertility clinic and included women aged 18-50 years with a positive pregnancy test following ET. The two groups studied were: women who stayed on IM progesterone following a positive pregnancy test and those who switched to vaginal progesterone after a positive test. The main outcome measured was risk of miscarriage < 24 weeks gestation as a proportion of non-biochemical pregnancies.
RESULTS
1988 women were included in the analysis. Among the baseline characteristics, the presence of prior miscarriages as well as prior failed ETs, and frozen cycles (vs fresh) as type of transfer were associated with IM progesterone use (p values ≤ 0.01). As per miscarriage risk < 24 weeks, 22.4% (274/1221) of patients in the IM progesterone group experienced a miscarriage compared with 20.7% (159/767) in the vaginal progesterone group (OR 0.90; 95% CI 0.73-1.13). A multivariable logistic regression model revealed an adjusted OR (aOR) of 0.97 (95% CI 0.77-1.22).
CONCLUSION
This study suggests that switching from IM to vaginal progesterone after a positive pregnancy test following an ET is not associated with miscarriage risk. Considering that IM progesterone imposes substantial discomfort, this study offers reassurance and some flexibility in treatment protocols. Further prospective studies are necessary to corroborate the results of this study.
Topics: Pregnancy; Humans; Female; Progesterone; Abortion, Spontaneous; Retrospective Studies; Prospective Studies; Fertilization in Vitro; Embryo Transfer; Dietary Supplements; Pregnancy Tests; Pregnancy Rate
PubMed: 37156908
DOI: 10.1007/s00404-023-07047-z -
JBRA Assisted Reproduction Mar 2024To evaluate the impact of double embryo vitrification on clinical outcomes.
OBJECTIVE
To evaluate the impact of double embryo vitrification on clinical outcomes.
METHODS
This retrospective cohort study included data from January 2013 to March 2021. The study group included women aged 33.3±5.7 years with double-vitrified embryos (n=381), while the control group included women aged 32.1±6.7 years with embryos vitrified once (n=780), all transferred at the blastocyst stage. The primary endpoint was live birth rate (LBR), and secondary endpoints included percent positive βHCG test, clinical/ongoing pregnancy rates, miscarriage/biochemical pregnancy rates and birthweight.
RESULTS
LBR was significantly lower in double-vitrified embryos (30.2%) than in embryos vitrified once (45.6%, p<.05). Similarly, double-vitrified embryos were associated with significantly lower positive βHCG tests (46% vs. 63.3%, p<.05) and clinical (34.9% vs. 52.2%, p<.05) and ongoing pregnancy (31.3% vs. 47.3%, p<.05) rates compared to embryos vitrified once. However, biochemical pregnancy (double vitrified: 24.1% vs. vitrified once: 17.9%, p>.05) and miscarriage rates (double vitrified: 10.2% vs. vitrified once: 9.4%, p>.05), as well as mean birthweight (double-vitrified embryos: 2950g vs. embryos vitrified once: 2837g, p>.05) did not differ significantly between two groups. On a secondary comparison, amongst double-vitrified embryos, the subgroup that was cultured for more than 24 hours between warming and second vitrification achieved significantly higher positive βHCG tests (49%) and clinical pregnancy (38%) rates, compared to embryos re-vitrified on the same day of warming (31.8% and 20.5%, respectively, p<.05). Nevertheless, LBR did not differ significantly amongst these study-group embryos (embryos that remained in culture for more than 24 hours: 32.2% vs. embryos that were re-vitrified on warming day: 20.5%, p>.05).
CONCLUSIONS
Double vitrification of embryos adversely affects clinical outcomes. However, it represents a valuable option concerning embryo wastage, with acceptable success rates.
PubMed: 38546119
DOI: 10.5935/1518-0557.20240014 -
Abdominal Radiology (New York) Jun 2024Gynecological emergencies can often present with a myriad of non-specific signs and symptoms, posing a diagnostic challenge to the clinician. They can be grossly divided... (Review)
Review
Gynecological emergencies can often present with a myriad of non-specific signs and symptoms, posing a diagnostic challenge to the clinician. They can be grossly divided into uterine or adnexal pathologies. Uterine pathologies can be secondary to intracavitary accumulation of blood [like in patients with transverse vaginal septum, Robert's uterus, accessory and cavitated uterine mass, unicornuate uterus with contralateral non-communicating functional horn], bleeding per vaginum [like in patients with retained products of conception, enhanced myometrial vascularity], pyometra [secondary to pelvic inflammatory disease, cervical obstruction secondary to benign and malignant causes] or complications of fibroids [like red degeneration, torsion of subserosal fibroid]. The adnexal pathologies can range from ectopic pregnancy in a urine pregnancy test (UPT) positive patient to haemorrhagic ovarian cyst, ovarian torsion, ruptured dermoid cyst and tubo-ovarian abscess in a UPT negative patient. Multimodality imaging including ultrasound (USG), computed tomography (CT) scan and magnetic resonance imaging (MRI) can narrow down the differentials and help in formulating an accurate diagnosis. The objective of this article is to familiarize the readers with multimodality imaging findings in common as well as uncommon acute gynecological emergencies and provide an algorithmic imaging approach for acute gynecological emergencies. USG is typically used as the first line diagnostic modality in diagnosis of acute gynecological emergencies. CT scan & MRI are helpful as a problem-solving tool in acute gynecological emergencies when USG findings are indeterminate.
PubMed: 38836883
DOI: 10.1007/s00261-024-04399-1