Perception of pregnant individuals, health providers and decision makers on interventions to cease substance consumption during pregnancy: a qualitative study.

BACKGROUND: Despite multiple recommendations and strategies implemented at a national and international level, cigarette smoking, alcohol consumption, and cannabis use during pregnancy remains high in most countries. The objective of this study was to examine key stakeholders' perception of the treatment interventions adopted in Spain, to identify political, organizational and personal factors associated with successful implementation, and to propose strategies for improvement. METHODS: A qualitative study with a phenomenological approach was conducted in 2022. The target groups were: (1) clinical decision makers in the field of addiction science, (2) health professionals who carry out treatment interventions, and (3) pregnant individuals who use tobacco, alcohol or cannabis. Two focus groups and eight in-depth interviews were conducted, recorded, and transcribed. Exploratory analysis and inductive open coding was performed, codes were merged into categories, and subcategories were identified. RESULTS: The analysis resulted in 10 subcategories which were further merged into three main categories: (1) Degree of adoption and utility of treatment interventions implemented; (2) Needs and demands with respect to the organization of treatment interventions; and, (3) Personal barriers to and facilitators for treatment. Respondents reported that despite multiple national and regional cessation initiatives, treatment interventions were rarely adopted in clinical practice. Health care administrators demanded reliable records to quantify substance use for better planning of activities. Health care professionals advocated for additional time and training and both echoed the importance of integrating cessation interventions into routine prenatal care and creating in-house specialized units. The difficulty in quitting, lack of awareness of risk for foetus and child and the controversial advice were identified as barriers by pregnant individuals. CONCLUSIONS: Consistent with previous work, this study found that cessation strategies implemented by the health authorities are not effective if they are not accompanied by organizational and behavioral changes. The current study identifies a set of factors that could be pivotal in ensuring the success of treatment interventions targeting tobacco, alcohol and cannabis use among pregnant individuals.

Lesión quística en la pelvis: un caso de útero doble con hemivagina ciega / Congenital cyst in the pelvis: a case of uterine duplicity with blind vagina

Se presenta un caso de útero doble, con hemivagina ciega, hematocolpos y agenesia renal ipsilateral, que debuta en la edad adulta, como una lesión quística en pelvis. Se trata de una anomalía mesonéfrica o wolfiana que induce un inadecuado proceso de fusión y reabsorción de los conductos de Müller durante el desarrollo embrionario y como consecuencia, la presencia de hemivagina ciega y agenesia renal unilateral. Las manifestaciones clínicas de este tipo de anomalías son muy variables, desde pacientes asintomáticas, con buenos resultados obstétricos como el caso que presentamos, hasta mujeres con clínica florida y pronóstico reproductivo nefasto (AU)

We report a case of uterine duplicity with blind hemivagina, hematocolpos and ipsilateral renal agenesis that manifested in adulthood with a cystic lesion in the pelvis. Uterine duplicity is a mesonephric or Wolffian anomaly inducing alterations in the fusion and resorption of the Müllerian duct during embryonic development, resulting in the presence of blind hemivagina and ipsilateral renal agenesis. The clinical manifestations of these anomalies are highly varied and range from asymptomatic patients, with good obstetric outcomes, as in the present case, to women with dramatic symptoms and extremely poor reproductive prognosis (AU)