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Gouret G, Faucher P, Kayem G, Pinton A. [Induced abortion between 14 and 16th: Clinical context and complications]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:415-419. [PMID: 37406810 DOI: 10.1016/j.gofs.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE This study aims to characterize the women's health care pathway and to evaluate the rate of complications during a surgical abortion according to the technique of dilatation and evacuation between 14 and 16 SA. METHOD Single-center prospective study at the Armand Trousseau Hospital with inclusion of women who had an abortion between 14 and 16 GA in the Obstetrics & Gynecology Department of the Armand Trousseau Hospital between March 2 and October 31, 2022. RESULTS Forty-six women underwent an abortion during this 8-month period. The average gestational age at which the abortions were performed was 15 weeks' gestation with an median delay of 14.0 days between the date of discovery of the pregnancy and the date of the abortion with more than half of the women (65.2 %, N=30) having consulted for the first time for an abortion request before 14 weeks' gestation. Of these women, 22 (48.9%) had to consult several hospitals before being treated. One woman (2.2% 95% CI [0.0-6.4]) had a haemorrhage defined by bleeding more than 500ml. Cervical suture for cervical tear was performed in four women (8.7% 95% CI [0.0-16.8]). There were no complications such as perforation, postoperative infection or surgical revision. No women were transfused. CONCLUSION The introduction in our center of surgical abortion using the dilatation and evacuation technique performed between 14 and 16 weeks' gestation wasn't accompanied by significant morbidity. The women's pathway before the procedure probably contributed to the later performance of the abortion.
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Affiliation(s)
- Gladys Gouret
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Philippe Faucher
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Gilles Kayem
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris Cité, Equipe de recherche en épidémiologie obstétricale périnatale et pédiatrique (Epopé), Centre de recherche épidémiologique et biostatistiques (CRESS), INSERM U1153, 53 avenue de l'observatoire, 75014, Paris, France
| | - Anne Pinton
- Service de gynécologie obstétrique, hôpital Trousseau, APHP, Sorbonne université, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris Cité, Equipe de recherche en épidémiologie obstétricale périnatale et pédiatrique (Epopé), Centre de recherche épidémiologique et biostatistiques (CRESS), INSERM U1153, 53 avenue de l'observatoire, 75014, Paris, France.
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Brandell K, Reynolds-Wright JJ, Boerma C, Gibson G, Hognert H, Tuladhar H, Heikinheimo O, Cameron S, Gemzell-Danielsson K. Medical Abortion before Confirmed Intrauterine Pregnancy: A Systematic Review. Semin Reprod Med 2022; 40:258-263. [PMID: 36626915 DOI: 10.1055/s-0042-1760117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
"Very early medical abortion" (VEMA) refers to medical abortion (with mifepristone and misoprostol) before intrauterine pregnancy is visualized on ultrasound. Our aim is to present the current evidence on efficacy, safety (focused on ectopic pregnancies), and how to assess treatment success of VEMA. We conducted a systematic review of studies reporting outcomes of VEMA. The field is small and so our objective was to map all relevant literature, without conducting meta-analysis. We searched PubMed, Medline, and Embase on April 19, 2022. We conducted a narrative synthesis of the evidence. A total of 373 articles were identified. Six articles (representing four observational and one pilot trial) were included in the final review. Across all included studies, treatment efficacy ranged between 91 and 100%. Prevalence of ectopic pregnancy was low and very few cases (n = 2) of ruptures were reported. Most studies used serial serum human chorionic gonadotrophin (s-hCG) levels to determine success of abortion; one study used low sensitivity urine hCG. From the available evidence, VEMA appears to be efficacious and does not appear to cause harm to ectopic pregnancies. Treatment can be assessed with pre- and postabortion s-hCG. Good quality, randomized controlled trial evidence is needed to best inform practice.
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Affiliation(s)
- Karin Brandell
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Södertalje Hospital, Södertalje, Sweden
| | | | | | - Gillian Gibson
- Womens Health, Auckland City Hospital, Auckland, New Zealand
| | - Helena Hognert
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Institution of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sharon Cameron
- NHS Lothian and University of Edinburgh, Edinburgh, United Kingdom
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Karolinska University Hospital, Stockholm, Sweden
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3
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Li X, Yuan Q, Geng L, Chen Z, Zhang R, Guo L, Yue S. Quality Assessment of the Clinical Practice Guidelines of Ostomy Care Based on the AGREE II Instrument. Front Public Health 2022; 10:856325. [PMID: 35859774 PMCID: PMC9289137 DOI: 10.3389/fpubh.2022.856325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/10/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives To assess the quality of clinical practice guidelines (CPGs) of ostomy care, and to analyze the status quo and challenges of guideline development. Methods CPGs of ostomy care were systematically searched in relevant guideline websites and electronic databases, including PubMed, ProQuest, Web of Science, CNKI, VIP, WANFANG, and SinoMed, from January 1, 2012, to November 24, 2021. Two appraisers used the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II) instrument to assess the quality of the included CPGs independently and objectively. The consistency of assessment was calculated using intraclass correlation coefficients (ICC). Results A total of 5 CPGs relevant to ostomy care were assessed by AGREE II and the general quality of them was good. There were two CPGs of grade A and three CPGs of grade B. The domain scope and purpose (87.78%) had the highest scores, followed by the clarity of presentation (87.22%), the rigor of development (69.17%), stakeholder involvement (68.33%), and editorial independence (65.00%), and the lowest was applicability (55.42%). The overall assessment score was 5.40. All the ICCs for the AGREE II appraisal conducted by the two appraisers were >0.75. Conclusions The five CPGs of ostomy care have the potential to be adopted in clinical practice. However, they still have some room for improvement, especially in the applicability domain. The development of ostomy care CPGs should follow the evidence-based progress and methodology of guideline formulation specifications while considering the effects of the CPGs and the practical issues.
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Affiliation(s)
- Xiaoyu Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Qiao Yuan
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Liangrong Geng
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiqi Chen
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- Department of Preventive Treatment, Tianjin Hospital of ITCWM Nankai Hospital, Tianjin, China
| | - Rui Zhang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Liqun Guo
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Shujin Yue
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Shujin Yue
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Noémie VB, Rozenberg S, Gilles C, Bomboir I, Joris A, Rousseau C, Manigart Y. Impact of Covid-lockdown on abortion management at a family planning in Brussels. EUR J CONTRACEP REPR 2022; 27:278-283. [PMID: 35727186 DOI: 10.1080/13625187.2022.2085682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In response to the Covid-19 lockdown, we developed a new abortion protocol in a family planning in Brussels. This study evaluates the effects of the lockdown on the abortion management and its impact on patients' characteristics. METHODS A retrospective study compared the characteristics and management of patients who terminated their pregnancies at the same family planning (CHU Saint-Pierre Brussels) between 14 March and 6 May 2020 and during the same time period in 2019. RESULTS Patients having an abortion in 2020 (n = 87) were in average two years older compared to patients having abortions in 2019 (n = 93) (31 years ± 13 vs 29 years ± 13 p < .011), the number of abortions was similar to those of previous years, and the characteristics of the population were identical. The management of abortions has changed significantly as the patients terminated their pregnancies earlier in 2020 than in 2019 (7 W and 1 day ± 3 days versus 8 W and 5 days ± 3 days p < .01), mostly with medication and at home (61.4% versus 2% p < .001), but with similar effectiveness. CONCLUSION Due to the lockdown, we have accelerated the time required to obtain an appointment and shortened the delay between the abortion request and the pregnancy termination, permitting an earlier management mainly through the use of medical- and at home abortion. Given the satisfactory results, we consider now to implement this new protocol beyond the lockdown period.
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Affiliation(s)
- Vanden Berghe Noémie
- Department of Obstetrics and Gynecology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Serge Rozenberg
- Department of Gynecology, The University Hospital Center (CHU) Saint-Pierre, Brussels, Belgium
| | - Chrsitine Gilles
- Department of Gynecology, The University Hospital Center (CHU) Saint-Pierre, Brussels, Belgium
| | - Isabelle Bomboir
- Department of Gynecology, The University Hospital Center (CHU) Saint-Pierre, Brussels, Belgium
| | - Aurélie Joris
- Department of Gynecology, The University Hospital Center (CHU) Saint-Pierre, Brussels, Belgium
| | - Charlotte Rousseau
- Department of Gynecology, The University Hospital Center (CHU) Saint-Pierre, Brussels, Belgium
| | - Yannick Manigart
- Department of Obstetrics and Gynecology, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Vitrant É, Rolland AL, Kyheng M, Delepine J, Bardiaux L, Parent C, Baffet H, Catteau-Jonard S, Robin G. [Evaluation of the success of medical abortion by a plasma hCG control threshold]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:382-389. [PMID: 34774854 DOI: 10.1016/j.gofs.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/07/2021] [Accepted: 10/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES In France, monitoring of the success of medical abortion is recommended 2 to 3 weeks after the procedure. However, there is no clear consensus on the modalities of this monitoring. The main objective of this study is to identify a threshold of serum hCG (human chorionic gonadotropin) control for medical abortions ≤7 weeks of gestation below which success can be confirmed without recourse to pelvic ultrasound. METHODS This is a retrospective multicenter study conducted over a 14-month period. The serum hCG level, measured between the 15th and 25th day following the abortion, was compared with the results of the pelvic ultrasound performed at the follow-up visit. Ultrasound failure was defined as retention or persistent pregnancy. RESULTS Among the 624 women included, the failure rate was 22.3%, including 86.3% of retentions, 8.6% of pregnancies stopped and 5% of pregnancies progressed. Using a ROC curve, the threshold value of hCG found to exclude failure at 95% was 253 IU/l (AUC=0.9202, sensitivity=84.17%, specificity=85.95% and positive predictive value [PPV]=63%). CONCLUSIONS A serum hCG level ≤253 IU/l is sufficient to affirm the efficacy of medical abortion. However, since PPV is only 63% for this threshold, ultrasound should be reserved for women with high hCG levels.
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Affiliation(s)
- É Vitrant
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, University Lille, 59000 Lille, France.
| | - A-L Rolland
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, University Lille, 59000 Lille, France
| | - M Kyheng
- Département de biostatistique de Lille, CHU de Lille, University Lille, 59000 Lille, France
| | - J Delepine
- Service de gynécologie-obstétrique et orthogénie, centre hospitalier de Calais, 62100 Calais, France
| | - L Bardiaux
- Service de gynécologie-obstétrique et orthogénie, GH Artois-Ternois, centre hospitalier de Arras, 62000 Arras, France
| | - C Parent
- Service de gynécologie-obstétrique et orthogénie, GH Territoire de l'Artois, centre hospitalier de Lens, 62300 Lens, France
| | - H Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, University Lille, 59000 Lille, France
| | - S Catteau-Jonard
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, University Lille, 59000 Lille, France
| | - G Robin
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, University Lille, 59000 Lille, France
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Yang X, Ding Y, Mei J, Xiong W, Wang J, Huang Z, Li R. Second-Trimester Cervical Shear Wave Elastography Combined With Cervical Length for the Prediction of Spontaneous Preterm Birth. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:820-829. [PMID: 35272890 DOI: 10.1016/j.ultrasmedbio.2022.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/06/2021] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
The goal of this study was to explore the value of shear wave elastography (SWE) combined with cervical length (CL) in the prediction of spontaneous preterm birth (sPTB) between 18 and 24 weeks of gestation. In this study, SWE was used to evaluate four regions of the cervix: the external and anterior lip (region A1), the external and posterior lip (region A2), the internal and anterior lip (region A3) and the internal and posterior lip (region A4). The cervical Young's modulus (YM) was compared between women who spontaneously delivered prematurely (<37 wk) and those who delivered full term. Finally, the predictive power of SWE was evaluated using receiver operating characteristic analysis. Overall, 773 patients were included in this study, of whom 60 (7.8%) had a sPTB. In the univariate analysis, prior sPTB, history of spontaneous abortion, history of cervical surgery, CL and YM at the anterior portion of both the internal and external os and the posterior portion of the internal os were associated with sPTB (p < 0.05). Multiple regression analyses were performed to develop the prediction probability for sPTB. YM and CL were independent predictors of sPTB in asymptomatic women, and the combination of YM and CL improved the ability to predict sPTB (area under the receiver operating characteristic curve = 0.98, 95% confidence interval: 0.97-0.99, p < 0.001). The interventions had relatively little impact on the outcome indicators measured. Cervical YM added to the CL may improve the predictive performance of second-trimester transvaginal ultrasound for sPTB.
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Affiliation(s)
- Xiaofeng Yang
- First Affiliate Hospital of Jinan University, Guangzhou, China
| | - Yuzhen Ding
- First Affiliate Hospital of Jinan University, Guangzhou, China
| | - Jie Mei
- Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Wen Xiong
- Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Jingyun Wang
- First Affiliate Hospital of Jinan University, Guangzhou, China
| | - Zhengrui Huang
- First Affiliate Hospital of Jinan University, Guangzhou, China
| | - Ruiman Li
- First Affiliate Hospital of Jinan University, Guangzhou, China.
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Gao Y, Ruan L, Cao L, Lu G, Hong Q, Zhang Q, Teng Y, Wang Z. Noninvasive isolation of transcervical trophoblast cells for fetal identification. J Obstet Gynaecol Res 2022; 48:1613-1620. [PMID: 35451149 DOI: 10.1111/jog.15256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/16/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify trophoblastic cells retrieved from the cervix at a gestational age (GA) of 5-9 weeks by a noninvasive modality in fetuses. METHOD Transcervical cells (TCCs) were noninvasively extracted by a cytobrush using the Papanicolaou sampling method. TCCs were immunostained with antihuman leukocyte antigen (HLA)-G and anticytokeratin (CK)-7 antibodies to identify trophoblastic cells. Maternal finger blood, gestational sacs, and 20 trophoblastic cells collected by a laser-guided microscopic single-cell capture system were examined and compared by short tandem repeat (STR) genotyping. RESULTS Forty-nine pregnant women with GA of 5-9 weeks and six nonpregnant healthy women were included in the study. Trophoblastic cells were identified in 37 (75.5%) TCC samples, among which 34 (69.4%) were eligible for STR genotyping analysis. No trophoblastic cells were identified in nonpregnant healthy women. The STR genotyping analyses revealed 24 female and 10 male fetuses. TCC trophoblastic cells exhibited the same STR profiles as gestational sac and maternal blood in all samples, which indicated that the TCC trophoblastic cells originated from fetuses. CONCLUSION This primary study validated that trophoblastic cells from TCCs at GA 5-9 weeks originated from the fetus. Further studies are needed to verify whether this method can be used for early noninvasive prenatal diagnosis and paternity testing.
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Affiliation(s)
- Yi Gao
- Obstetrics and Gynecology Department, the 8th People's Hospital of Shanghai, Shanghai, China
| | - Liping Ruan
- Obstetrics and Gynecology Department, the 8th People's Hospital of Shanghai, Shanghai, China
| | - Leilei Cao
- Obstetrics and Gynecology Department, the 8th People's Hospital of Shanghai, Shanghai, China
| | - Gaochuan Lu
- Obstetrics and Gynecology Department, the 8th People's Hospital of Shanghai, Shanghai, China
| | - Qin Hong
- Obstetrics and Gynecology Department, the 8th People's Hospital of Shanghai, Shanghai, China
| | - Qian Zhang
- Obstetrics and Gynecology Department, the 8th People's Hospital of Shanghai, Shanghai, China
| | - Yincheng Teng
- Obstetrics and Gynecology Department, the 6th People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Zhijie Wang
- Obstetrics and Gynecology Department, the 8th People's Hospital of Shanghai, Shanghai, China
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Jin XX, Sun L, Lai XL, Li J, Liang ML, Ma X. Effect of Mirena placement on reproductive hormone levels at different time intervals after artificial abortion. World J Clin Cases 2022; 10:511-517. [PMID: 35097076 PMCID: PMC8771403 DOI: 10.12998/wjcc.v10.i2.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/24/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Improper methods of contraception greatly increase the risk of abortion, cervical or endometrial lesions, and the number of recurrent artificial abortions. These complications result in the deterioration of a patient’s outcome. Further, the proportion of artificial abortions is highest among unmarried females. Placement of an intrauterine device, such as the Mirena, after an artificial abortion may decrease the likelihood of an endometrial injury caused by recurrent abortions while significantly improving its contraceptive effects.
AIM To discuss the effect of Mirena placement on reproductive hormone levels at different time points after an artificial abortion.
METHODS Women (n = 119) undergoing an artificial abortion operation were divided into the study (n = 56) and control (n = 63) groups. In the study group, the Mirena was inserted immediately after the artificial abortion, whereas in the control group, it was inserted 4–7 d after the onset of the first menstrual cycle after abortion. All participants were followed-up for 6 mo to observe the continuation and expulsion rates and adverse reactions and to measure the levels of serum estradiol (E2), follicle stimulating hormone (FSH), and luteinizing hormone (LH).
RESULTS The continuation rates were 94.64% and 93.65% in the study group and the control group, respectively. The expulsion rates were 1.79% and 3.17% in the study group and the control group, respectively. There was no statistically significant difference between the two groups (P > 0.05). There were also no statistically significant differences in the proportion of patients with bacterial vaginitis, trichomonas vaginitis, or cervicitis between the groups (P > 0.05). Six months after Mirena placement, E2 Levels were 45.50 ± 7.13 pg/mL and 42.91 ± 8.10 pg/mL, FSH 13.60 ± 3.24 mIU/mL and 14.54 ± 3.11 mIU/mL, and LH 15.11 ± 2.08 mIU/mL and 14.60 ± 3.55 mIU/mL in the study and control groups, respectively. There were no significant differences in hormone levels between the two groups (P > 0.05). There were also no statistically significant differences in the proportions of abnormal menstruation, prolonged menstruation, or pain during intercourse between the study and control groups after Mirena placement (P > 0.05). There were no statistically significant differences in uterine volume, sexual desire, sexual activity, or the sexual satisfaction score between the study and control groups before and after Mirena placement (P > 0.05).
CONCLUSION Placement of a Mirena intrauterine device immediately after an artificial abortion does not increase the risk of adverse reactions and can help prevent endometrial injury caused by recurrent abortions.
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Affiliation(s)
- Xiao-Xiao Jin
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Ling Sun
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Xiao-Li Lai
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Jie Li
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Mei-Li Liang
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Xia Ma
- Department of Obstetrics and Gynecology, Zhejiang Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
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Polis CB, Otupiri E, Hindin M, Chiu DW, Keogh SC, Aidoo C, Larsen-Reindorf R, Bell SO. Prevalence and Correlates of Perceived Infertility in Ghana. Stud Fam Plann 2021; 51:207-224. [PMID: 32964426 PMCID: PMC7539950 DOI: 10.1111/sifp.12136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Perceived infertility is an understudied phenomenon in low‐ and middle‐income countries, where biomedical infertility can have severe consequences, particularly for women. We conducted a nationally representative survey of Ghanaian women, estimated the prevalence of and reasons for perceived infertility, and assessed factors associated with higher levels of perceived infertility using a partial proportional odds model. Among 4,070 women, 13 percent believed they were “very likely” to have difficulty getting pregnant when they wanted to, 21 percent believed this was “somewhat likely,” and 66 percent believed this was “not at all likely.” Reasons for perceived infertility varied by whether the respondent was currently seeking pregnancy. In multivariable analysis, several factors were associated with higher levels of perceived infertility, while unexpectedly, women who reported ever using contraception were less likely to report perceived infertility. Acknowledging the need to address infertility globally and understanding the role of perceived infertility are important components in supporting people's ability to decide whether and when to have children.
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Affiliation(s)
- Chelsea B Polis
- Chelsea B. Polis, Guttmacher Institute, New York, NY.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Easmon Otupiri
- Doris W. Chiu, Sarah C. Keogh, Guttmacher Institute, New York, NY
| | - Michelle Hindin
- Suzanne O. Bell, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Easmon Otupiri, Cara Aidoo, Roderick Larsen-Reindorf, School of Public Health, Kwame Nkrumah University of Science and Technology, Ghana. Michelle Hindin, Population Council, New York, NY
| | - Doris W Chiu
- Chelsea B. Polis, Guttmacher Institute, New York, NY
| | - Sarah C Keogh
- Chelsea B. Polis, Guttmacher Institute, New York, NY
| | - Cara Aidoo
- Doris W. Chiu, Sarah C. Keogh, Guttmacher Institute, New York, NY
| | | | - Suzanne O Bell
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Tchuenkam LW, Mbonda AN, Tochie JN, Mbem-Ngos PP, Noah-Ndzie HG, Bang GA. Transvaginal strangulated bowel evisceration through uterine perforation due to unsafe abortion: a case report and literature review. BMC WOMENS HEALTH 2021; 21:98. [PMID: 33663467 PMCID: PMC7934394 DOI: 10.1186/s12905-021-01247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/24/2022]
Abstract
Background Induced abortion, whether therapeutic or elective, is a surgical procedure frequently practiced worldwide. It is a significant cause of maternal morbidity and mortality. When the procedure is performed in precarious conditions, by unqualified personnel, it leads to serious consequences, including uterine perforation and its associated lesions. Its management remains a medico-surgical emergency. Case presentation We present two cases of unsafe abortions performed by cervical dilatation and intrauterine curettage which resulted in uterine perforation and intestinal evisceration through the vagina leading to acute intestinal obstruction. Both patients underwent intensive resuscitation followed by an emergency laparotomy. The first case was a 26-year-old woman living in rural Cameroon. Following a procedure of termination of her pregnancy, the patient noted the presence of bowel at the vaginal introitus associated with signs of intestinal obstruction. She was transferred to a specialized center was after 4 days later of the onset of the evisceration. Considering the gangrened eviscerated terminal ileum, a right hemicolectomy with anastomosis was performed, as well as a suture of the uterine perforation. The second patient was an 18-year-old African living as a refugee in Cameroon. She was referred for abdominal pain in the context of intestinal obstruction with a viable jejunal loop extruding through the vagina. A simple jejunal resection was performed with end-to-end anastomosis and suture of the uterine perforation. In both cases, the postoperative course was uneventful. Conclusions Uterine perforation is a serious complication of intrauterine gynecological procedures and instrumental abortion in particular. It can lead to evisceration of the intra-abdominal viscera through the uterine perforation. It is therefore a real surgical emergency with multiple and fatal consequences.
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Affiliation(s)
| | | | - Joel Noutakdie Tochie
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Patrick P Mbem-Ngos
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Hugues G Noah-Ndzie
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Guy Aristide Bang
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.,Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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11
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Liu K, Zhang X, Ma X, Jia X, Zhao X, Yang X, Zhang Y. A case report of cervical pregnancy after in vitro fertilization complicated by tuberculosis and a literature review. Open Med (Wars) 2020; 15:1083-1086. [PMID: 33336064 PMCID: PMC7718636 DOI: 10.1515/med-2020-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/20/2020] [Accepted: 09/08/2020] [Indexed: 11/22/2022] Open
Abstract
Although female genital tuberculosis may lead to infertility, pregnancy is still possible, especially through in vitro fertilization (IVF). In this eventuality, even latent tuberculosis (TB) infection is prone to reactivate. Because some of the symptoms of TB overlap with those of pregnancy, diagnosis and treatment may be delayed. We report the case of a 30-year-old infertile woman with repeated genital tuberculosis (GTB) who underwent two laparoscopic surgeries and anti-TB treatments. The woman conceived through IVF and, unfortunately, a cervical pregnancy was diagnosed, together with a third recurrence of GTB. When the condition became stable after anti-TB treatment, the pregnancy was terminated using oral mifepristone in combination with an ultrasound-guided local injection of methotrexate. The gestational sac was expelled 4 days later with minimal blood loss. In view of the reciprocal influence and interconnection between IVF, pregnancy, and TB, we conducted a literature review to provide valuable information for early diagnosis and treatment, as well as for routine screening before IVF of TB in infertile patients.
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Affiliation(s)
- Kun Liu
- Reproductive Medicine Centre, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Xuehong Zhang
- Reproductive Medicine Centre, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Xiaoling Ma
- Reproductive Medicine Centre, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Xueling Jia
- Reproductive Medicine Centre, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Xiaodong Zhao
- Reproductive Medicine Centre, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Xia Yang
- Reproductive Medicine Centre, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Yufeng Zhang
- Reproductive Medicine Centre, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
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12
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Castan B, Brun JL, Stahl JP, Martin C, Mercier F, Fritel X, Agostini A. [Prevention of postoperative or associated of care pelvic inflammatory diseases. Is there a need for antibiotic prophylaxis for first trimester surgical-induced abortion to prevent pelvic inflammatory diseases? CNGOF good practice points]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:646-648. [PMID: 32590078 DOI: 10.1016/j.gofs.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Antibiotic prophylaxis is not recommended during surgical induced abortions. Systematic screening for Chlamydia trachomatis and Neisseria gonorrheae infection by polymerase chain reaction (PCR) on a vaginal sample is recommended before any surgical abortion. Moreover, the bacteriological result should be available before the abortion so that antibiotic treatment effective against the identified bacteria, if any, can be proposed before the procedure. The absence of bacteriological result on the day of the abortion must not, however, delay the procedure. If screening is positive for a sexually transmitted infection (STI), and the bacteriological result is only available after the abortion, it is recommended that antibiotic treatment start as soon as possible. The first-line antibiotic treatment is ceftriaxone 500mg in a single dose by the intramuscular route for N. gonorrheae, doxycycline 200mg per day orally for 7 days for C. trachomatis and azithromycin 500mg the first day (D1) then 250mg per day from D2 to D4 orally if Mycoplasma genitalium is detected by multiplex PCR. In case of positive screening, antibiotic treatment of the woman's partner(s) is recommended, adapted to the STI agent(s).
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Affiliation(s)
- B Castan
- Service des maladies infectieuses et tropicales, centre hospitalier de Périgueux, 24000 Périgueux, France
| | - J-L Brun
- Service de chirurgie gynécologique, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France.
| | - J-P Stahl
- Service des maladies infectieuses et tropicales, hôpital Michallon, CHU de Grenoble, 38043 Grenoble, France
| | - C Martin
- Service d'anesthésie-réanimation, hôpital Nord, AP-HM, 13020 Marseille, France
| | - F Mercier
- Service d'anesthésie-réanimation, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - X Fritel
- Service de gynécologie obstétrique, hôpital de la Milétrie, CHU de Poitiers, 86000 Poitiers, France
| | - A Agostini
- Service de gynécologie obstétrique, hôpital de la Conception, AP-HM, 13005 Marseille, France
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Abstract
Medication abortion, also referred to as medical abortion, is a safe and effective method of providing abortion. Medication abortion involves the use of medicines rather than uterine aspiration to induce an abortion. The U.S. Food and Drug Administration (FDA)-approved medication abortion regimen includes mifepristone and misoprostol. The purpose of this document is to provide updated evidence-based guidance on the provision of medication abortion up to 70 days (or 10 weeks) of gestation. Information about medication abortion after 70 days of gestation is provided in other ACOG publications [1].
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15
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Swartz JJ, Rowe C, Morse JE, Bryant AG, Stuart GS. Women's knowledge of their state's abortion regulations. A national survey. Contraception 2020; 102:318-326. [PMID: 32771370 PMCID: PMC7409738 DOI: 10.1016/j.contraception.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/28/2022]
Abstract
Objectives States vary significantly in their regulation of abortion. Misinformation about abortion is pervasive and propagated by state-mandated scripts that contain abortion myths. We sought to investigate women’s knowledge of abortion laws in their state. Our secondary objective was to describe women’s ability to discern myths about abortion from facts about abortion. Study design This was a cross-sectional study of English- and Spanish-speaking women aged 18–49 in the United States. We enrolled members of the GfK KnowledgePanel, a probability-based, nationally-representative online sample. Our primary outcome was the proportion of correct answers to 12 questions about laws regulating abortion in a respondent’s state. We asked five questions about common abortion myths. We used descriptive statistics to characterize performance on these measures and bivariate and multivariate modeling to identify risk factors for poor knowledge of state abortion laws. Results Of 2223 women contacted, 1057 (48%) completed the survey. The mean proportion of correct answers to 12 law questions was 18% (95% CI 17–20%). For three of five assessed myths, women endorsed myths about abortion over facts. Those who believe abortion should be illegal (aOR 2.18, CI 1.40–3.37), and those living in states with neutral or hostile state policies toward abortion (neutral aOR 1.99, CI 1.34–2.97; hostile aOR 1.6, CI 1.07–2.36) were at increased odds of poor law knowledge. Conclusions Women had low levels of knowledge about state abortion laws and commonly endorse abortion myths. Women’s knowledge of their state’s abortion laws was associated with personal views about abortion and their state policy environment. Implications Supporters of reproductive rights can use these results to show policy makers that their constituents are unlikely to know about laws being passed that may profoundly affect them. These findings underscore the potential benefit in correcting widely-held, medically-inaccurate beliefs about abortion so opinions about laws can be based on fact.
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Affiliation(s)
- Jonas J Swartz
- Division of Women's Community and Population Health, Department of OB/GYN, Duke University Medical Center, Durham, NC, United States; University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States.
| | - Carly Rowe
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
| | - Jessica E Morse
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
| | - Amy G Bryant
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
| | - Gretchen S Stuart
- University of North Carolina School of Medicine, Division of Family Planning, Dept of OBGYN, Chapel Hill, NC, United States
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16
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Efficacy of phloroglucinol for the treatment of pain of gynaecologic or obstetrical origin: a systematic review of literature of randomised controlled trials. Eur J Clin Pharmacol 2019; 76:1-6. [PMID: 31435708 DOI: 10.1007/s00228-019-02745-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Antispasmodics like phloroglucinol are commonly used to alleviate pain. Various authorities recommend the use of this drug for conditions such as dysmenorrhoea, threatened abortion or labour pains. The goal was to carry out a systematic review analysing the existing data concerning the efficacy of phloroglucinol to treat pain in obstetrical or gynaecologic cases. The protocol was registered in Prospero (CRD 42018094065). METHODS The keywords "phloroglucinol" and "randomised controlled trials" were used to search Medline, Embase and the Cochrane Library. We selected randomised, controlled against placebo trials testing the effect of phloroglucinol on gynaecologic or obstetrical pain either as a primary or secondary endpoint. We excluded trials exploring pain caused by intestinal, renal, metabolic or other causes and trials that were not available for critical review in either English or French. A quantitative synthesis (meta-analysis) was planned if the included trials were sufficiently homogenous. If this were not the case, a descriptive synthesis would be presented. RESULTS Twelve trials identified studied the effect of phloroglucinol in gynaecologic or obstetrical conditions. Only two trials corresponded to the inclusion criteria of this review, one of which was not available for critical review. CONCLUSIONS Phloroglucinol is not well evaluated in this field. Whether for labour pains, abortion pains or benign gynaecologic pains, the results found are insufficient to promote the use of this drug in these indications.
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Morra I, Ferrara C, Sglavo G, Sansone A, Saccone G, Perriera L, Di Carlo C. Incidence of uterine rupture in second-trimester abortion with gemeprost alone compared to mifepristone and gemeprost. Contraception 2018; 99:152-154. [PMID: 30468720 DOI: 10.1016/j.contraception.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To compare uterine rupture rates in women having a medical abortion receiving gemeprost alone to those receiving mifepristone plus gemeprost. STUDY DESIGN We reviewed the records of women undergoing medical abortion at 13 0/7-23 6/7 weeks from January 2007 to December 2014 at a single center in Italy. Prior to January 2011, we used gemeprost 1 mg vaginally every 3 h up to a maximum of five doses. After January 2011, we added mifepristone 200 mg orally 24 h prior to the same gemeprost protocol. The primary outcome of the study was the incidence of uterine rupture. We compared the outcome between women receiving gemeprost alone with the combination of gemeprost and mifepristone. RESULTS One thousand and sixty-one (58.5%) and 753 (41.5%) women underwent medical abortion in the gemeprost-alone and the gemeprost/mifepristone groups, respectively. Five (0.47%) uterine ruptures occurred in the gemeprost and four uterine ruptures occurred in the gemeprost/mifepristone groups, respectively (0.53%) (p=.89). All uterine ruptures occurred in women with prior cesarean delivery. CONCLUSIONS We rep orted no difference in the incidence of uterine rupture between the gemeprost-alone and gemeprost and mifepristone groups. IMPLICATIONS Uterine rupture is a rare complication of second-trimester medical abortion with gemeprost. Use of mifepristone prior to gemeprost does not affect this risk.
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Affiliation(s)
- Ilaria Morra
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Cinzia Ferrara
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriella Sglavo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Anna Sansone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
| | - Lisa Perriera
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Costantino Di Carlo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Marrugal-Lorenzo JA, Serna-Gallego A, González-González L, Buñuales M, Poutou J, Pachón J, Gonzalez-Aparicio M, Hernandez-Alcoceba R, Sánchez-Céspedes J. Inhibition of adenovirus infection by mifepristone. Antiviral Res 2018; 159:77-83. [PMID: 30268911 DOI: 10.1016/j.antiviral.2018.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/20/2018] [Accepted: 09/26/2018] [Indexed: 11/18/2022]
Abstract
The repurposing of drugs approved by the regulatory agencies for other indications is emerging as a valuable alternative for the development of new antimicrobial therapies, involving lower risks and costs than the de novo development of novel antimicrobial drugs. Adenovirus infections have showed a steady increment in recent years, with a high clinical impact in both immunosuppressed and immunocompetent patients. In this context, the lack of a specific drug to treat these infections supports the search for new therapeutic alternatives. In this study, we examined the anti-HAdV properties of mifepristone, a commercially available synthetic steroid drug. Mifepristone showed significant in vitro anti-HAdV activity at low micromolar concentrations with little cytotoxicity. Our mechanistic assays suggest that this drug could affect the microtubule transport, interfering with the entry of the virus into the nucleus and therefore inhibiting HAdV infection.
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Affiliation(s)
- José A Marrugal-Lorenzo
- Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Seville, Spain
| | - Ana Serna-Gallego
- Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Seville, Spain
| | - Loreto González-González
- Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Seville, Spain
| | - Maria Buñuales
- Gene Therapy Unit CIMA, Foundation for Applied Medical Research, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Spain
| | - Joanna Poutou
- Gene Therapy Unit CIMA, Foundation for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Jerónimo Pachón
- Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Seville, Spain; Department of Medicine, University of Seville, Seville, Spain
| | - Manuela Gonzalez-Aparicio
- Gene Therapy Unit CIMA, Foundation for Applied Medical Research, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Spain
| | - Ruben Hernandez-Alcoceba
- Gene Therapy Unit CIMA, Foundation for Applied Medical Research, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Spain.
| | - Javier Sánchez-Céspedes
- Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Seville, Spain; Department of Medicine, University of Seville, Seville, Spain.
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