Ectopic pregnancy among American Indian and Alaska Native women, 2002-2009

Baseline results from NenŨnkUmbi/EdaHiYedo: A randomized clinical trial to improve sexual and reproductive health among American Indian adolescents

We report on baseline findings from NenUnkUmbi/EdaHiYedo, a community based participatory research randomized controlled trial with American Indian adolescents to reduce sexual and reproductive health disparities. American Indian adolescents aged 13-19 years participated in a baseline survey that was administered in five schools. We used zero-inflated negative binomial regression to evaluate how the count of protected sexual acts was associated with independent variables of interest. We stratified models by self-reported gender of adolescents and tested for a two-way interaction effect between gender and the independent variable of interest. Two hundred twenty-three girls and 222 boys (n = 445) were sampled. The average number of lifetime partners was 1.0 (standard deviation = 1.7). Each additional lifetime partner was associated with a 50% increase in the number of protected sexual acts incident rate ratio (IRR = 1.5, 95% confidence interval [CI] 1.1-1.9) and more than a twofold increase in the likelihood of not having protected sexual acts (adjusted odd ratio [aOR] = 2.6, 95% CI 1.3-5.1). Each additional number of substances used in adolescentss' lifetime was associated with an increased likelihood of not having protected sexual acts (aOR = 1.2, 95% CI 1.0-1.5). In boys, each one standard deviation increase in depression severity was associated with a 50% reduction in the number of times a condom was used adjusted IRR (aIRR = 0.5, 95% CI 0.4-0.6, p < .001). Each 1-unit increase in positive prospections of pregnancy was associated with a pronounced decrease likelihood of not having protected sexual acts (aOR = 0.01, 95% CI 0.0-0.1). Findings support the importance of tribally driven tailoring of sexual and reproducive health interventions and services for American Indian adolescents.

The maternal health of American Indian and Alaska Native people: A scoping review

Indigenous people in the United States experience disadvantage in multiple domains of health. Yet, their maternal health receives limited research attention. With a focus on empirical research findings, we conduct a scoping review to address two questions: 1) what does the literature tell us about the patterns and prevalence of maternal mortality and morbidity of American Indian and Alaska Native (AI/AN) people? and 2) how do existing studies explain these patterns? A search of CINAHL, Embase and Medline yielded 4757 English-language articles, with 66 eligible for close review. Of these, few focused specifically on AI/AN people's maternal health. AI/AN people experience higher levels of maternal mortality and morbidity than non-Hispanic White people, with estimates that vary substantially across samples and geography. Explanations for the maternal health of AI/AN people focused on individual factors such as poverty, cultural beliefs, and access to healthcare (e.g. lack of insurance). Studies rarely addressed the varied historical and structural contexts of AI/AN tribal nations, such as harms associated with colonization and economic marginalization. Research for and by Indigenous communities and nations is needed to redress the effective erasure of AI/AN people's maternal health experiences and to advance solutions that will promote their health and well-being.

Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations &#x2013; a review

This review assessed sexual health and sexually transmitted infection (STI) burden among American Indian/Alaska Native (AI/AN) peoples within the context of current clinical and public health services. We conducted a review of published literature about sexual health and bacterial STIs among AI/AN populations in the United States using Medline (OVID), CINAHL (EbscoHost) and Scopus. Peer-reviewed journals published during 1 January 2005-2 December 2021 were included and supplemented by other publicly available literature. A total of 138 articles from reference lists met inclusion criteria, including 85 peer-review articles and 53 additional references. Results indicate a disproportionate burden of STIs is carried by AI/AN populations compared to non-Hispanic Whites. Risk for STIs in AI/AN people has origins in historical trauma and structural and social determinants of health. STI services are available for AI/AN populations, but many barriers to care exist. Community-based sexual health programming has been successful, but has thus far focused primarily on adolescents and young adults. A myriad of factors contributes to high rates of STIs among AI/AN populations. Longstanding disparities show a clear need to increase the availability of integrated, low-barrier STI prevention and treatment services. Implementation of multi-level (individual, physician, clinic, healthcare organisation, and/or community level), culturally relevant sexual health and STI interventions should be community-based and person-centred, acknowledge social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures.

Ectopic pregnancy rate in Iranian midwifery clients and infertile patients treated by assisted reproductive technologies

OBJECTIVE

There are some studies on the prevalence of ectopic pregnancy (EP) in a different population of Iranian women. This study aimed to estimate the ectopic pregnancy prevalence in obstetrical clients and infertile patients treated by assisted reproductive technologies in Iran.

METHODS

International and national databases including PubMed, Web of Science, Ovid, Scopus, ScienceDirect, Magiran, Iran doc, and Iran Medex were searched up to January 2016. Also, conference databases were searched. All studies in which, the ectopic pregnancy prevalence in Iranian obstetrical clients and infertile patients treated by assisted reproductive technologies were reported, included and reviewed. Data of studies were extracted into a standard data sheet. Meta-analysis was conducted by a random-effects model with 95% confidence interval.

RESULTS

Eight studies were included, involving overall 571 826 women of whom 1446 had an ectopic pregnancy. The overall prevalence of ectopic pregnancy in obstetrical units of the hospitals and assisted reproductive technologies patients was 2.9 (95% CI: 2.1, 3.7) and 53 (95% CI: 20.4, 85.6) per 1000 clients, respectively.

CONCLUSION

There is limited evidence on the ectopic pregnancy prevalence in Iranian obstetrical clients and assisted reproductive technologies patients. Furthermore, a significant heterogeneity existed between the results. So, more population-based studies on national data are needed for the exact estimation of the ectopic pregnancy prevalence in Iran.

[A clinical analysis of gynecological diseases in 147 children]

OBJECTIVE

To study the clinical features of gynecological diseases in hospitalized children.

METHODS

A retrospective analysis was performed for the clinical data of 147 children with gynecological diseases who were hospitalized and treated in the department of gynecology.

RESULTS

Among the 147 children, ovarian tumors were most common (53 cases, 36.1%), followed by reproductive tract dysplasia or malformation (29 cases, 19.7%), adolescent dysfunctional uterine bleeding (18 cases, 12.2%), traumatic injury in the vulva/vagina (15 cases, 10.2%), and vaginal foreign body (8 cases, 5.4%). The main symptoms of ovarian tumors included abdominal pain and abdominal or pelvic mass. Progressive abdominal pain was a main symptom in children with reproductive tract dysplasia or malformation. The children with adolescent dysfunctional uterine bleeding manifested as irregular or a lot of vaginal bleeding. The children with ovarian tumors and reproductive tract malformation or dysplasia were given surgical treatment, and those with adolescent dysfunctional uterine bleeding were given different sex hormones based on their clinical manifestations and endometrial thickness. Eight children with vaginal foreign body underwent hysteroscopy for vaginal examination, and the foreign body was successfully removed without the damage of the hymen. One patient with tubal pregnancy underwent laparoscopic tubal pregnancy debridement. One patient with hydatid mole was diagnosed with invasive hydatid mole after complete curettage of uterine cavity and then received chemotherapy.

CONCLUSIONS

The top three gynecological diseases in children are ovarian tumors, reproductive tract dysplasia or malformation, and adolescent dysfunctional uterine bleeding. Common chief complaints of the patients include abdominal pain, abdominal masses, and irregular vaginal bleeding. Diagnosis and treatment should fully consider the physiological and reproductive features of children and give full play to the advantages of laparoscopy, hysteroscopy, and ultrasound.