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Introdução: O dispositivo intrauterino (DIU) é uma das estratégias contraceptivas mais eficazes. Porém, apesar de ser amplamente distribuído pelo Sistema Único de Saúde (SUS), há baixa adesão ao método. São constatadas diversas barreiras para esse quadro, tais como desconhecimento acerca do dispositivo, além da reduzida oferta para inserção do contraceptivo por parte das Equipes de Saúde da Família (eSF). Tendo em vista que a ampliação do acesso ao DIU pode contribuir para a diminuição das gravidezes não planejadas, bem como para a autonomia e para o empoderamento das mulheres, algumas estratégias foram desenvolvidas por uma eSF para facilitar o acesso ao DIU. Objetivo: Refletir a respeito do impacto da incorporação de estratégias de educação em saúde para divulgar o método dentro da própria equipe, de sua área de cobertura e da diminuição de barreiras para a inserção, na ampliação do acesso ao DIU, no quantitativo de dispositivos inseridos, no número de gestações não planejadas e na possibilidade de aumento do empoderamento feminino. Métodos: Os dados coletados foram extraídos das informações presentes em planilhas e relatórios produzidos pela própria eSF. Utilizou-se da estatística descritiva para apresentar e analisar os dados obtidos, a partir de ferramentas de formulação de gráficos e tabelas. Resultados: Após mudança no processo de trabalho, visando ao acesso ampliado à inserção do DIU, observou-se um aumento no quantitativo do procedimento assim como na percentagem de gravidezes desejadas. Conclusões: O DIU surge como um instrumento para possibilitar o exercício dos direitos sexuais e reprodutivos e para alavancar atitudes emancipatórias das mulheres. Quanto menos barreiras as mulheres encontram para a inserção do DIU, maior é a escolha por este método, sendo a inserção por demanda espontânea, ou seja, no momento em que a mulher procura a eSF para fazê-la. Nesse sentido, as atividades de educação continuada tornam-se potentes ferramentas para possibilitar maior acesso ao método. Fazem-se necessários estudos de longa duração para que essas hipóteses sejam avaliadas, todavia, parece haver uma ligação positiva entre essas duas variáveis.
Introduction: Intrauterine device (IUD) is one of the most effective contraceptive strategies. Despite being widely distributed by the Brazilian Unified Health System (Sistema Único de Saúde SUS), there is low adherence to the method. There are several barriers to this situation, such as lack of knowledge about the device, in addition to the reduced offer for contraceptive insertion by primary health care providers. Given that increased access to the IUD can contribute to reducing unplanned pregnancies, as well as empowering women, some strategies have been developed by a primary health care team to facilitate access to IUDs. Objective: This research reflected on the impact of incorporating health education strategies to disseminate the method and reduction of barriers to insertion, broadening IUD access, the number of devices inserted, the number of unplanned pregnancy and the possibility of increased female empowerment. Methods: Data were extracted from information present in spreadsheets and reports produced by the team itself. Descriptive statistics were used to present and analyze the data obtained, using tools for formulating graphics and tables. Results: After changing the work process to expanded access to IUD insertion, an increase in the number of procedures and the percentage of planned pregnancies was observed. Conclusions: The IUD appears as an instrument to enable the exercise of sexual and reproductive rights and to leverage women's emancipatory attitudes. The fewer barriers women encounter when inserting an IUD, the greater the choice for this method, with insertion being on spontaneous demand and continuing education activities, powerful tools to enable greater access to it. Long-term studies are necessary for these hypotheses to be evaluated, however, there appears to be a positive link between these two variables.
Introducción: El dispositivo intrauterino (DIU) es una de las estrategias anticonceptivas más efectivas. Sin embargo, a pesar de su amplia distribución a través del Sistema Único de Salud, existe una baja adhesión a este método. Se han identificado diversas barreras para esta situación, como el desconocimiento sobre el dispositivo y la oferta limitada de su inserción por parte de los equipos de salud familiar (eSF). Con el objetivo de ampliar el acceso al DIU y reducir los embarazos no deseados, así como promover la autonomía y empoderamiento de las mujeres, algunos equipos de eSF han desarrollado estrategias para facilitar su acceso. Objetivo: Reflexionar sobre el impacto de la incorporación de estrategias de educación en salud para difundir el método dentro del propio equipo y su área de cobertura, así como la eliminación de barreras para la inserción, en la ampliación del acceso al DIU, en la cantidad de dispositivos insertados, en el número de embarazos no planeados y en la posibilidad de aumentar el empoderamiento femenino. Métodos: Los datos recopilados se extrajeron de las hojas de cálculo e informes producidos por el propio eSF. Se utilizó estadística descriptiva para presentar y analizar los datos obtenidos mediante herramientas de creación de gráficos y tablas. Resultados: Después de un cambio en el proceso de trabajo destinado a ampliar el acceso a la inserción del DIU, se observó un aumento en la cantidad de procedimientos realizados. También se registró un aumento en el porcentaje de embarazos deseados. Conclusiones: El DIU se presenta como una herramienta que permite el ejercicio de los derechos sexuales y reproductivos y promueve actitudes emancipatorias en las mujeres. Cuantas menos barreras encuentren las mujeres para la inserción del DIU, mayor será la elección de este método, con la inserción a demanda, es decir, cuando la mujer lo solicita al eSF, y las actividades de educación continua como poderosas herramientas para facilitar un mayor acceso. Se necesitan estudios a largo plazo para evaluar estas hipótesis, aunque parece existir una relación positiva entre estas dos variables.
الموضوعات
Humans , Contraception , Women's Health , Family Development Planning , Intrauterine Devicesالملخص
Background: Postpartum intrauterine contraceptive devices (PPIUCD) offer highly effective, reliable, non-hormonal, and immediately reversible contraception, with no adverse impact on lactation. Despite these advantages, their acceptance remains low, with factors influencing rejection not fully understood, particularly in specific regions like Vadodara. This study aimed to assess the acceptability and associated factors of immediate PPIUCD use among women in SSG hospital, Vadodara.Methods: A cross-sectional study was conducted from 1st to 30th March 2024, involving 170 postpartum women in SSG hospital, Vadodara. Participants were selected using a systematic approach, and data were collected through structured questionnaires.Results: Acceptance of immediate PPIUCD usage was found to be 12.7%. Reasons for non-acceptance included concerns about complications (24.8%), bad experience in the past (10?), and husband抯 refusal (17.7%). Women with secondary education were more likely to accept PPIUCD, as were those who attended four or more antenatal care visits.Conclusions: Despite the benefits of immediate PPIUCD, its acceptance remains low, influenced by educational level, concerns about complications, and cultural factors such as male partner抯 refusal and religious beliefs. Enhancing women抯 education and providing effective counselling during antenatal care visits are crucial for addressing misconceptions and fears surrounding PPIUCD, thereby promoting its utilization in postpartum family planning.
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Hydrops fetalis is a presenting illness with various immune and non-immune etiologies. It involves fluid accumulation in body cavities, and symptoms specific to its underlying cause. In this case, we report on a preterm neonate with a history of bad obstetrics who presented with hydrops fetalis due to fetal anemia related to RH incompatibility. The patient received an intrauterine transfusion for severe fetal anemia and subsequently required NICU admission. Routine preterm care was provided, along with specific management for jaundice resulting from isoimmune hemolytic anemia.
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The objective of the study is to report a case of IUDs migrating into the rectum that were accidentally discovered during an abdominal hysterectomy. This was a 47-year-old G9P8 patient with eight live vaginal births and one abortion dating back 7 years. As management, she would have received intrauterine suctioning followed by IUD insertion. The diagnosis of IUD migration was made during an abdominal hysterectomy for high grade cervical dysplasia CIN2. The migrating IUD perforated the right end of the posterior aspect of the uterine isthmus and the anterior aspect of the upper rectum. It was removed using forceps with its "T" that was lodged in the uterine wall and its body and thread in the rectum. The rectal breach was sutured with vicryl and total hysterectomy with bilateral adnexectomy could be performed without any other particularities. Migration of a copper IUD into the rectum is exceptional. However, it should be considered in a patient with digestive disorders in the days following the insertion of an IUD. The absence of the son should be a warning, and imaging and especially the digestive endoscopy allow the diagnosis to be made and at the same time its extraction to be carried out as soon as possible.
الملخص
Uterine perforation is an uncommon complication of intrauterine device insertion, with an incidence of one in 1,000 insertions. Perforation may be complete, with the device totally in the abdominal cavity, or partial, with the device to varying degrees within the uterine wall. Some studies show a positive association between lactation and perforation, but a causal relationship has not been established. Very rarely, a device may perforate into bowel or the urinary tract. Perforated intrauterine devices can generally be removed successfully at laparoscopy.
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Intraovarian migration of intrauterine contraceptive device (IUD) is a rare complication, only few cases have been reported. Arguably no reported case in Nigeria to best of knowledge. The patient was Mrs. S.I, a 29-year-old primiparous presented with a 6-hour history of abdominal pain, the pain was said to be sudden in onset pain associated with vomiting. She used an IUD for contraception for about 2 years prior to her presentation. The physical examination showed a patient with good hemodynamic and ventilatory status. Abdominal and vaginal examination revealed marked tenderness at suprapubic and left iliac region, with positive cervical excitation and left adnexal tenderness respectively. Provisional diagnosis of acute pelvic inflammatory disease was made, empirical broad spectrum antibiotic therapy commenced, pelvic scanning done revealed a hyperechoic structure, likely intrauterine device, perforating the uterine fundus and extending into the left ovary. Subsequently, she had laparotomy and the removal of the device. She did well post-surgery and was discharged home to follow in the clinic on the third day after surgery. Intraovarian migration of IUD is one of the rare complications of the device. High index of suspicion with radiological imaging support is necessary in making the diagnosis in a woman of reproductive age group with IUD in- situ regardless of the visible IUD string or not.
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Background: High fertility rate, high maternal mortality and high infant mortality rates are the shared problems of the all the developing countries of the world. According to Directorate of Health Services surveys, 40% of women who intend to use a family planning method in the first year postpartum are not using one. Contraceptive use is negligible among postpartum women, particularly young mothers. We aimed to determine the reasons for acceptability, non-acceptability, side effects and continuation of four contraceptive methods condoms, Depotmedroxyprogesterone acetate, (DMPA), copper intrauterine contraceptive devices (IUCD), progesterone only pills (POPs) in lactating mother after 6 weeks of delivery.Methods: A total of 200 healthy nursing mothers, who needed contraception were enrolled in this prospective observational study. Women were explained about all four contraceptive methods used for the study. The reason for accepting a particular method was sought. The study participant were followed up at third and sixth month and side effects, failure rate, continuation rates, reasons for discontinuation of method were assessed.Results: The most acceptable method was condom (40.5%) followed by DMPA (31%), IUCD (20.5%) and POPs (8%). The most common reason for selection of condom was fear of side effects with other methods (66%). Long acting method like DMPA and IUCD has good continuation rate of 87% and 85% respectively. Failure of contraception was seen only with condoms (2.8%).Conclusions: This study showed condoms was most acceptable method but had failure whereas DMPA and Cu-IUCD have high continuation rate with no failure.
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Adenocarcinoma of the cervix presenting during pregnancy is an exceedingly rare occurrence, and the optimal management approach remains uncertain due to limited reported cases. Here we are presenting a case of a multiparous lady who presented with complaints of amenorrhoea for 3 months, pain abdomen, spotting per vaginum, mass felt per vaginum. Ultrasonography showed single live intrauterine pregnancy at 11 weeks 4 days of gestational age with an ill-defined hyperechoic lesion measuring 4.36×4.92×4.16 cm in cervix. HPE of cervical biopsy confirmed cervical adenocarcinoma-endocervical type, grade 2. On MRI, a heterogeneous exophytic irregular mass involving the external os, protruding into the upper vaginal cavity was identified with infiltration into the anterior upper vaginal wall, pelvic lymphadenopathy, and sub-centimetric inguinal lymph nodes were observed. The patient underwent radical hysterectomy with bilateral pelvic lymph node dissection. The surgical specimen exhibited stromal invasion exceeding 5mm in depth and width greater than 7mm, involving entire cervical wall with lympho-vascular space invasion. The tumor was ER/PR negative, strongly positive for P16, and HPV studies were also positive. Adjuvant external beam radiotherapy (EBRT) was administered to the pelvis, and the patient is currently in remission.
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Background: This study aimed to compare the efficacy of two labor induction methods, mifepristone alone and mifepristone followed by misoprostol, in cases of intrauterine fetal demise (IUFD) beyond 28 weeks of gestation.Methods: A prospective study was carried out at, BRD Medical College in Gorakhpur and aimed to investigate the efficacy of two different methods for labor induction in pregnancies with intrauterine fetal demise (IUFD) beyond 28 weeks of gestation during September 2019 to August 2020. Sixty participants were divided into two groups of 30 each, with mifepristone administered orally in both groups. Group 2 received additional vaginal misoprostol. Patient demographics, Bishop scores, induction to active labor intervals, and induction to delivery intervals were examined. Augmentation methods, side effects, complications, and time to full dilatation were analyzed.Results: The groups exhibited similar patient characteristics, including age, parity, socioeconomic status, and literacy rates. Gestational age at induction and Bishop scores were comparable. Both groups showed substantial improvements in Bishop scores. The induction to active labor interval was shorter in the mifepristone group, and the induction to delivery interval was similar. The mifepristone group required fewer mifepristone tablets, while the combination group used less misoprostol, reducing side effects. Complications were minimal, with a decreased need for augmentation methods in both groups.Conclusions: Mifepristone, whether used alone or followed by misoprostol, proved effective in labor induction for IUFD beyond 28 weeks. Mifepristone's ability to enhance cervical ripening and prostaglandin sensitivity makes it a promising option for reducing the risks associated with delayed birth in cases of IUFD. These findings suggest that mifepristone can be a valuable addition to obstetric practices, particularly in cases where traditional induction methods may pose greater risks.
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Los dispositivos intrauterinos de cobre son utilizados como métodos anticoncepcionales y es uno de los métodos más utilizados por su seguridad, reversibilidad y eficacia en la prevención de embarazos, que es superior al 97 %. Se presenta un caso de falla en la anticoncepción con dispositivos intrauterinos de cobre después de 5 años de uso en gestante de 26 años, que acudió al área de emergencias cursando con embarazo de 38 semanas y 4 días en periodo expulsivo; se obtuvo recién nacido a término sano. El periodo de alumbramiento patológico (prolongado) por presencia de dispositivo intrauterino de cobre en membranas ovulares(AU)
Copper intrauterine devices are used as contraceptive methods and are one of the most used methods due to their safety, reversibility and effectiveness in preventing pregnancy, which is greater than 97%. A case of failure in contraception with a copper intrauterine devices is presented after 5 years of use in a 26-year-old pregnant woman, who went to the emergency room with a pregnancy of 38 weeks and 4 days in the expulsive period; a healthy term newborn was obtained.The pathological (prolonged) delivery period due to the presence of copper intrauterine devices in ovular membranes(AU)
الموضوعات
Humans , Female , Pregnancy , Adult , Pregnancy, Prolonged , Parturitionالملخص
Background: Endometrial receptivity plays an important role in implantation and successful pregnancy. In literature, various attempts have been made to improve endometrial receptivity. Endometrial scratch injury (ESI) is one such intervention widely offered to improve endometrial receptivity in women with a history of in-vitro-fertilization (IVF) failure. In our present study, this procedure of ESI was performed in cases with previously failed intrauterine insemination (IUI) and its effect on pregnancy rate was assessed.Methods: A prospective, randomised, controlled study was conducted at Fertility Clinic, Bhabha Atomic Research Centre Hospital, Mumbai. Total 200 women requiring IUI with previously failed one IUI were included in the study. They were randomly divided into 2 groups of 100 each. Both the groups underwent controlled ovarian stimulation with clomiphene citrate and gonadotropins followed by IUI. Study group underwent “endometrial scratching” in mid-proliferative phase of the same cycle preceding IUI. Control group underwent IUI alone. Pregnancy rates (clinical and ongoing) were compared in both the groups.Results: Endometrial scratching group had significantly higher (<0.0002) (8.4±2.3 mm versus 7.3±1.9 mm) endometrial thickness at the time of ovulation trigger. Clinical pregnancy rate was significantly higher (p<0.0001) (42% versus 16%) in endometrial scratching group with no significant difference in ectopic pregnancy, miscarriage and multiple pregnancy rates in both the groups.Conclusions: Due to its role in improving pregnancy rates in women with previously failed IUI, clinicians should offer ESI in mid-proliferative phase of the same cycle preceding IUI, before offering advanced IVF treatment.
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Background Maternal atmospheric pollution during pregnancy may alter fetal intrauterine development programming, thereby increasing the risk of childhood obesity in the future. Objective To investigate the effects of atmospheric pollution exposure during pregnancy on the incidence of childhood obesity in offspring. Methods English databases (PubMed, Web of Science, and Medline) and Chinese databases (Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure, and VIP Information Chinese Journal Service Platform) were searched for literature reporting exposure to atmospheric pollution during pregnancy and childhood obesity published from 1 January 2000 to 31 August 2023. The quality of the included literature was evaluated using the quality assessment tools for observational cohort and cross-sectional studies recommended by the US National Institutes of Health. Results Twenty-four studies meeting the inclusion criteria were identified and the associated atmospheric pollutants included particulate matter, ozone, nitrogen oxide, carbon oxide, and sulfur oxide. In comparison to the non-exposed group, prenatal exposure to various common atmospheric pollutants were significantly associated with an elevated risk of childhood obesity in offspring. Conclusion Maternal exposure to atmospheric pollution during pregnancy is associated with an elevated risk of childhood obesity in subsequent years. Future studies should pay more attention to the effects of atmospheric pollution on the distribution of children's body fat and metabolic development, and further identify potential mechanisms of atmospheric pollutant exposure leading to childhood obesity.
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Objective To investigate the anti-fibrosis action of the therapy of tonifying kidney and removing stasis(shortened to Bushen Quyu method)on moderate-to-severe intrauterine adhesion and its influence on extracellular matrix degradation related factors in menstrual blood.Methods A total of 124 patients with moderate-to-severe intrauterine adhesions of kidney deficiency and blood stasis syndrome who were to undergo transcervical resection of adhesion(TCRA)were randomly divided into a study group and a control group,with 62 patients in each group.Both groups were given TCRA treatment.After the operation,the control group was treated with Progesterone + Estradiol Valerate Tablets,and the study group was treated with the combination of the Bushen Quyu method by using modified Guishen Decoction based on the treatment of the control group.The treatment covered 3 menstrual cycles.The changes in menstrual status,transvaginal color Doppler sonography parameters,scores of kidney deficiency and blood stasis syndrome,and scores of uterine adhesion in the two groups were observed before and after the treatment.Moreover,the two groups were observed before and after treatment in the changes of vascular endothelial growth factor(VEGF),transforming growth factor β1(TGF-β1),platelet-derived growth factor(PDGF),and connective tissue growth factor(CTGF)as well as the mRNA expression levels of matrix metalloproteinase 9(MMP-9),matrix metalloproteinase inhibitory factor 1(TIMP-1),phosphatidylinositol-3-hydroxykinase(PI3K)and collagen type I A1 protein(COL1A1).After treatment,the clinical efficacy and safety of the two groups were assessed.Results(1)After 3 menstrual cycles of treatment,the total effective rate in the study group was 93.55%(58/62),and that in the control group was 80.65%(50/62).The intergroup comparison showed that the therapeutic effect of the study group was significantly superior to that of the control group(P＜0.05).(2)After treatment,the menstrual flow,menstrual cycle and menstrual period of the two groups were significantly improved compared with those before treatment(P＜0.05),and the recovery of menstrual flow,menstrual cycle and menstrual period in the study group was significantly superior to that in the control group after treatment(P＜0.05).(3)After treatment,the transvaginal color Doppler sonography parameters of uterine blood flow index(FI),pulsatility index(PI),resistance index(RI),uterine cavity volume,and endometrial thickness in the two groups were significantly improved compared with those before treatment(P＜0.05).And the study group had significantly higher FI,uterine cavity volume,and endometrial thickness and had lower PI and RI than the control group(P＜0.05 or P＜0.01).(4)After treatment,the scores of uterine adhesion and the scores of kidney deficiency and blood stasis syndrome in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the above scores in the study group were significantly lower than those of the control group after treatment(P＜0.01).(5)After treatment,the levels of VEGF,TGF-β1,PDGF,and CTGF in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the levels of the above cytokines in the study group were significantly lower than those in the control group after treatment(P＜0.01).(6)After treatment,the relative mRNA expression levels of MMP-9 and PI3K in the menstrual blood of the two groups were significantly higher and the mRNA expression level of COL1A1 was significantly lower than that before treatment(P＜0.05).And the study group had higher mRNA expression levels of MMP-9 and PI3K in the menstrual blood than the control group after treatment(P＜0.05 or P＜0.01).(7)The total incidence of adverse reactions in the control group was 25.81%(16/62)and that in the study group was 16.13%(10/62).The intergroup comparison showed that the difference between the two groups was not statistically significant(P＞0.05).The symptoms of adverse reactions in the two groups disappeared after symptomatic treatment,and there were no adverse reactions related to the medication of Chinese medicine during the study.Conclusion The combination of Bushen Quyu formula combined with western medicine is more effective than western medicine alone for the treatment of patients with uterine adhesions after TCRA.The application of Bushen Quyu formula can further promote the recovery of menstruation in the patients,improve the circulation of blood flow in the endometrium,increase the endometrial thickness,regulate the expression of fibrosis factors,up-regulate the mRNA expressions of PI3K and MMP-9,restore the balance of the extracellular matrix(ECM),and prevent the reoccurrence of intrauterine adhesions.And its clinical medication is safe.
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Objective To compare the efficacy of three different methods in the prevention of adhesion after the HEOS system for different degrees of intrauterine adhesions.Methods 284 patients with mild,moderate and severe intrauterine adhesions,who were treated with the HEOS system,were divided into three groups,the intrauterine device with sodium hyaluronate gel was placed in Group A,Foley water capsule tube with sodium hyaluronate gel was placed in Group B,and sodium hyaluronate gel was placed in Group C only.The recovery of uterine adhesion,improvement of menstruation,endometrial thickness,and adverse reactions were compared among the three groups.Results The mild intrauterine adhesions group showed statistical differences among the three groups(P<0.05).Group A had a higher menstrual improvement rate than Group C(P<0.017),and there was no significant difference in other therapeutic indicators(P>0.017).However,the adverse reaction rate in Group A was also higher than that in Group C(P<0.017).In the moderate intrauterine group,there was a significant difference in the improvement rate of intrauterine adhesions between Group B and the other two groups(P<0.017).Group A and B were higher than Group C in terms of menstrual status,endometrial thickness,and adverse reactions(P<0.017).In severe intrauterine adhesions,Group A had higher efficacy indicators than other groups(P<0.017).Conclusions The curative effect index and adverse reaction rate were analyzed,after operation.For the light,moderate,and severe intrauterine adhesions,sodium hyaluronate gel,Foley water capsule tube with sodium hyaluronate gel,and intrauterine device with sodium hyaluronate gel were the best choice for adhesion.Individual and hierarchical management can achieve good clinical effects,which is worth popularizing.
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Objective:To conjecture the correlation between fetal hydrothorax(FHT)and pregnancy outcome through the analysis of 95 fetuses with hydrothorax and their mothers.Methods:In this case series study, 95 FHT patients admitted to the Third Affiliated Hospital of Zhengzhou University from January 2016 to October 2022 were retrospectively analyzed.According to the pregnancy outcome, these patients were divided into the induced labor group (13 patients) and the delivery group (82 patients). General data and genetic examinations of patients in the induced labor group were analyzed to explore their pathogenesis and genetics.According to the neonatal Apgar score, patients in the delivery group were divided into the normal group and the asphyxia group.Fifteen indicators including the maternal age, gestational week at first diagnosis, maternal complications, FHT location, FHT severity, FHT outcome during pregnancy, fetal ascites, hydrops fetalis, other abnormal fetal structures, amniotic fluid volume, intrauterine treatment, gestational week of delivery, mode of delivery, sex of the newborn, and newborn birth weight in the 2 groups were comparatively analyzed by the chi-square test.With the neonatal Apgar score as the dependent variable, variables that had statistical significance during the univariate analysis were included in the regression analysis, and a multivariate binary Logistic regression equation was established to explore the factors affecting the pregnancy outcome.Results:There were significant differences in the FHT outcome during pregnancy (16/22/13 cases vs.2/18/11 cases, χ2=6.994, P=0.030), FHT severity (27/24 cases vs.9/22 cases, χ2=4.475, P=0.034), hydrops fetalis (14/37 cases vs.23/8 cases, χ2=17.012, P=0.001), amniotic fluid volume (21/30 cases vs.24/7 cases, χ2=10.228, P=0.001), intrauterine treatment (19/32 cases vs.2/29 cases, χ2=9.603, P=0.002), gestational week of delivery[(38.15±2.05) weeks vs.(34.83±3.14) weeks, t=5.748, P=0.001], and newborn birth weight[(3 325.00±637.41) g vs.(2 714.58±837.99) g, t=3.727, P=0.001]between the normal and asphyxia groups(all P<0.05). Among them, hydrops fetalis ( OR=7.070, P=0.020) and severe FHT ( OR=6.927, P=0.043) were risk factors for neonatal Apgar scores.Intrauterine treatment ( OR=0.062, P=0.027) and gestational week of delivery( OR=0.577, P=0.022) could be used as a protective factor for neonatal Apgar scores. Conclusions:Diagnosis of FHT during the early gestational weeks and multiple fetal structural abnormalities, especially hydrops fetalis, have higher probabilities of abnormal genetic examinations, and the fetal prognosis was poor.It is recommended to carry out chromosomal karyo type and microarray tests, as well as whole exome sequencing and detection of genetic syndromes(if necessary), to avoid unnecessary fetal treatment and improve the survival rate of perinatal infants after intrauterine treatment.The poor prognosis is related to hydrops fetalis and severe FHT; however, timely intrauterine treatment and prolonging pregnancy can improve the pregnancy outcome and increase the survival rate of perinatal infants.
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Objective:To evaluate the impact of human papillomavirus(HPV)infection on the clinical outcomes of intrauterine insemination(IUI)in infertile women.Methods:The clinical data of 685 patients(1046 cycles)who underwent IUI treatment were retrospectively analyzed at Tangdu Hospital of Air Force Medical University from January 2019 to July 2021,including 554 cases of artificial insemination with husband sperm(AIH).According to HPV infection,patients were divided into two groups,HPV positive group and HPV negative group,propensity score matching(PSM,1 ∶ 2)was used for IUI(80 cases in HPV-positive group and 158 cases in HPV-negative group)and AIH(65 cases in HPV-positive group and 129 cases in HPV-negative group)treatment patients,and the clinical outcomes of these patients were compared respectively.Results:There was no statistically significant difference in clinical pregnancy rate,live birth rate,ectopic pregnancy rate,abortion rate,macrosomia birth rate,and low body weight birth rate between HPV-positive group and HPV-negative group after matching with IUI treat-ment patients(P>0.05).There was no statistically significant difference in clinical pregnancy rate,live birth rate,ectopic pregnancy rate,miscarriage rate,macrosomia birth rate,and low body weight birth rate between the HPV positive group and the HPV negative group after matching AIH treatment patients(P>0.05).Conclusions:HPV infection in infertile female may not affect the clinical outcomes of IUI patients.
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BACKGROUND:The key to preventing the recurrence of intrauterine adhesions is to reconstruct the endometrium with normal function.The latest breakthrough in the treatment of recurrent intrauterine adhesions in and outside China is the use of degradable materials to prepare hydrogels to prevent the recurrence of adhesions. OBJECTIVE:To review the research advance in hydrogel-promoted endometrial repair in intrauterine adhesions. METHODS:PubMed,Web of Science,China National Knowledge Infrastructure(CNKI),and WanFang databases were searched systematically,with the keywords"intrauterine adhesions,endometrial injury,endometrium regeneration,hydrogel"in Chinese and English.Relevant articles published in each database from January 1990 to March 2023 were collected. RESULTS AND CONCLUSION:In recent years,research on hydrogel-promoted endometrial repair in uterine adhesions in and outside China has made some progress and plays an important role in the prevention and treatment of intrauterine adhesions and the promotion of endometrial repair:(1)As an important carrier in tissue engineering,hydrogel itself has excellent biocompatibility,biodegradability and three-dimensional network structure,which can be better applied in the treatment of intrauterine adhesions.(2)The hydrogel-based carrier system can promote the proliferation and differentiation of endometrial epithelial cells by transporting drugs/biologics/stem cells,and restore normal uterine morphology to prevent adhesion recurrence.(3)Hyaluronic acid hydrogels can not only meet good biocompatibility,but also promote the proliferation and differentiation of endometrial epithelial cells,and will be hydrolyzed by corresponding enzymes in utero,without affecting the normal metabolism of the body.They are currently commonly used uterine anti-adhesion agents in the clinic and are also the most commonly used hydrogel carriers in tissue engineering research.(4)Poloxamer hydrogel with excellent temperature-sensitive properties can rapidly gelate into the body,quickly form a physical barrier,and can play a slow-release effect on carrying substances and provide a platform for cell growth/adhesion.(5)There are broad prospects for the preparation of therapeutic hydrogels using materials with different characteristics,such as temperature-sensitive hydrogels,pH-responsive hydrogels and photosensitive hydrogels,but there are still many problems to be solved,such as the safety of the hydrogel system,whether the degradation products cause immune reactions,and whether they have an impact on the normal body's menstrual period.A large number of animal experiments and clinical trials are needed to verify its safety and efficacy,and continuously improve the treatment strategy.
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Objective To investigate the clinical factors affecting live birth rate in patients who underwent hysteroscopic adhesiolysis and subsequent embryo transfer.Methods A total of 643 patients who had undergone hysteroscopic surgery to remove various degrees of intrauterine adhesion(IUA)and subsequently received embryo transfer between January 2018 and December 2020 were retrospectively analyzed.Postoperative treatment regimens and pregnancy outcomes after embryo transfer were collected.The primary endpoint was live birth rate.A multivariate logistic regression analysis was performed to further investigate the factors affecting pregnancy outcomes.Results Among the 643 IUA patients,20.5%(132/643)patients were diagnosed as having mild IUA,63.6%(409/643)patients moderate IUA,and15.9%(102/643)patients severe IUA.The median time from hysteroscopy to the first cycle of embryo transfer was 126(73,225)d.The clinical pregnancy rate was 32.7%(210/643)and the live birth rate was 24.7%(159/643).Logistic regression analysis found that age(OR =0.926,95%CI:0.880-0.974,P =0.003)and endometrial thickness on the day of transplantation(OR =1.188,95%CI:1.030-1.370,P =0.018)were prognostic factors of live birth.The live birth rate significantly decreased with age in the mild and moderate adhesion groups(P =0.004 and 0.018),while in the severe adhesion group,the live birth rate decreased with age,but the difference was not significant(P =0.526).Postoperative estrogen dosage,number of artificial cycles,interval between hysteroscopy and transplantation,fresh or frozen-thawed embryo transfer,and type of embryo transferred had no significant impact on live birth.Conclusions Maternal age and endometrial thickness on the day of transplantation are the most important predictors of live birth in patients undergoing embryo transfer after hysteroscopic adhesiolysis.Fresh or frozen-thawed embryo transfer after surgery and the interval between hysteroscopy and transplantation do not affect the live birth rate.
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Objective:To explore the perinatal characteristics and early postnatal circulatory function of the larger fetus in monochorionic diamniotic twin pregnancy complicated with selective intrauterine growth restriction (sIUGR).Methods:From February 2018 to August 2022, a total of 91 larger fetuses of the sIUGR pregnancies who were hospitalized in the neonatal intensive care unit of Peking University Third Hospital were retrospectively included. The perinatal factors, clinical monitoring indicators, and echocardiographic data of the larger twins in pregnancies with three types of sIUGR were compared using one-way analysis of variance and LSD test, Kruskal-Wallis H test, Chi-square test, and Bonferroni correction. Results:The gestational age, birth weight, and placental weight were (30.6±1.5) weeks, (1 503.9±286.4) g, and (548±120) g in the type Ⅱ sIUGR larger twins and were (30.5±2.3) weeks, (1 523.5±424.4) g, and (560±109) g in type Ⅲ, which were all smaller, lower, and lighter than those in the type Ⅰ[(33.0±1.7) weeks, (2 022.1±372.3) g, and (630±131) g, respectively] (LSD test, all P<0.05). Compared with type Ⅰ sIUGR larger twins, type Ⅱ and Ⅲ sIUGR larger twins had longer hospital stay [36.0 d (27.0-43.0 d) and 32.0 d (15.0-47.0 d) vs. 17.0 d (9.5-22.0 d)], higher proportion of preterm births due to fetal distress [63.6% (21/33) and 75.0% (15/20) vs. 31.6% (12/38), χ2=7.30 and 9.93] (Bonferroni correction, all P<0.017); Compared with type Ⅰ sIUGR larger twins, type Ⅱ sIUGR larger twins had higher proportion of postnatal use of vasoactive drugs [45.5% (15/33) vs. 18.4% (7/38), χ2=6.04, P=0.014]. The interventricular septum thickness was larger in the type Ⅲ sIUGR larger twins than those in the type Ⅰ and Ⅱ twins [(4.4±1.4) vs. (3.8±0.9) and (3.3±0.9) mm]; the thickness of left ventricular free wall was the largest in the type Ⅲ larger twins, followed by those in the type Ⅰ and type Ⅱ [(4.6±1.3) vs. (3.1±0.7) vs. (2.7±0.6) mm]; the left ventricular end-diastolic diameter, right ventricular outflow tract diameter, right ventricular anteroposterior diameter, and pulmonary artery diameter in type Ⅰ larger twins were increased comparing with those in type Ⅱ and Ⅲ [left ventricular end-diastolic diameter: (15.0±2.1) vs. (13.4±2.3) and (12.3±3.2) mm; right ventricular outflow tract diameter: (8.7±1.4) vs. (7.3±1.4) and (7.1±0.8) mm; right ventricular anteroposterior diameter: (7.1±1.5) vs. (6.5±0.9) and (6.4±1.0) mm; pulmonary artery diameter: (6.8±1.1) vs. (6.3±0.9) and (6.3±0.8) mm] (LSD test, all P<0.05). Conclusion:The larger fetuses of type Ⅱ and Ⅲ sIUGR pregnancies had smaller gestational age and lighter birth weight who are more prone to have fetal distress, so it is necessary to strengthen dynamic monitoring and circulatory support for such neonates during the perinatal period and early postnatal period. The thickening of the left ventricular wall and interventricular septum in the early postnatal period of type Ⅲ larger fetuses may lead to the decrease of ventricular diastolic function reserve, thereby the evaluation and monitoring of the myocardial diastolic function of these neonates in the early postnatal period are critical.
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[Objective]To explore the application and effect of traditional Chinese medicine(TCM)clinical decision-making system in the treatment of moderate or severe intrauterine adhesion(IUA).[Methods]A prospective randomized controlled trial was conducted.Patients with moderate or severe IUA who underwent hysteroscopic uterine adhesiolysis in a tertiary hospital of TCM in Hangzhou from January 2022 to December 2022 were selected.The patients were divided into control group(51 cases),decision system group(53 cases)and clinician group(54 cases)according to whether they were treated by TCM dominant disease clinical decision-making system.The improvement of menstrual volume,American Fertility Society(AFS)score,endometrial thickness,endometrial blood flow parameters and the efficacy of TCM accompanying symptoms were compared among the three groups before and after treatment.[Results]Compared with control group,the menstrual volume of decision system group and clinician group were significantly improved(P＜0.05),but there was no significant difference between decision system group and clinician group(P＞0.05).Compared with control group,the AFS scores of uterine cavity in decision system group and clinician group were significantly decreased(P＜0.01),and there was no significant difference between decision system group and clinician group(P＞0.05).The endometrial thickness was significantly increased and the endometrial blood flow parameters were significantly decreased in the three groups after treatment,and the differences were statistically significant(P＜0.01),but there was no significant difference among the three groups before and after treatment(P＞0.05).Compared with control group and decision system group,the clinical physician group had significantly improved efficacy of TCM accompanying symptoms(P＜0.05),and there was no significant difference between control group and decision system group(P＞0.05).[Conclusion]TCM clinical decision system for IUA can significantly improve the menstrual volume of patients with moderate or severe IUA,reduce postoperative AFS score and prevent the recurrence of adhesion.