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Women's Health Issues : Official... 2023We aimed to investigate the acceptability of regular self-testing among people with increased risk for delayed pregnancy recognition when provided with free at-home...
OBJECTIVES
We aimed to investigate the acceptability of regular self-testing among people with increased risk for delayed pregnancy recognition when provided with free at-home pregnancy tests and to explore the feasibility of this intervention among a larger sample.
MATERIALS AND METHODS
In 2019-2020, we recruited participants across the United States by using flyers posted online and in community settings and abortion clinics. We purposively sampled people with pregnancy capacity who were 18 to 24 years old, had irregular menses, or had a recent second-trimester abortion. Participants were mailed pregnancy tests and instructions. Participants received text message reminders to test monthly over a 3-month period and were asked to text back results. Participants also completed online surveys at baseline, after 1 month, and after 3 months. A purposive subsample of participants was selected to participate in semi-structured interviews. Interviews were analyzed using thematic analysis of interview guide topics and emergent themes.
RESULTS
61 participants were enrolled. Fifty-four participants (90%) responded to the text reminders and 52 (85%) reported testing in all 3 months. Fifty-eight (95%) said tests were easy to use, 59 (97%) said the results were clear, and all participants found it convenient to text their results. Fourteen participants completed qualitative interviews. All described continuing to test after the study and indicated high acceptability for text reminders. Interviewees described convenience and cost as primary benefits for preferring at-home pregnancy testing.
CONCLUSIONS
Regular self-testing and texting results is feasible and acceptable to participants provided with free at-home urine pregnancy tests. These results can inform future studies designed to investigate the effect of regular self-testing on timing of pregnancy detection to facilitate early entry to prenatal care or early abortion.
Topics: Pregnancy; Female; Humans; United States; Adolescent; Young Adult; Adult; Pilot Projects; Feasibility Studies; Text Messaging; Surveys and Questionnaires; Prenatal Care
PubMed: 36822914
DOI: 10.1016/j.whi.2023.01.002 -
Cureus Mar 2022To determine whether first- and second-trimester maternal serum biomarkers are useful for the prediction of pregnancy complications like preterm birth, intrauterine...
OBJECTIVE
To determine whether first- and second-trimester maternal serum biomarkers are useful for the prediction of pregnancy complications like preterm birth, intrauterine growth restriction (IUGR), and macrosomia.
METHODS
We conducted a retrospective analysis of 353 women having first- or second-trimester combined test for Down syndrome screening who delivered at our institution between January 2018 and December 2020. Associations between first- and second-trimester serum markers and adverse pregnancy outcomes among those who underwent prenatal screening for Down syndrome in our clinic were studied. The adverse pregnancy outcomes, serum levels of pregnancy-associated plasma protein-A (PAPP-A), β-human chorionic gonadotropin (β-hCG), and maternal serum alpha-fetoprotein (ms-AFP) were recorded and analyzed. Correlation analyses of PAPP-A, free βhCG, and ms-AFP with pregnancy outcomes were studied. We sought to predict the risks of preterm delivery (PTD, <37 weeks gestational age), low birth weight (LBW, <2500 grams) and macrosomia (>4000 grams).
RESULTS
A total of 353 women who had first- and second-trimester screening test for Down syndrome were included. Two hundred fifty (70.08%) of them had first-trimester and 103 (41.2%) had second-trimester test. Mean age of the patients who underwent screening test for Down syndrome was 29.3±5.9, mean maternal weight was 67.3±13.6, mean gestational weeks at birth was 38.6±2.1 weeks and mean birth weight was 3260.9±511.1, preterm birth rate was 40/353 (11.3%), IUGR rate was 21/353 (5.9%), macrosomia rate was 17/353 (4.8%), stillbirth rate was 3/353 (0.8%). When laboratory and clinical parameters affecting birth weight and birth weeks were analysed in correlation analysis, both birth week and birth weight were found to be positively correlated with maternal weight. Of first-trimester markers Papp-A MoM (Multiples of Median) was found to be positively correlated with fetal birth weight (p = 0.044). Of second-trimester biochemical parameters ms-AFP was found to be negatively correlated with fetal birth weight (p = 0.039).
CONCLUSION
The study concluded that there is a relationship between serum markers and adverse pregnancy outcomes. Significant associations were found between the levels of first- and second-trimester serum markers PAPP-A, AFP and IUGR, macromia and additionally significant association was found between maternal weight and both delivery week and fetal weight. These results can highlight the pregnancies at risk and follow-up intervals may be arranged according to risk scala which may help at antenatal follow-up of high-risk patients.
PubMed: 35425672
DOI: 10.7759/cureus.23115 -
Taiwanese Journal of Obstetrics &... Jul 2022To determine the possible relationship between follicular fluid 25-hydroxyvitamin D [25(OH)D] levels and fertility outcome of women who underwent IVF/ICSI with the...
OBJECTIVE
To determine the possible relationship between follicular fluid 25-hydroxyvitamin D [25(OH)D] levels and fertility outcome of women who underwent IVF/ICSI with the diagnosis of lean polycystic ovary syndrome.
MATERIALS AND METHODS
Thirty patients who were diagnosed with PCOS according to the Rotterdam criteria and decided on IVF/ICSI were included in the study. Thirty patients who were scheduled for IVF/ICSI for reasons other than PCOS and matched in terms of age and BMI were taken as the control group (non-PCOS). According to BMI values, patients in both PCOS and non-PCOS groups were lean. Women in both groups were aged 21-35 years with a normal BMI (18.5-24.9 kg/m2) and first IVF/ICSI attempt. Both groups of patients were followed up using the antagonist protocol. Vit D levels were measured in serum and follicular fluid (FF) samples taken on the day of oocyte collection. The correlation between FF vit D levels, the number of total oocytes, MII oocytes and 2 PN zygotes, HOMA-IR, hormonal and demographic parameters, clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate were evaluated.
RESULTS
At the time of oocyte retrieval women with PCOS had similar serum Vitamin D compared to non-PCOS women (21.8 (12.6-24.8) ng/ml vs 22.3 (11.5-25.1) ng/ml, p < 0.54). In FF, assessed on the day of oocyte retrieval, the concentration of Vitamin D was similar in women with PCOS when compared to non-PCOS women (11.2 (9.2-14.4) ng/ml vs 13.3 (11.1-17.4) ng/ml, p < 0.06). For both groups, Vitamin D levels were lower in FF compared to serum vit D. A positive correlation was found between serum and FF Vitamin D concentrations in the full cohort. A positive and significant correlation was found between FF-vit D levels and the number of total oocyte (r = 0.344, p < 0.04) and MII oocyte (r = 0.404, p < 0.02) in the PCOS group. The number of total oocyte, MII oocyte and 2 PN zygotes of the PCOS group were significantly higher than the non-PCOS group. Positive pregnancy test rate, clinical pregnancy and live birth rates were similar in both groups. The miscarriage rates in the non-PCOS group were significantly higher than in the PCOS group. A positive and significant correlation was also found between FF vit D levels and positive pregnancy test (r = 0.566, p < 0.03) and CPR (r = 0.605, p < 0.02) in PCOS group. There was no correlation between FF-vit D levels and live birth and miscarriage rates in neither the PCOS nor the non-PCOS group.
CONCLUSIONS
Both serum and FF 25-hydroxyvitamin D level of women with PCOS at the time of oocyte retrieval are similar to non-PCOS controls. While FF 25-hydroxyvitamin D levels correlate with total and MII oocyte counts, positive pregnancy test and CPR, it does not correlate with miscarriage and live birth rates.
Topics: Abortion, Spontaneous; Female; Fertility; Follicular Fluid; Humans; Polycystic Ovary Syndrome; Pregnancy; Vitamin D; Vitamins
PubMed: 35779910
DOI: 10.1016/j.tjog.2022.03.041 -
Obstetrics and Gynecology Jul 2021To assess pregnancy risk after intrauterine device (IUD) placement by the number and timing of unprotected intercourse episodes in the prior 14 days. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To assess pregnancy risk after intrauterine device (IUD) placement by the number and timing of unprotected intercourse episodes in the prior 14 days.
METHODS
This was a secondary analysis of a randomized trial that compared the copper T380A IUD and levonorgestrel 52-mg intrauterine system for emergency contraception. At enrollment, participants had a negative urine pregnancy test result and reported the frequency and timing of any unprotected intercourse in the preceding 14 days. We assessed pregnancies 1 month after IUD placement and compared pregnancy risk by single or multiple unprotected intercourse episodes and by timing (5 or fewer days before IUD placement or 6 or more days before).
RESULTS
Among the 655 participants, one pregnancy occurred in a patient who reported intercourse once 48 hours before IUD placement. Multiple unprotected intercourse episodes were reported by 286 participants (43.7%), and 95 participants (14.4%) reported at least one unprotected intercourse episode 6 or more days before IUD placement. No pregnancies occurred among those with multiple unprotected intercourse episodes (0%, 97.5% CI 0-1.3%) or with any unprotected intercourse episode 6-14 days before IUD placement (0.0%, 97.5% CI 0.0-3.8%). Pregnancy risk difference did not significantly differ by single compared with multiple unprotected intercourse episodes (0.3%, 95% CI -0.3% to 0.8%), nor by unprotected intercourse 5 or fewer days before IUD placement or 6 or more days before (0.2%, 95% CI -0.2% to 0.5%).
CONCLUSION
With a negative urine pregnancy test result at IUD placement, 1-month pregnancy risk remains low, regardless of frequency or timing of unprotected intercourse in the prior 14 days.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT02175030.
Topics: Adolescent; Contraception, Postcoital; Female; Humans; Intrauterine Devices, Medicated; Pregnancy; Pregnancy, Unwanted; Risk Assessment; Unsafe Sex; Young Adult
PubMed: 34259467
DOI: 10.1097/AOG.0000000000004433 -
Journal of Korean Medical Science Jan 2021Antiphospholipid syndrome (APS), which is characterized by the presence of antiphospholipid antibodies (aPL), is associated with increased risk of thrombosis and... (Review)
Review
Antiphospholipid syndrome (APS), which is characterized by the presence of antiphospholipid antibodies (aPL), is associated with increased risk of thrombosis and obstetric complications, including preterm delivery and recurrent pregnancy losses. APS shows diverse clinical manifestations and the risk of complications varies among clinical subtypes. Although these patients are usually treated with aspirin and anticoagulants, the optimal treatment in various clinical settings is unclear, as the risk of complications vary among clinical subtypes and the management strategy depends on whether the patient is pregnant or not. Also, there are unmet needs for the evidence-based, pregnancy-related treatment of asymptomatic women positive for aPL. This review focuses on the management of positive aPL or APS in pregnant and postpartum women, and in women attempting to become pregnant. For asymptomatic aPL positive women, no treatment, low dose aspirin (LDA) or LDA plus anticoagulants can be considered during antepartum and postpartum. In obstetric APS patients, preconceptional LDA is recommended. LDA plus low molecular weight heparin is administered after confirmation of pregnancy. Vascular APS patients should take frequent pregnancy test and receive heparin instead of warfarin after confirmation of pregnancy. During pregnancy, heparin plus LDA is recommended. Warfarin can be restarted 4 to 6 hours after vaginal delivery and 6 to 12 hours after cesarean delivery. Most importantly, a tailored approach and patient-oriented treatment are mandatory.
Topics: Antibodies, Antiphospholipid; Anticoagulants; Antiphospholipid Syndrome; Aspirin; Female; Heparin, Low-Molecular-Weight; Humans; Postpartum Period; Pregnancy; Thrombosis
PubMed: 33496084
DOI: 10.3346/jkms.2021.36.e24 -
PloS One 2022Congenital Malaria (CM) is an underestimated and under-researched problem in Colombia, despite its severe clinical, epidemiological, economic, and public health...
Congenital Malaria (CM) is an underestimated and under-researched problem in Colombia, despite its severe clinical, epidemiological, economic, and public health consequences. The objective was to determine the general frequency of CM, the specific frequency of CM by diagnostic test and plasmodial species, and identify its associated factors. A retrospective study was carried out using the records of 567 newborns. qPCR and Thick Blood Smear (TBS) were performed. The frequency of infection was determined with a 95% confidence interval. Associated factors were identified by non-parametric tests and odds ratios; the confusion was controlled with a logistic regression model. All cases corresponded to submicroscopic CM (negative with TBS and positive with PCR), and the frequency was 12.2% (95%CI = 9.4-14.9). The detection was statistically higher in the umbilical cord with 16,2% (95%CI = 12.4-19.9) versus peripheral blood of the newborn with 2.2% (95%CI = 0.7-4.9). CM was statistically higher in newborn whose mothers had malaria in the last year, gestational and placental malaria. The median birth weight in newborn infected with CM was lower compared to the one of healthy neonates. Because the control program in Colombia is based on TBS, it must be improved with the inclusion of other tests that allow the detection of submicroscopic CM. In addition, the program has other limitations such as do not have specific actions for pregnant women and have a passive surveillance system. These difficulties do not allow to show the magnitude of CM, its consequences on neonatal and infant health, constituting a serious problem of health injustice.
Topics: Adolescent; Adult; Birth Weight; Colombia; Cross-Sectional Studies; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Malaria, Falciparum; Malaria, Vivax; Plasmodium falciparum; Plasmodium vivax; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Parasitic; Retrospective Studies; Umbilical Cord; Young Adult
PubMed: 35180230
DOI: 10.1371/journal.pone.0263451 -
Frontiers in Medicine 2022Gestational trophoblastic neoplasia is an uncommon disease, whose clinical manifestations are similar to ectopic pregnancy, thus some rare pelvic lesion can be...
BACKGROUND
Gestational trophoblastic neoplasia is an uncommon disease, whose clinical manifestations are similar to ectopic pregnancy, thus some rare pelvic lesion can be misdiagnosed as ectopic pregnancy.
AIMS
This study was presented to investigate the characteristics of gestational trophoblastic neoplasia misdiagnosed as ectopic pregnancy and reduce the misdiagnosis.
METHODS
The clinicopathological data for 14 cases of gestational trophoblastic neoplasia misdiagnosed as ectopic pregnancy at West China Second Hospital Sichuan University from January 2006 to December 2020 were retrospectively analyzed.
RESULTS
The main clinical manifestations were amenorrhea, abnormal vaginal bleeding, and abdominal pain. At initial diagnosis, the serum hCG level was >10,000 mIU/mL in 5 patients and <10,000 mIU/mL in 7 patients, and a positive urine pregnancy test alone was found in 2 patients. Vaginal ultrasonography showed no abnormalities in 7 cases, adnexal mass in 5 cases, and tubal thickening in 2 cases. The patient's previous pregnancy was an abortion in 7 cases, full-term in 4 cases, and a hydatidiform mole in 3 cases. Clinical stage: 3 cases were stage I, 3 were stage II, 7 were stage III, and 1 case was stage IV (liver and spleen metastases). The median FIGO prognostic score was 13.5 points (12-21 points), with 9 cases having a score >13 points (very high risk). From 14 patients, only 3 had molar pregnancy previously. Only 3 patients had no metastasis at GTN diagnosis (from these 3, only one after molar pregnancy). After chemotherapy alone or in combination with surgery, all patients survived, with a median follow-up of 84 months (23-102 months).
CONCLUSION
If we have positive hCG, without a sonographic topic gestation confirmation, associated with metastatic lesions, the GTN diagnosis should be considered instead of ectopic pregnancy, if the patient have had a pregnancy once during her life.
PubMed: 36405579
DOI: 10.3389/fmed.2022.1018573 -
PLoS Neglected Tropical Diseases Jan 2020Large-scale deworming programs have, to date, mostly targeted preschool- and school-age children. As community-based deworming programs become more common, deworming...
BACKGROUND
Large-scale deworming programs have, to date, mostly targeted preschool- and school-age children. As community-based deworming programs become more common, deworming will be offered to women of reproductive age. The World Health Organization recommends preventive chemotherapy be administered to pregnant women only after the first trimester. It is therefore important for deworming programs to be able to identify women in early pregnancy. Our objective was to validate a short questionnaire which could be used by deworming program managers to identify and screen out women in early pregnancy.
METHODOLOGY/PRINCIPAL FINDINGS
In May and June 2018, interviewers administered a questionnaire, followed by a pregnancy test, to 1,203 adult women living in the Peruvian Amazon. Regression analyses were performed to identify questions with high predictive properties (using the pregnancy test as the gold standard). Test parameters were computed at different decision tree nodes (where nodes represented questions). With 106 women confirmed to be pregnant, the positive predictive value of asking the single question 'Are you pregnant?' was 100%, at a 'cost' of a false negative rate of 1.9% (i.e. 21 women were incorrectly identified as not pregnant when they were truly pregnant). Additional questions reduced the false negative rate, but increased the false positive rate. Rates were dependent on both the combination and the order of questions.
CONCLUSIONS/SIGNIFICANCE
To identify women in early pregnancy when deworming programs are community-based, both the number and order of questions are important. The local context and cultural acceptability of different questions should inform this decision. When numbers are manageable and resources are available, pregnancy tests can be considered at different decision tree nodes to confirm pregnancy status. Trade-offs in terms of efficiency and misclassification rates will need to be considered to optimize deworming coverage in women of reproductive age.
Topics: Adult; Female; Helminthiasis; Humans; Middle Aged; Peru; Pregnancy; Pregnancy Tests; Surveys and Questionnaires
PubMed: 31999690
DOI: 10.1371/journal.pntd.0007901 -
Animals : An Open Access Journal From... Jun 2021One of the most recent techniques for the on-farm diagnosis of early pregnancy (EP) in cattle is B-mode ultrasonography. Under field conditions, acceptable results may... (Review)
Review
One of the most recent techniques for the on-farm diagnosis of early pregnancy (EP) in cattle is B-mode ultrasonography. Under field conditions, acceptable results may be achieved with ultrasonography from Days 25 to 30 post-AI. The reliability of the test greatly depends on the frequency of the transducer used, the skill of the examiner, the criterion used for a positive pregnancy diagnosis (PD), and the position of the uterus in the pelvic inlet. Non-pregnant animals can be selected accurately by evaluating blood flow in the corpus luteum around Day 20 after AI, meaning we can substantially improve the reproductive efficiency of our herd. Pregnancy protein assays (PSPB, PAG-1, and PSP60 RIA, commercial ELISA or rapid visual ELISA tests) may provide an alternative method to ultrasonography for determining early pregnancy or late embryonic/early fetal mortality (LEM/EFM) in dairy cows. Although the early pregnancy factor is the earliest specific indicator of fertilization, at present, its detection is entirely dependent on the use of the rosette inhibition test; therefore, its use in the field needs further developments. Recently found biomarkers like interferon-tau stimulated genes or microRNAs may help us diagnose early pregnancy in dairy cows; however, these tests need further developments before their general use in the farms becomes possible.
PubMed: 34204926
DOI: 10.3390/ani11061666 -
Asia Pacific Journal of Clinical... 2020Thyroid disease in pregnancy can have devastating effect on the fetus. In Harbin, China, there is insufficient knowledge about the incidence of and contributing factors...
BACKGROUND AND OBJECTIVES
Thyroid disease in pregnancy can have devastating effect on the fetus. In Harbin, China, there is insufficient knowledge about the incidence of and contributing factors to thyroid disease in pregnancy. This study investigates whether urine iodine concentration (UIC), as a proxy for iodine intake, affects the thyroid structure and/or function during each trimester.
METHODS AND STUDY DESIGN
Data of 24000 pre-pregnant women were collected from January 2017 to August 2019. Serum thyroid hormone levels were measured, and thyroid ultrasonography was performed. If thyroid ultrasonography and thyroid function findings were normal before pregnancy and were abnormal after pregnancy, the current gestational age was recorded and the UIC was measured. Finally, a total of 500 participants were included in the study.
RESULTS
There were significant differences in the incidence of abnormal thyroid structure and function between trimester groups (p<0.05). Thyroid nodular lesions were the most common abnormal ultrasound finding, and positive thyroid peroxide antibodies (TPOAb) were the most common abnormal thyroid function test results. There were significant differences in the median UIC between trimester groups (p<0.001); the median UIC decreased with increasing gestational age. The incidence of abnormal thyroid structure or function was not significantly different across UIC groups (p>0.05).
CONCLUSIONS
In women from Harbin, thyroid structural or functional abnormalities commonly occur in the second and third trimesters of pregnancy. Thyroid nodular lesions and positive TPOAb are the commonest thyroid abnormalities. The median UIC significantly declines with increasing gestational age. Pregnant women in Harbin have iodine-deficient states.
Topics: China; Female; Humans; Iodine; Pregnancy; Pregnancy Trimesters; Thyroid Function Tests; Thyroid Gland
PubMed: 33377373
DOI: 10.6133/apjcn.202012_29(4).0014