Association between in vitro fertilisation embryo transfer and placental pathology in women with preterm birth: a retrospective cohort study.

CONTEXT: The number of women who achieve pregnancy through assisted reproductive technology (ART), including in vitro fertilisation and embryo transfer (IVF-ET), is increasing worldwide. Placenta-mediated diseases associated with ART, such as gestational hypertension, preeclampsia, disorders of placental implantation, and placental abruption, are also increasing. AIMS: To determine the association between placental pathologies and IVF-ET in women with preterm births. METHODS: This retrospective cohort study examined archived placenta specimens of women who achieved pregnancy through either spontaneous conception or IVF-ET. In total, 1677 women with singleton pregnancies who gave birth consecutively between 20 and 37weeks of gestation at Seoul National University Bundang Hospital and underwent placental pathologic evaluation between April 2013 and October 2018 were included. Data from all pathologic reports were reviewed. KEY RESULTS: The IVF-ETgroup had a higher median maternal age and rate of nulliparity than the natural conception group. The incidence rate of obstetric complications, except preterm premature rupture of membranes and placenta previa, was similar in both groups. The IVF-ET group had a higher incidence rate of placental infarction than the natural conception group (26.4% vs 16.4%, P =0.012). Multivariate logistic regression analysis indicated that IVF, hypertensive disorders, and fetal growth restriction were significantly associated with placental infarction. CONCLUSIONS: IVF-ET was independently associated with the risk of placental infarction in women with preterm births. IMPLICATIONS: The use of IVF-ET may cause abnormal placental formation with an increased risk of anatomical and vascular pathology, which are observed in preterm deliveries and may contribute to pregnancy complications.

Impact of Illness Uncertainty on Health-Related Quality of Life in Patients With Unruptured Intracranial Aneurysms After Coil Embolization.

ABSTRACT: BACKGROUND: This study aimed to identify the impact of illness uncertainty on physical and mental health-related quality of life (HRQoL) in patients with unruptured intracranial aneurysms (UIAs) after coil embolization. METHODS: A cross-sectional study was conducted and HRQoL was evaluated using the Short Form-12 Health Survey Questionnaire, which assesses physical and mental HRQoL. RESULTS: The participants had a mean age of 56.4 years, and among them, 190 (71.2%) were women. Physical and mental HRQoL were negatively correlated with physical symptoms, anxiety, depression, and illness uncertainty. Mental HRQoL was positively correlated with social support. Physical HRQoL was significantly influenced by depression (ß = -0.26, P = .004) and was not influenced by illness uncertainty (ß = -0.10, P = .101). Mental HRQoL was significantly influenced by anxiety (ß = -0.45, P < .001), depression (ß = -0.19, P = .003), social support (ß = 0.14, P = .004), and illness uncertainty (ß = -0.14, P = .005). The finding that illness uncertainty influences HRQoL suggests a basis for interventions aimed at improving mental HRQoL by reducing illness uncertainty in patients with UIAs. CONCLUSION: The physical and mental HRQoL in patients with UIAs after coil embolization is negatively influenced by depression, whereas mental HRQoL is also affected by anxiety, illness uncertainty, and social support. These results may serve as reference data for the design and development of interventions to improve HRQoL in patients with UIAs after coil embolization.

Illness Uncertainty of the Patients With Unruptured Intracranial Aneurysms Treated by Coil Embolization.

ABSTRACT: BACKGROUND: Patients with unruptured intracranial aneurysms (UIAs) treated by coil embolization may experience illness uncertainty despite successful treatment. This study aimed to investigate illness uncertainty in patients with UIAs treated by coil embolization and to identify the factors affecting illness uncertainty. METHODS: This cross-sectional study involved data collected from 267 patients with UIAs who received coil embolization within 2 years at a tertiary hospital in South Korea. The data were collected through structured questionnaires and the patients' medical records. The questionnaires included information on sociodemographic characteristics, the Hospital Anxiety and Depression Scale, the Multidimensional Scale of Perceived Social Support, and Mishel Uncertainty in Illness Scale data. We collected clinical characteristics through the medical records. Data analysis was performed using descriptive statistics, an independent t test, a 1-way analysis of variance, and a Pearson correlation test. We used a multiple linear regression analysis with significant variables in the univariate analysis to determine which variables had a significant impact on illness uncertainty. RESULTS: The mean Mishel Uncertainty in Illness Scale score was 52.33 (12.93). We identified age ( P = .002), education level (high school graduation, P = .014; college or higher, P < .001), anxiety ( P < .001), and social support ( P < .001) as factors affecting illness uncertainty. CONCLUSION: Patients with UIAs who underwent coil embolization did not exhibit severe illness uncertainty. The factors affecting illness uncertainty were age, educational level, anxiety, and social support. This study provides insight into illness uncertainty in this patient population and may help develop appropriate nursing interventions.

A new quantification system for assessing the degree of acute cervical insufficiency based on physical and sonographic examination.

OBJECTIVES: Acute cervical insufficiency accounts for 10-25 % of all mid-trimester pregnancy losses. However, the definition and description for the degree of acute cervical insufficiency were obscure and different among the many studies. The aim of this study was to suggest a new 4-digit quantification system and to evaluate the outcome according to the new system in women with acute cervical insufficiency. STUDY DESIGN: A retrospective cohort study was conducted in patients with acute cervical insufficiency who underwent physical examination indicated cervical cerclage. Acute cervical insufficiency was defined as painless external os dilation with prolapsed and/or visible membranes on speculum examination. The status of fetal membranes was described using two values: 1) size of the prolapsed membrane (P, measured using ultrasound); and 2) size of visible fetal membranes (M, evaluated by speculum examination). The status of cervix was described using two values: 1) dilatation of the narrowest os (O, measured by ultrasound); and 2) functional cervical length (C, measured by ultrasound). The patients were divided into 3 groups as follows: Stage I, patients with visible fetal membranes (M > 0) but with a remaining functional cervix (C > 0) (N = 7); stage II, those with visible fetal membranes (M > 0) and a functional cervical length of 0 but without prolapsed membranes (P = 0) (N = 33); and stage III, those with prolapsed membranes (P > 0) (N = 40). RESULTS: 1) Patients who delivered before 34 weeks of gestation had a significantly lower median gestational age at cerclage operation and a significantly higher median P, M, C values than those who delivered at or beyond 34 weeks of gestation(P < 0.01 for gestational age at operation, P and M values; P < 0.05 for C value); 2) The higher the stage based on PMOC quantification system, the greater the risk of preterm delivery before <24, <32, <34, and <37 weeks of gestation (P < 0.001 for all); 3) The neonatal survival rate was 100 % (7/7) for stage I, 93.9 % (31/33) for stage II, and 60 % (24/40) for stage III. CONCLUSION: The PMOC system was a simple method to describe the individualized conditions and to predict the risk of preterm births in all spectrums of acute cervical insufficiency.

[The effects of a physical activity reinforcement program on exercise compliance, depression, and anxiety in continuous ambulatory peritoneal dialysis patients].

PURPOSE: This study was to evaluate the effects of a physical activity reinforcement program on exercise compliance, depression, and anxiety in continuous ambulatory peritoneal dialysis(CAPD) patients. METHOD: A nonequivalent control group with a pre-post test was designed. Data collection was done from December, 2002 to June, 2003 at a hospital. The degree of depression and anxiety of the patients was assessed by the score of SCL-90-R, and exercise compliance was measured by exercise period, frequency, time and intensity. The experimental group was composed of 19 participants who were educated based on an exercise education protocol and carried out walking exercises two to four times a week after hearing verbal persuasion biweekly through the telephone or a face-to-face interview for 12 weeks, while 17 participants in control group received no intervention. RESULT: 1. The experimental group showed significant improvement in self-efficacy of exercise compliance (U=79.00, p=.01), exercise period (chi2=20.84, p=.00), exercise frequency (chi2=9.03, p=.01), exercise time (chi2=9.03, p=.01) and exercise intensity (chi2=11.09, p=.00) compared to those of the control group. 2. The experimental group showed a lower depression score (U=84.50, p=.01) than the results of the control group. 3. However, there were no changes in anxiety level compared to the control group. CONCLUSION: The physical activity reinforcement program was found to have an effect on exercise compliance and the depression score of CAPD patients. The results provided evidence for the importance of physical activity and verbal persuasion in CAPD patients.

Nutrient profiles of korean-americans, non-Hispanic whites and blacks with and without hypertension in the United States.

PURPOSE: We compared the nutrient profiles of hypertensive Korean-Americans, non-Hispanic Whites and Blacks with those of normotensive Korean-Americans, Whites, and Blacks. METHODS: This study was a cross-sectional comparative design of nutrient profiles among three ethnic groups. Korean-Americans were interviewed at Korean-American health clinics and churches in Chicago and data were collected by the 24-hour dietary recall method. Age- and sex-matched data of non-Hispanic Whites and Blacks were selected from the Third National Health and Nutrition Examination Survey for comparison. Descriptive statistics, one way ANOVA with post hoc test, and the propensity score matching method within each hypertensive and normotensive group were used for data analysis. Subjects included 102 subjects with hypertension (Korean-Americans, n = 37; Whites, n = 37; Blacks, n = 28), and 149 subjects without hypertension (Korean-Americans, n = 55; Whites, n = 55; Blacks, n = 39) for final statistical analyses. RESULTS: Significant differences in nutrient profiles among the three groups were as follows. In both hypertensive and normotensive groups, Korean-Americans consumed less energy from fat and saturated fatty acids and more energy from carbohydrates than did Whites and Blacks. All three ethnic groups exceeded the dietary reference intakes of sodium, but did not meet those of calcium and potassium. CONCLUSION: The findings suggest that protein may be needed to replace excessive carbohydrate intake in Korean-Americans and to replace fat intake in Whites and Blacks. Health professionals need to emphasize the importance of increasing calcium and potassium intake and decreasing sodium intake in their nutrition education for these ethnic groups to help prevent and control hypertension.

The effect of a comprehensive lifestyle modification program on glycemic control and body composition in patients with type 2 diabetes.

PURPOSE: This paper describes the effects of a comprehensive lifestyle modification program (CLMP) on glycemic control and body composition in patients with type 2 diabetes. METHODS: This study was performed from October 2003 to April 2005, and used an experimental design with random assignment. The experimental group (n = 25) received CLMP for 4 months and follow-up sessions for 9 months. CLMP included nurse-led education on exercise and diet, and counseling on stress management and self-monitoring of their diabetic health. The control group (n = 23) received a 1-hour educational session on diabetic diet at the beginning of the study. Glucose level and body composition were measured in both groups a total of five times: at baseline (pre-intervention) and at 0, 3, 6 and 9 months post intervention. RESULTS: Repeated-measures ANOVA showed that there were statistically significant differences in fasting blood sugar and HbA1c levels between the two groups (both p < .05). Both groups demonstrated statistically significant changes in body composition over time, but there was no significant difference in the pattern of change between the two groups. CONCLUSION: CLMP is a useful program, and its multiple approaches by nurses as the leaders and coordinators appear to have positive and synergistic roles in improving and maintaining stable glucose level and body composition in patients with type 2 diabetes.