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BMJ Open Feb 2022Urine pregnancy tests are often inaccessible in low-income settings. Expanded provision of home pregnancy testing could support self-care options for sexual and... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Urine pregnancy tests are often inaccessible in low-income settings. Expanded provision of home pregnancy testing could support self-care options for sexual and reproductive health and rights. We conducted a systematic review of pregnancy self-testing effectiveness, values and preferences and cost.
DESIGN
Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.
DATA SOURCES
PubMed, CINAHL, LILACS and EMBASE and four trial registries were searched through 2 November 2020.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
We included trials and observational studies that compared urine self-testing for pregnancy to health worker-led pregnancy testing on effectiveness outcomes; quantitative and qualitative studies describing values and preferences of end users and health workers and costs of pregnancy self-testing.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. Meta-analysis was conducted using random effects models. Findings were summarised in GRADE evidence profiles and synthesised qualitatively.
RESULTS
For effectiveness, four randomised trials following 5493 individuals after medical abortion showed no difference or improvements in loss to follow-up with home pregnancy self-testing compared with return clinic visits. One additional trial of community health workers offering home pregnancy tests showed a significant increase in pregnancy knowledge and antenatal counselling among 506 clients. Eighteen diverse values and preferences studies found support for pregnancy self-testing because of quick results, convenience, confidentiality/privacy, cost and accuracy. Most individuals receiving pregnancy self-tests for postabortion home management preferred this option. No studies reported cost data.
CONCLUSION
Pregnancy self-testing is acceptable and valued by end users. Effectiveness data come mostly from articles on postabortion care, and cost data are lacking. Greater availability of pregnancy self-tests, including in postabortion care and CHW programs, may lead to improved health outcomes.
PROSPERO REGISTRATION NUMBER
CRD42021231656.
Topics: Abortion, Induced; Female; Health Personnel; Humans; Pregnancy; Qualitative Research; Self-Testing
PubMed: 35228285
DOI: 10.1136/bmjopen-2021-054120 -
Expert Review of Endocrinology &... Jul 2022Normal thyroid status throughout pregnancy is important for both maternal and fetal health. Despite the bulk of contemporary research honing on thyroid function in...
INTRODUCTION
Normal thyroid status throughout pregnancy is important for both maternal and fetal health. Despite the bulk of contemporary research honing on thyroid function in gestation and the relevant disorders, there are still gaps in our current knowledge about the etiology and treatment of thyroid diseases in pregnant women.
AREAS COVERED
This article analyzes the adaptation of the thyroid gland to gestational physiological changes and attempts to explain the effect of several factors on thyroid function in pregnancy. It also stresses proper utilization and interpretation of thyroid tests during pregnancy and underlines the significance of proper screening and treatment of pregnant women aiming at favorable health outcomes.
EXPERT OPINION
Appropriate strategies for diagnosing and treating thyroid disease in pregnancy are important. Laboratory thyroid testing plays a leading role, but test results should be interpreted with caution. Given the possible serious maternal and fetal/neonatal complications of thyroid disease in pregnancy, we recommend universal screening with TSH measurements of all pregnant women. Additional assessment with determination of the levels of free thyroid hormones and thyroid antibodies may be necessary under certain conditions. The economic burden of such interventions should be considered.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Pregnant Women; Thyroid Diseases; Thyroid Function Tests
PubMed: 35831988
DOI: 10.1080/17446651.2022.2099372 -
Journal of Obstetrics and Gynaecology... Oct 2020This study sought to evaluate available evidence of the safety of penicillin skin testing (PST), challenge, and desensitization in pregnancy, with efforts to improve... (Review)
Review
OBJECTIVE
This study sought to evaluate available evidence of the safety of penicillin skin testing (PST), challenge, and desensitization in pregnancy, with efforts to improve perinatal care for patients with a penicillin allergy history and mitigate the negative sequelae of unverified penicillin allergy labels.
METHODS
A systematic review of studies was conducted using Cochrane Library, Medline, EMBASE, and International Pharmaceutical Abstracts. Included were peer-reviewed studies without date restrictions, published in English or French, relating to PST, challenge, or desensitization in pregnancy. Editorials, opinion pieces, and letters were excluded. Review authors independently screened citations and full-text articles, extracted data, and conducted quality assessment. Given the heterogeneity of study designs, a narrative synthesis was conducted.
RESULTS
The search identified 1195 references, of which 18 studies met inclusion criteria. In total there were 231 patients with varying histories of penicillin allergy, the majority requiring treatment for syphilis or group B streptococcal (GBS) disease during pregnancy. Of the 203 participants who underwent PST, 83.7% had negative test results. Allergy-related reactions were rare in PST (1.5%) and challenge (0%), and although these reactions were more common in desensitization (19.7%), most were benign. Among the 231 cases, only one adverse pregnancy outcome was reported (0.4%).
CONCLUSION
This review demonstrates that the known prevalence of true penicillin allergy extends to pregnant women. PST and desensitization can be safely applied during pregnancy and are tools that should be used more frequently. Further data on the safety of challenge during pregnancy are recommended.
Topics: Anti-Bacterial Agents; Desensitization, Immunologic; Drug Hypersensitivity; Female; Humans; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Skin Tests; Streptococcal Infections; Streptococcus agalactiae; Syphilis; Treponema pallidum
PubMed: 32005632
DOI: 10.1016/j.jogc.2019.11.067 -
Journal of Medical Imaging and... Aug 2020Pulmonary embolism (PE) is a leading cause of maternal mortality with women at increased risk of PE during pregnancy and the early postpartum period. Clinical assessment... (Review)
Review
Pulmonary embolism (PE) is a leading cause of maternal mortality with women at increased risk of PE during pregnancy and the early postpartum period. Clinical assessment of suspected PE during pregnancy is challenging as signs and symptoms associated with PE overlap with physiological changes of pregnancy. Clinical tests and rules commonly used to assess pre-test probability of PE were historically not well validated in the pregnant population. The challenges of clinical assessment in the pregnant and postpartum population result in a lowered threshold for diagnostic imaging. Computed tomographic pulmonary angiography (CTPA) and nuclear medicine lung scintigraphy or ventilation/perfusion (V/Q) scans are the main types of diagnostic imaging for suspected PE. Both methods are associated with small levels of ionising radiation exposure to mother and foetus. Accuracy of the diagnostic imaging tests is paramount. Haemodynamic changes of pregnancy, including increased heart rate, increased blood volume and altered flow velocity in the pulmonary arteries, may influence the quality of imaging. This comprehensive review examines the literature and evidence for the investigation and diagnostic imaging of suspected pulmonary embolism during pregnancy with CTPA and V/Q. Clinical decision-making tools, biomarkers and diagnostic imaging during pregnancy and postpartum will be considered with a focus on diagnostic accuracy and yield, radiation dose exposure (maternal-foetal) and protocol modifications. Current practice guideline recommendations and recent literature on diagnostic pathways are also presented.
Topics: Computed Tomography Angiography; Female; Humans; Pregnancy; Pregnancy Complications; Puerperal Disorders; Pulmonary Artery; Pulmonary Embolism
PubMed: 32307898
DOI: 10.1111/1754-9485.13027 -
Talanta Mar 2023Human chorionic gonadotropin (hCG), a glycoprotein hormone secreted from the placenta, is an important biomarker for pregnancy. In this study, we designed a precise,...
Human chorionic gonadotropin (hCG), a glycoprotein hormone secreted from the placenta, is an important biomarker for pregnancy. In this study, we designed a precise, rapid and fully automatic device with an electrochemical point-of-care biosensor capable of quantitative hCG detection from human urine samples for early pregnancy detection. Gold and Ag/AgCl electrodes, whose structure with optimum isopotential region and current density, were simulated using COMSOL Multiphysics® software and custom-made from Flex Medical. The sensing surface was fabricated with DSP self-assembled monolayers (SAMs) and covalently immobilized anti-hCG-beta antibody. The detection method involved a sandwich assay using anti-hCG alpha-HRP. Based on an automated agitation design implemented in our device, the surface reaction rate is significantly improved comparing to routinely performed sandwich assays, and therefore a rapid detection of very low concentration can be achieved. Electrochemical impedance spectroscopy (EIS) and chronoamperometry (CA) measurements were used to characterize the immobilization of the antibodies and to determine the sensor activities respectively. The sensors displayed a limit of detection (LOD) of 2.17 mIU/ml within established clinical hCG levels for early detection of pregnancy. They responded very well to hCG, but not to luteinizing hormone (LH), which has a high degree of cross-reactivity with hCG. The results showed that the immunosensor has high specificity, good reproducibility, and long-term stability for the detection of hCG in urine samples.
Topics: Pregnancy; Female; Humans; Biosensing Techniques; Immunoassay; Point-of-Care Systems; Reproducibility of Results; Chorionic Gonadotropin; Pregnancy Tests
PubMed: 36525867
DOI: 10.1016/j.talanta.2022.124156 -
Theriogenology Jan 2024Primiparous and multiparous dairy cattle were evaluated for pregnancy using both transrectal ultrasonography and a point-of-care pregnancy test (Alertys OnFarm Test),...
Primiparous and multiparous dairy cattle were evaluated for pregnancy using both transrectal ultrasonography and a point-of-care pregnancy test (Alertys OnFarm Test), which measures pregnancy-associated glycoproteins through lateral diffusion, between Days 28-34 of pregnancy results were compared. A total of 637 animals were included in this study. Pregnancy was confirmed via manual palpation between Days 57-64. Data on parity, calving, and time of artificial insemination (AI) were also collected and evaluated. Overall the accuracy of the lateral diffusion test was 93.1% with 98.9% sensitivity, 88.7 % specificity, 86.8 % positive predictive value, and 99.1% negative predictive value. In heifers, the Alertys OnFarm Test had 100% sensitivity and 81.6% specificity. In contrast, the test had a sensitivity and specificity of 98.5 and 89.5%, respectively for multiparous cows. The pregnancy loss between early diagnosis and confirmation increased with parity. Heifers suffered losses as low as 2.6%, whereas animals in the third parity had significantly more losses (17.9%). Season also affected losses with spring pregnancy losses being considerably higher than autumn losses. The veterinary workload was also evaluated. Using the combined method of pregnancy testing, animals were first tested with the lateral diffusion test; then, the test-negative animals were scanned again, and the number of scanned animals was reduced. The results ranged between 3274% on farms. We concluded that veterinary workload could be reduced by using the point-of-care test. However, farm-level differences may have affected the results of the present study.
Topics: Pregnancy; Cattle; Animals; Female; Point-of-Care Systems; Abortion, Veterinary; Parity; Pregnancy Outcome; Pregnancy Tests; Insemination, Artificial; Lactation; Cattle Diseases
PubMed: 37897849
DOI: 10.1016/j.theriogenology.2023.10.014 -
Sensors (Basel, Switzerland) Sep 2022Due to the recent pandemic caused by coronavirus disease 2019 (COVID-19), the lateral flow immunoassay used for its rapid antigen test is more popular than ever before.... (Review)
Review
Due to the recent pandemic caused by coronavirus disease 2019 (COVID-19), the lateral flow immunoassay used for its rapid antigen test is more popular than ever before. However, the history of the lateral flow immunoassay is about 60 years old, and its original purpose of use, such as a COVID-19 rapid antigen test or a pregnancy test, was the qualitative detection of a target analyte. Recently, the demand for quantitative analysis of lateral flow immunoassays is increasing in various fields. Lateral flow immunoassays for quantitative detection using various materials and sensor technologies are being introduced, and readers for analyzing them are being developed. Quantitative analysis readers are highly anticipated for their future development in line with technological advancements such as optical, magnetic field, photothermal, and electrochemical sensors and trends such as weight reduction, miniaturization, and cost reduction of systems. In addition, the sensing, processing, and communication functions of portable personal devices such as smartphones can be used as tools for the quantitative analysis of lateral flow immunoassays. As a result, lateral flow immunoassays can efficiently achieve the goal of rapid diagnosis by point-of-care testing. Readers used for the quantification of lateral flow immunoassays were classified according to the adopted sensor technology, and the research trends in each were reviewed in this paper. The development of a quantitative analysis system was often carried out in the assay aspect, so not only the readers but also the assay development cases were reviewed if necessary. In addition, systems for quantitative analysis of COVID-19, which have recently been gaining importance, were introduced as a separate section.
Topics: COVID-19; Humans; Immunoassay; Immunologic Tests; Middle Aged; Miniaturization; Point-of-Care Systems; Point-of-Care Testing
PubMed: 36236497
DOI: 10.3390/s22197398 -
The Journal of Perinatal Education Jul 2023Since early 2020, the world has been dealing with the COVID-19 pandemic. The rapid changing situation led to unforeseeable challenges and questions for many people,...
Since early 2020, the world has been dealing with the COVID-19 pandemic. The rapid changing situation led to unforeseeable challenges and questions for many people, including pregnant women. Through a textual analysis of personal narratives told via pregnancy and/or laboring vlogs during COVID-19, this present study aims to understand how women from China who live in another country during pregnancy have utilized YouTube vlogs to share their experiences. Through this analysis, we identify various challenges that these women experienced during their pregnancy. The COVID-19 pandemic exaggerated the normal difficulties of these issues and also created additional problems for these women, including regular pregnancy tests, choice of birthing locations, and the support and caring that were normal during this time period.
PubMed: 37520791
DOI: 10.1891/JPE-2021-0036 -
Scientific Reports Sep 2023Infertility has been recognized as a distressing experience among couples worldwide, cutting across various cultures. This present study was conducted to assess the... (Randomized Controlled Trial)
Randomized Controlled Trial
Infertility has been recognized as a distressing experience among couples worldwide, cutting across various cultures. This present study was conducted to assess the impact of a supportive stress management program led by an infertility coach for women undergoing fertility treatment. This randomized controlled clinical trial study was performed on 60 infertile women undergoing assisted reproductive techniques at Maryam Infertility Center located in Sari in 2018. After random allocation in two groups, 30 individuals were in the intervention group and 30 in the control group. The intervention program was implemented according to the infertility coach's counseling protocol in six stages. The control group received only routine ward counseling. In order to measure stress, the Newton Infertility Stress Questionnaire was used firstly before intervention and then after oocyte puncture, embryo transfer, and pregnancy testing. Data analysis was performed using SPSS statistical software version 18 and Shapiro-Wilk, Chi-square, Mann-Whitney, independent t-test, Friedman test, Wilcoxon test, GEE test, and Cohen's effect size. Our analysis approach has also been based on the analysis of (ITT). The significance level was 0.05. The mean ± SD scores of infertility perceived stress before the intervention in the control was 146.16 ± 16.90 and the intervention group was 156.53 ± 9.31, after intervention at the time of oocyte puncture in the controls was 165.36 ± 8.98 and the intervention group was 155.83 ± 10.70, at the day of embryo transfer in the control group was 156.35 ± 14.45 and in the intervention group was 123.58 ± 22.9 and in the pregnancy test day in the control group was 185.76 ± 26.56 and in the intervention group was 127.61 ± 21.57 (P < 0.001). According to Friedman test, the mean of stress in three situations after the intervention showed a significant difference in reduction of the mean of stress (P < 0.001). In the control group, the stress score of the samples had an increasing trend, which was significant during the measurement steps based on Friedman test results (P < 0.001). In the intervention group, paired t-test results showed no significant comparing mean score of Newton's infertility stress before and after oocyte puncture day (P = 0.711), comparing the mean of stress before and after pregnancy test day (P = 0.003) and also comparing of mean stress before and after pregnancy on the day of embryo transfer according to Wilcoxon test (P < 0.001). And comparing mean stress before and after pregnancy test day, paired t-test (P = 0.001) showed significant statistical differences. According to the results of the GEE test, changes in stress scores over time were significant between the two groups (P < 0.001), as well as the effect of stress on oocyte puncture day (0.41), embryo transfer day (1.69), pregnancy test day (P < 0.001) (2.46) had a significant effect on the day of embryo transfer and pregnancy test day. Based on the results of this study, the infertility coach program demonstrated the ability to decrease the perceived stress related to infertility. Additionally, it showed potential in enhancing treatment outcomes, such as oocyte count and positive pregnancy results, among infertile women undergoing assisted reproductive techniques.Trial registration: Iranian Registry for Clinical Trial (the link to trial: https://www.irct.ir/trial/33357 ). Registered 11-11-2018.
Topics: Female; Humans; Pregnancy; Fertility; Infertility, Female; Iran; Mentoring; Stress, Psychological
PubMed: 37666933
DOI: 10.1038/s41598-023-41845-4 -
Case Reports in Obstetrics and... 2021The description of this case concerns the early diagnosis and the surgical treatment of a patient diagnosed with an ectopic ovarian pregnancy. A gravida 2, para 0 woman...
The description of this case concerns the early diagnosis and the surgical treatment of a patient diagnosed with an ectopic ovarian pregnancy. A gravida 2, para 0 woman with a history of termination of pregnancy in the second trimester, was referred to the outpatients of the Gynecologic Department of the General Hospital of Trikala, reporting vaginal bleeding, accompanied by a deep, mild pain in the abdomen for a few days. The urine pregnancy test was positive. The transvaginal ultrasound in combination with the -chorionic gonadotropin level was indicative of an ectopic pregnancy, and the surgical treatment of the patient was decided. Intraoperatively, the presence of an ovarian ectopic pregnancy was detected, and a wedge resection of the affected ovary was performed. The patient was discharged from our clinic on the third postoperative day, with instructions for weekly follow-up of the -chorionic gonadotropin level until it returns to normal values.
PubMed: 33680524
DOI: 10.1155/2021/6618751