Low-dose acetylsalicylic acid does not modify maternal vascular reactivity in nulliparas.

OBJECTIVE: To assess if the low-dose acetylsalicylic acid (ASA) would be capable of modifying endothelial function throughout pregnancy in nulliparous patients. METHODS: A double-blind, randomized clinical trial with 277 were included. A total of 139 were orally administered 100 mg/day of ASA, and 138 received placebo. Endothelial function was assessed by flow-mediated dilation (FMD) in the brachial artery before the start of medication (11-14 weeks) and 20-24 and 30-34 weeks of gestation. The intervention was maintained until 34 weeks. The Mann-Whitney U test was used to compare the placebo and ASA groups. The comparison of FMD during pregnancy was performed using the Friedman test. RESULTS: The groups (ASA and placebo) were similar regarding to age, weight, height, and body mass index (BMI) (p > .005). The comparison of values of FMD (%) between placebo vs. ASA at 11 and 14 weeks (8.9 vs. 9.7%, p: .253), 20 and 24 weeks (8.8 vs. 10.7%, p: .152), and 30 and 34 weeks (10.7 vs. 9.8%, p: .314) did not show significant changes throughout pregnancy. We observed a significant prevalence of PE in the placebo regarding to ASA group [14 (10.2%) vs. 8 (5.8%), p: .171]. CONCLUSION: Acetylsalicylic acid did not modify the endothelial function assessed by FMD of the brachial artery during pregnancy in nulliparous women.

Use of naproxen versus intracervical block for pain control during the 52-mg levonorgestrel-releasing intrauterine system insertion in young women: a multivariate analysis of a randomized controlled trial.

BACKGROUND: To compare the effectiveness of 550 mg naproxen sodium versus 6 mL 2%-lidocaine intracervical block in pain lowering at the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) placement in young women. METHODS: In this randomized controlled trial, 100 women aged 15-24 years were block-randomized to receive either 6 mL 2%-lidocaine intracervical block 5 min before the LNG-IUS insertion or 550 mg naproxen 30 min before the procedure. Forty-nine women received 550 mg naproxen and 51 received intracervical block. The primary outcome was pain at LNG-IUS insertion. Secondary outcomes were ease of insertion, insertion failures, and correct IUS positioning. Neither participants nor doctors were blinded. Pain at insertion was assessed by using a Visual Analog Scale (VAS). RESULTS: Women randomized to lidocaine intracervical block presented lower mean pain score at insertion, when compared to women who received naproxen (5.4 vs. 7.3, respectively; p < 0.001). Parous women had a 90.1% lower chance of experiencing severe pain (p = 0.004). There was a 49.8% reduction in the chance of severe pain for every 1-cm increase in the hysterometry (p = 0.002). The only complication observed during insertion was vasovagal-like reactions (7%). The insertion was performed without difficulty in 82% of the women. Participants in the intracervical block group presented higher proportion of malpositioned IUS on transvaginal ultrasound examination compared to women in naproxen group. Nevertheless, all the malpositioned IUS were inserted by resident physicians. CONCLUSION: Lidocaine intracervical block was found to be more effective than naproxen in reducing LNG-IUS insertion pain. TRIAL REGISTRATION NUMBER: RBR-68mmbp, Brazilian Registry of Clinical Trials, Retrospectively registered (August 4, 2020), URL of trial registry record: https://ensaiosclinicos.gov.br/rg/RBR-68mmbp/ .

Effect of eCG in a short-term synchronization treatment on ovarian status, estrus synchrony, and ovulation in dairy goats managed under tropical conditions.

The aim of this study was to assess the need of using eCG on short-term estrus synchronization protocol in nulliparous (NUL) and multiparous (MULT) dairy goats during the breeding season. Alpine (n = 20), Nubian (n = 20), and Saanen (n = 16) goats received 60 mg medroxyprogesterone acetate intravaginal sponges for 6 days plus 30 µg d-cloprostenol and 200 IU eCG (G-eCG, n = 28) or saline (G-Control, n = 28) 24 h before sponge removal. The NUL and MULT goats of each breed were equally assigned into the two treatments. Transrectal ultrasonography was used to evaluate ovulatory parameters, and teaser goats were used for estrus detection every 12 h from sponge removal to ovulation. eCG did not affect (P > 0.05) estrus response (~86%), diameter of ovulatory follicles (~6.8 mm), and number of ovulations (~1.6). Nevertheless, eCG led to earlier (P < 0.05) ovulation (G-eCG = 65.1 and G-Control = 73.2 h) and increased (P < 0.05) the ovulation rate (G-eCG = 96.4% and G-Control = 67.9%). In the absence of eCG, no differences regarding reproductive parameters (P > 0.05) were found between parity orders. Alpine MULT goats underwent a superior (P < 0.05) number of ovulations (2.2) in comparison to NUL goats (1.3). In conclusion, the exclusion of eCG from short-term estrus synchronization protocol did not interfere with estrus response but decreased the ovulation rate.

Reproductive performance in gilts following applications of different insemination doses and techniques.

This study evaluated the applicability of intrauterine artificial insemination (IUAI) in gilts and the impact of age at insemination and different body characteristics of gilts on the success rate for cannula insertion. Additionally, reproductive performance was evaluated for IUAI and cervical artificial insemination (CAI), considering different semen dose sizes. A total of 636 gilts were assigned in a 2 × 2 factorial design: two artificial insemination techniques (CAI and IUAI) and two semen dose sizes (1.5 × 109 sperm cells/50 mL or 2.5 × 109 sperm cells/80 mL). In those gilts assigned to IUAI (n = 319) the success rate for intrauterine cannula insertion was evaluated according to weight at first detected estrus, body condition score (BCS), and age at insemination. Reproductive performance, occurrence of bleeding, and semen backflow during all inseminations were compared among groups (2 × 2). Two subgroups were evaluated regarding the time expended to perform insemination (n = 380), and the semen backflow collected during 1 h after insemination (n = 114). The success rate for intrauterine cannula insertion, based on a successful insertion in all inseminations performed during estrus, was 58.9%. Additionally, greater possibility (>60%; P ≤ 0.04) of cannula insertion was observed in heavier gilts (≥124 kg), as well as in older gilts (≥225 d) and those with greater BCS (>3). There were no differences among the groups in pregnancy rate (≥95.3%; P = 0.23), farrowing rate (≥93.7%; P = 0.54), total piglets born (≥14.5; P = 0.45), as well as, bleeding (P = 0.48) and backflow (P = 0.48) during insemination. However, the percentage of semen backflow volume and percentage of sperm cells in the backflow were lower in gilts inseminated by CAI with 1.5 billion sperm cells/50 mL (P < 0.01) than in the other groups. There was no expressive reduction in time expended to perform IUAI compared to CAI. However, gilts inseminated with 1.5 billion sperm cells/50 mL showed a lower total time to inseminate than all other groups (P < 0.01). In conclusion, higher weight, BCS, and age increased the success rate for cannula insertion. However, IUAI did not optimize the insemination procedure, and remains limited for gilts due to the low success rate for cannula insertion. Reproductive performance was not affected by IUAI or CAI using 1.5 or 2.5 billion sperm cells in 50 or 80 mL, respectively, suggesting the possibility of using CAI with 1.5 billion sperm cells/50 mL in gilts.

Perspectives of intrauterine artificial insemination applicability in gilts / Perspectivas de aplicabilidade da inseminação artificial intrauterina em leitoas

The application of the intrauterine artificial insemination (IUAI) technique allows optimization of a swine production system due to the reductions in volume and number of sperm cells in the insemination dose, and by reducing the time taken to perform the insemination. However, IUAI is not recommended for gilts due to the difficulty of intrauterine cannula passage through the cervix. This difficulty is associated mainly with the fact that the reproductive tract is smaller in gilts than in pluriparous females. However, few studies have evaluated the application of IUAI in gilts. In these studies, there are variations in approach concerning the definition of the success rate for cannula passage through the cervix, the type of cannula and the body characteristics of the gilts used, making it difficult to extrapolate the recommendation for the use of IUAI in gilts. Considering the evidence that such characteristics influence or even determine the success of the application of IUAI, there is a necessity for an understanding of the influence of these factors in the improvement and later application of the technique. Gilts represent about 15-20% of the breeding group, and the use of IUAI could optimize the processes of insemination on farms. The approach used in this review highlights the aspects that could aid in structuring further studies for improving IUAI in gilts, allowing its use on commercial farms.(AU)

A aplicação da técnica de inseminação artificial intrauterina (IAU) permitiu uma otimização do sistema de produção de suínos por possibilitar a redução do volume e número de células espermáticas na dose inseminante e, também, por diminuir o tempo de execução da inseminação. Porém, a IAU não tem sido recomendada para leitoas devido à dificuldade de passagem do cateter intrauterino através da cérvix. Essa dificuldade é associada principalmente ao menor tamanho do trato reprodutivo de leitoas se comparado ao das fêmeas pluríparas. Entretanto, ainda são poucos os estudos que avaliaram a aplicação de IAU em leitoas. Nesses estudos, existem variações quanto à definição da taxa de sucesso na inserção do cateter através da cérvix, ao tipo de cateter e, também, quanto às características corporais das matrizes utilizadas, dificultando extrapolações de recomendação do uso da IAU em leitoas. Considerando os indícios de que tais características podem influenciar ou, até mesmo, determinar o sucesso de aplicação da técnica, ainda há necessidade de compreender a influência desses fatores para que a técnica possa ser aprimorada e posteriormente aplicada. Leitoas representam cerca de 15 a 20% do grupo de cobertura e viabilizar a IAU nessa categoria pode otimizar os processos de inseminação nas granjas. A abordagem realizada nessa revisão traz aspectos que podem auxiliar na estruturação de futuros estudos para aprimorar a IAU em leitoas e permitir seu emprego em granjas comerciais.(AU)

Perspectives of intrauterine artificial insemination applicability in gilts / Perspectivas de aplicabilidade da inseminação artificial intrauterina em leitoas

ABSTRACT: The application of the intrauterine artificial insemination (IUAI) technique allows optimization of a swine production system due to the reductions in volume and number of sperm cells in the insemination dose, and by reducing the time taken to perform the insemination. However, IUAI is not recommended for gilts due to the difficulty of intrauterine cannula passage through the cervix. This difficulty is associated mainly with the fact that the reproductive tract is smaller in gilts than in pluriparous females. However, few studies have evaluated the application of IUAI in gilts. In these studies, there are variations in approach concerning the definition of the success rate for cannula passage through the cervix, the type of cannula and the body characteristics of the gilts used, making it difficult to extrapolate the recommendation for the use of IUAI in gilts. Considering the evidence that such characteristics influence or even determine the success of the application of IUAI, there is a necessity for an understanding of the influence of these factors in the improvement and later application of the technique. Gilts represent about 15-20% of the breeding group, and the use of IUAI could optimize the processes of insemination on farms. The approach used in this review highlights the aspects that could aid in structuring further studies for improving IUAI in gilts, allowing its use on commercial farms.

RESUMO: A aplicação da técnica de inseminação artificial intrauterina (IAU) permitiu uma otimização do sistema de produção de suínos por possibilitar a redução do volume e número de células espermáticas na dose inseminante e, também, por diminuir o tempo de execução da inseminação. Porém, a IAU não tem sido recomendada para leitoas devido à dificuldade de passagem do cateter intrauterino através da cérvix. Essa dificuldade é associada principalmente ao menor tamanho do trato reprodutivo de leitoas se comparado ao das fêmeas pluríparas. Entretanto, ainda são poucos os estudos que avaliaram a aplicação de IAU em leitoas. Nesses estudos, existem variações quanto à definição da taxa de sucesso na inserção do cateter através da cérvix, ao tipo de cateter e, também, quanto às características corporais das matrizes utilizadas, dificultando extrapolações de recomendação do uso da IAU em leitoas. Considerando os indícios de que tais características podem influenciar ou, até mesmo, determinar o sucesso de aplicação da técnica, ainda há necessidade de compreender a influência desses fatores para que a técnica possa ser aprimorada e posteriormente aplicada. Leitoas representam cerca de 15 a 20% do grupo de cobertura e viabilizar a IAU nessa categoria pode otimizar os processos de inseminação nas granjas. A abordagem realizada nessa revisão traz aspectos que podem auxiliar na estruturação de futuros estudos para aprimorar a IAU em leitoas e permitir seu emprego em granjas comerciais.

Prevalencia y factores de riesgo de Incontinencia Urinaria de esfuerzo en mujeres deportistas nulíparas / Stress urinary incontinenece: Prevalance and risk factors in sportive women

Resumen El objetivo de este estudio fue descubrir la prevalencia de la incontinencia urinaria de esfuerzo (IUE) en las mujeres nulíparas deportistas y qué factores de riesgo se asocian a la misma. Se hizo una búsqueda minuciosa en bases de datos utilizando palabras claves en español, inglés y portugués. Se incluyeron solamente artículos con esta población, publicados del 2000 a 2015, y con metodologías de cohortes, casos y controles, de prevalencia, revisiones bibliográficas, y ensayos clínicos aleatorios. La muestra de estudios comprendió 20 artículos, la mayoría en el idioma inglés. Se encontró que la prevalencia de IUE encontrada fue muy variada, ya que se presentaron casos en los que solo el 9% de mujeres evaluadas la padecían, mientras que, en otros, la totalidad de la población la presentaba. No obstante, las investigaciones con una prevalencia alta concordaron en que las poblaciones estudiadas practicaban deportes de alto impacto y eran de países nórdicos. En cuanto a los factores de riesgo (FR) personales, se destacaron el estreñimiento, la lumbalgia, la inhabilidad de detener el flujo urinario y el asma considerados también factores predictores. Por su parte, los deportes con mayor predisposición a padecer IUE fueron los considerados de alto impacto, así como aquellos que involucraban atajar un objeto. Otros factores que mostraron resultados importantes fueron: la cantidad de años de practicar el deporte, el nivel y el volumen semanal de entrenamiento. Se concluye que a pesar de que aún no existe suficiente evidencia científica que explique la relación de la IUE en mujeres nulíparas deportistas, esta investigación demuestra que el deporte juega un papel importante en el desencadenamiento de este padecimiento.

Abstract The purpose of this study was to discover the prevalence of Stress Urinary Incontinence (SUI) in nulliparous female athletes and the associated risk factors. A thorough search was conducted in databases using keywords in Spanish, English, and Portuguese. Only articles with the following characteristics were included: those containing the described population, published from 2000 to 2015, and using methodologies such as cohort studies, case-control studies, prevalence studies, systematic reviews, and randomized trials. The sample included 20 studies, mainly in English. It was found that the prevalence of SUI varied widely, ranging from 9% in some cases to the total amount of participants evaluated in others. Despite of this, the investigations that showed the highest prevalence of SUI were found in sports involving high impact activities and were originally from Nordic countries. Regarding personal risk factors, constipation, low back pain, inability to interrupt the urine flow, and asthma were also considered predictive factors. In addition, sports with a higher risk of SUI were those that involved high impact and catching objects. Other factors that showed important results were: years of practice and level and volume of training per week. It is concluded that, although there is still not enough scientific evidence to explain the relationship between SUI and nulliparous female athletes, this research shows that the type of sport plays an important role in the presence of SUI.

Resumo O objetivo deste estudo foi investigar a prevalência de incontinência urinária de esforço (IUE) em mulheres nulíparas e quais fatores de risco estão associados a ela. Uma busca minuciosa nas bases de dados foi realizada usando palavras-chave em espanhol, inglês e português. Foram incluídos apenas artigos publicados de 2000 a 2015, e com metodologias de estudos quantitativos (estudos transversais, coorte, caso-controle), revisões de literatura e ensaios clínicos randomizados. A amostra incluiu 20 artigos, a maioria no idioma inglês. Verificou-se que a prevalência de IUE encontrada foi muito variada, pois houve casos em que apenas 9% das mulheres avaliadas apresentaram, enquanto que, em outros, se manifestou em toda a população. No entanto, nas pesquisas que encontraram uma alta prevalência da IUE as populações estudadas praticavam esportes de alto impacto e eram de países nórdicos. Em relação aos fatores de risco pessoal (FR), constipação, dor lombar, incapacidade de interromper o fluxo urinário e asma também foram considerados fatores preditivos. Por outro lado, os esportes com maior predisposição para suas praticantes sofrerem IUE foram os de alto impacto e que precisem pegar um objeto. Outros fatores que mostraram resultados importantes foram: o número de anos de prática do esporte, o nível e o volume semanal de treinamento. Conclui-se que, embora não haja evidências científicas suficientes para explicar a relação da IUE em mulheres atletas nulíparas, esta pesquisa mostra que o esporte desempenha um papel importante no desencadeamento dessa condição.

Maternal Characteristics Affect Fetal Growth Response in the Women First Preconception Nutrition Trial.

The objective of this secondary analysis was to identify maternal characteristics that modified the effect of maternal supplements on newborn size. Participants included 1465 maternal-newborn dyads in Guatemala, India, and Pakistan. Supplementation commenced before conception (Arm 1) or late 1st trimester (Arm 2); Arm 3 received usual care. Characteristics included body mass index (BMI), stature, anemia, age, education, socio-economic status (SES), parity, and newborn sex. Newborn outcomes were z-scores for length (LAZ), weight (WAZ), and weight to length ratio-for-age (WLRAZ). Mixed-effect regression models included treatment arm, effect modifier, and arm * effect modifier interaction as predictors, controlling for site, characteristics, and sex. Parity (para-0 vs. para ≥1), anemia (anemia/no anemia), and sex were significant effect modifiers. Effect size (95% CI) for Arm 1 vs. 3 was larger for para-0 vs. ≥1 for all outcomes (LAZ 0.56 (0.28, 0.84, p < 0.001); WAZ 0.45 (0.20, 0.07, p < 0.001); WLRAZ 0.52 (0.17, 0.88, p < 0.01) but only length for Arm 2 vs. 3. Corresponding effects for para ≥1 were >0.02. Arm 3 z-scores were all very low for para-0, but not para ≥1. Para-0 and anemia effect sizes for Arm 1 were > Arm 2 for WAZ and WLRAZ, but not LAZ. Arm 1 and 2 had higher WAZ for newborn boys vs. girls. Maternal nulliparity and anemia were associated with impaired fetal growth that was substantially improved by nutrition intervention, especially when commenced prior to conception.

Trends in the Mode of Delivery of Pregnant Women in Rural Guatemala from a Quality Improvement Database.

Purpose To evaluate trends and factors associated with mode of delivery in the rural Southwest Trifinio region of Guatemala. Description We conducted a retrospective analysis of self-reported antepartum factors and postpartum outcomes recorded in a quality improvement database among 430 women enrolled in a home-based maternal healthcare program between June 1, 2015 and August 1, 2017. Assessment Over the study period, the rates of cesarean delivery (CD) increased (from 30 to 45%) and rates of vaginal delivery (VD) decreased (70-55%) while facility-based delivery attendance remained stable around 70%. Younger age (23.5 years for VD vs. 21.6 years for CD, p < 0.001), nulliparity (25.1% for VD vs. 45.0% for CD, p < 0.001), prolonged/obstructed labor (2.4% for VD vs. 55.6% for CD, p < 0.001), and fetal malpresentation (0% for VD vs. 16.3% CD, p < 0.001) significantly influenced mode of delivery in univariate analysis. The leading indications for CD were labor dysfunction (47.5%), malpresentation (14.5%), and prior cesarean delivery (19.8%). The CD rate among the subpopulation of term, nulliparous women with singleton pregnancies in vertex presentation also increased from 20% of all CD in 2015, to 38% in 2017. Conclusion Among low-income women from rural Guatemala, the CD rate has increased above the World Health Organization (WHO) recommendations in a period of 3 years. Additional research on the factors affecting this trend are essential to guide interventions that might improve the appropriateness of CD, and to determine if reducing or stabilizing rates is necessary.

Insertion of an intrauterine catheter for post-cervical artificial insemination in gilts: a case report / Introdução do cateter intrauterino para inseminação artificial pós-cervical em leitoas: um relato de caso

The aim of this case report was to characterize the insertion of an intrauterine catheter (IC) in gilts to perform post-cervical artificial insemination (PCAI). Attempts to insert ICs through the cervixes of gilts were performed using either a standard sow foam tip catheter (SFC; n = 25) or a standard gilt foam tip catheter (GFC; n = 25). The percentage of passage, depth and degree of difficulty for insertion were evaluated. The average depth of IC insertion was 10.1 ± 1.3 cm for SFC and 10.0 ± 1.2 cm for GFC. For both catheters, insertion depths of greater than 10 cm were achieved in the first insemination in 44% of gilts. Insertion depths of greater than 6 cm were observed in 72% and 60% of attempts using SFC and GFC, respectively. A high level of difficulty for IC insertion was observed, mainly while using GFC. In conclusion, the routine application of PCAI in gilts on swine farms remains limited by the low success rate for intrauterine catheter insertion. In further studies, we suggest evaluating reproductive performance using low insertion depths for PCAI in gilts, and assessing the use of sow foam tip catheter as a guide to introduce the IC.(AU)

O objetivo deste relato de caso foi caracterizar a inserção de um cateter intrauterino (IC) em leitoas para realização da inseminação pós-cervical (PCAI). Tentativas de inserir o IC através da cérvix em leitoas foram realizadas usando um cateter de ponta de espuma padrão utilizado para porcas (SFC; n=25) e um cateter de ponta de espuma padrão utilizado para leitoas (GFC; n=25). O percentual de passagem, profundidade e grau de dificuldade para a inserção do IC através da cérvix foram avaliados. A profundidade média de inserção do IC foi 10,1 ± 1,3 cm para SFC e 10,0 ± 1,2 cm para GFC. Para ambos cateteres, profundidades maiores que 10 cm para a inserção do IC na primeira inseminação foram possíveis em 44% das leitoas. Inserções maiores que 6 cm foram observadas em 72% e 60% das tentativas utilizando SFC e GFC, respectivamente. Alto nível de dificuldade para a inserção do IC foi observada, principalmente para GFC. A aplicação da PCAI em leitoas, na rotina prática em granjas de suínos, permanece limitada pela baixa taxa de sucesso para a inserção do IC. Em estudos futuros, sugerimos o uso de menor profundidade de inserção para realizar a PCAI em leitoas e o uso de cateteres de porcas como guia para introduzir o cateter intrauterino.(AU)

Comparison of Measurements of Bone Mineral Density in Young and Middle-Aged Adult Women in Relation to Dietary, Anthropometric and Reproductive Variables.

The objective of this study was to compare current measurements of bone mineral density (BMD) of the lumbar spine (LS), femoral neck (FN), and total femur (TF) regions with initial values recorded 12 years ago in women from Northwest Mexico, and evaluate their correlation with dietary, anthropometric, and reproductive variables. BMD was assessed by Dual-energy X-ray absorptiometry. Participants were grouped as follows: Nulliparous (G1); women who were mothers 12 years ago (G2); and women who were nulliparous 12 years ago, but are now mothers (G3). In all three groups, current LS BMD was higher than initial (p ≤ 0.05) and current TF BMD in G2 was higher than initial values (p ≤ 0.05). When comparing current FN and TF BMD among the three groups, G2 had higher values than G3 (p ≤ 0.05). G2 also showed higher LS BMD than G1 and G3 (p = 0.006). Age at menarche was inversely-correlated with FN and TF BMD in G1 (p < 0.01), while the body mass index (BMI) correlated positively with all three bone regions in G2 (p < 0.05). This study shows that in women without and with children, age at menarche, BMI, and age were factors associated to BMD in healthy subjects in reproductive age.

Correlation between electromyography and perineometry in evaluating pelvic floor muscle function in nulligravidas: A cross-sectional study.

OBJECTIVE: To correlate the results of electromyography and perineometry in the assessment of PFM function in nulligravidas. METHODS: The cross-sectional observational study was approved by the internal review board of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) and was conducted in the Instituto Paraibano de Pesquisa Professor Joaquim Amorim Neto (IPESQ). Thirty-eight nulligravidas aged 18-39 years of age, who had already initiated their sexual life, participated in the study. Exclusion criteria consisted of the presence of genital prolapse, a history of pelvic or urogenital surgery and the presence of neurological disease producing muscle disorders. For the evaluation procedure, the women were submitted to a clinical evaluation of the pelvic floor muscles followed by electromyography. Perineometry was performed 72 h later. Prior to electromyography and perineometry, the women were given standardized training with electromyographic biofeedback to teach them to contract only their pelvic floor muscles. RESULTS: A highly positive, statistically significant correlation (r = 0.968; P < 0.001) was found between the electromyographic and perineometric findings. CONCLUSIONS: A strong correlation was found between perineometric and electromyographic findings of pelvic floor muscle function.

Insertion of an intrauterine catheter for post-cervical artificial insemination in gilts: a case report / Introdução do cateter intrauterino para inseminação artificial pós-cervical em leitoas: um relato de caso

The aim of this case report was to characterize the insertion of an intrauterine catheter (IC) in gilts to perform post-cervical artificial insemination (PCAI). Attempts to insert ICs through the cervixes of gilts were performed using either a standard sow foam tip catheter (SFC; n = 25) or a standard gilt foam tip catheter (GFC; n = 25). The percentage of passage, depth and degree of difficulty for insertion were evaluated. The average depth of IC insertion was 10.1 ± 1.3 cm for SFC and 10.0 ± 1.2 cm for GFC. For both catheters, insertion depths of greater than 10 cm were achieved in the first insemination in 44% of gilts. Insertion depths of greater than 6 cm were observed in 72% and 60% of attempts using SFC and GFC, respectively. A high level of difficulty for IC insertion was observed, mainly while using GFC. In conclusion, the routine application of PCAI in gilts on swine farms remains limited by the low success rate for intrauterine catheter insertion. In further studies, we suggest evaluating reproductive performance using low insertion depths for PCAI in gilts, and assessing the use of sow foam tip catheter as a guide to introduce the IC.

O objetivo deste relato de caso foi caracterizar a inserção de um cateter intrauterino (IC) em leitoas para realização da inseminação pós-cervical (PCAI). Tentativas de inserir o IC através da cérvix em leitoas foram realizadas usando um cateter de ponta de espuma padrão utilizado para porcas (SFC; n=25) e um cateter de ponta de espuma padrão utilizado para leitoas (GFC; n=25). O percentual de passagem, profundidade e grau de dificuldade para a inserção do IC através da cérvix foram avaliados. A profundidade média de inserção do IC foi 10,1 ± 1,3 cm para SFC e 10,0 ± 1,2 cm para GFC. Para ambos cateteres, profundidades maiores que 10 cm para a inserção do IC na primeira inseminação foram possíveis em 44% das leitoas. Inserções maiores que 6 cm foram observadas em 72% e 60% das tentativas utilizando SFC e GFC, respectivamente. Alto nível de dificuldade para a inserção do IC foi observada, principalmente para GFC. A aplicação da PCAI em leitoas, na rotina prática em granjas de suínos, permanece limitada pela baixa taxa de sucesso para a inserção do IC. Em estudos futuros, sugerimos o uso de menor profundidade de inserção para realizar a PCAI em leitoas e o uso de cateteres de porcas como guia para introduzir o cateter intrauterino.

Insertion of an intrauterine catheter for post-cervical artificial insemination in gilts: a case report / Introdução do cateter intrauterino para inseminação artificial pós-cervical em leitoas: um relato de caso

The aim of this case report was to characterize the insertion of an intrauterine catheter (IC) in gilts to perform post-cervical artificial insemination (PCAI). Attempts to insert ICs through the cervixes of gilts were performed using either a standard sow foam tip catheter (SFC; n = 25) or a standard gilt foam tip catheter (GFC; n = 25). The percentage of passage, depth and degree of difficulty for insertion were evaluated. The average depth of IC insertion was 10.1 ± 1.3 cm for SFC and 10.0 ± 1.2 cm for GFC. For both catheters, insertion depths of greater than 10 cm were achieved in the first insemination in 44% of gilts. Insertion depths of greater than 6 cm were observed in 72% and 60% of attempts using SFC and GFC, respectively. A high level of difficulty for IC insertion was observed, mainly while using GFC. In conclusion, the routine application of PCAI in gilts on swine farms remains limited by the low success rate for intrauterine catheter insertion. In further studies, we suggest evaluating reproductive performance using low insertion depths for PCAI in gilts, and assessing the use of sow foam tip catheter as a guide to introduce the IC.

O objetivo deste relato de caso foi caracterizar a inserção de um cateter intrauterino (IC) em leitoas para realização da inseminação pós-cervical (PCAI). Tentativas de inserir o IC através da cérvix em leitoas foram realizadas usando um cateter de ponta de espuma padrão utilizado para porcas (SFC; n=25) e um cateter de ponta de espuma padrão utilizado para leitoas (GFC; n=25). O percentual de passagem, profundidade e grau de dificuldade para a inserção do IC através da cérvix foram avaliados. A profundidade média de inserção do IC foi 10,1 ± 1,3 cm para SFC e 10,0 ± 1,2 cm para GFC. Para ambos cateteres, profundidades maiores que 10 cm para a inserção do IC na primeira inseminação foram possíveis em 44% das leitoas. Inserções maiores que 6 cm foram observadas em 72% e 60% das tentativas utilizando SFC e GFC, respectivamente. Alto nível de dificuldade para a inserção do IC foi observada, principalmente para GFC. A aplicação da PCAI em leitoas, na rotina prática em granjas de suínos, permanece limitada pela baixa taxa de sucesso para a inserção do IC. Em estudos futuros, sugerimos o uso de menor profundidade de inserção para realizar a PCAI em leitoas e o uso de cateteres de porcas como guia para introduzir o cateter intrauterino.

Performance reprodutiva de leitoas submetidas à inseminação artificial pós-cervical / Reproductive performance of gilts submitted to post-cervical artificial insemination

O objetivo deste trabalho foi avaliar o desempenho reprodutivo de nulíparas submetidas à inseminação artificial pós-cervical (IAPC) comparada à inseminação artificial tradicional (IAT). Foram avaliados ocorrência de sangramento, ocorrência de refluxo, dificuldade no transpasse da cérvix e total de células refluídas até 30 minutos após inseminação. Fêmeas submetidas à IAPC (n=279) foram inseminadas com doses de 1,5 x 109 diluídas em 45mL, e fêmeas submetidas à IAT (n=273) inseminadas com doses de 2,5 x 109 em 80mL. O transpasse da cérvix foi possível em 91,04% (254/279) das leitoas. A dificuldade no transpasse foi de 41,58% (116/279), não comprometendo o desempenho reprodutivo (P>0,05). Presença de sangramento não afetou a taxa de parto nem o número de leitões nascidos para ambos os tratamentos (P>0,05). O percentual de espermatozoides presentes no refluxo foi maior na IAT, não sendo observada diferença no tamanho de leitegada de acordo com o percentual de espermatozoides no refluxo (P>0,05) e no número de leitões nascidos totais (11,63 e 11,81) entre os tratamentos IAT e IAPC, respectivamente. Pode-se realizar IAPC em leitoas sem causar redução no desempenho, utilizando-se doses com 1,5 x 109 células espermáticas.(AU)

The objective of this study was to evaluate the reproductive performance of gilts subjected to post-cervical artificial insemination (PCAI) compared to traditional artificial insemination (TAI). We also evaluated the degree of difficulty in bypassing the cervix, time required to perform the insemination, presence of bleeding after insemination, semen backflow, as well as the volume and the total reflow cells 30 minutes after insemination. Gilts submitted to PCAI (n = 279) were inseminated with 45 mL doses of 1.5 x 109 sperm cells and the ones submitted to TAI (n = 273) were inseminated with 80 mL doses with 2.5 x 109 cells. The bypassing of the cervix was possible in 91.04% (254/279) of gilts. The difficulty bypassing the cervix in at least one of the gilt's PCAI procedures happened with 41.58% (116/279) of the females, but it did not affect reproductive performance (P>0.05). The presence of bleeding after insemination did not affect the farrowing rate and total number of piglets born for both treatments (P>0.05). The average time needed to carry out the PCAI was 1.47 minutes and the TAI was 4.04 minutes. The percentage of sperm present in the reflux was higher in TAI than the PCAI, but no correlation was found between litter size and the percentage of sperm in reflux (P>0.05) and the total number of piglets born (11.63 and 11.81) between TAI and PCAI treatments, respectively. Thus, it is possible to perform the post-cervical artificial insemination in gilts without causing a reduction in reproductive performance, using doses with a concentration of 1.5 x 109 sperm cells.(AU)

Performance reprodutiva de leitoas submetidas à inseminação artificial pós-cervical / Reproductive performance of gilts submitted to post-cervical artificial insemination

O objetivo deste trabalho foi avaliar o desempenho reprodutivo de nulíparas submetidas à inseminação artificial pós-cervical (IAPC) comparada à inseminação artificial tradicional (IAT). Foram avaliados ocorrência de sangramento, ocorrência de refluxo, dificuldade no transpasse da cérvix e total de células refluídas até 30 minutos após inseminação. Fêmeas submetidas à IAPC (n=279) foram inseminadas com doses de 1,5 x 109 diluídas em 45mL, e fêmeas submetidas à IAT (n=273) inseminadas com doses de 2,5 x 109 em 80mL. O transpasse da cérvix foi possível em 91,04% (254/279) das leitoas. A dificuldade no transpasse foi de 41,58% (116/279), não comprometendo o desempenho reprodutivo (P>0,05). Presença de sangramento não afetou a taxa de parto nem o número de leitões nascidos para ambos os tratamentos (P>0,05). O percentual de espermatozoides presentes no refluxo foi maior na IAT, não sendo observada diferença no tamanho de leitegada de acordo com o percentual de espermatozoides no refluxo (P>0,05) e no número de leitões nascidos totais (11,63 e 11,81) entre os tratamentos IAT e IAPC, respectivamente. Pode-se realizar IAPC em leitoas sem causar redução no desempenho, utilizando-se doses com 1,5 x 109 células espermáticas.(AU)

The objective of this study was to evaluate the reproductive performance of gilts subjected to post-cervical artificial insemination (PCAI) compared to traditional artificial insemination (TAI). We also evaluated the degree of difficulty in bypassing the cervix, time required to perform the insemination, presence of bleeding after insemination, semen backflow, as well as the volume and the total reflow cells 30 minutes after insemination. Gilts submitted to PCAI (n = 279) were inseminated with 45 mL doses of 1.5 x 109 sperm cells and the ones submitted to TAI (n = 273) were inseminated with 80 mL doses with 2.5 x 109 cells. The bypassing of the cervix was possible in 91.04% (254/279) of gilts. The difficulty bypassing the cervix in at least one of the gilt's PCAI procedures happened with 41.58% (116/279) of the females, but it did not affect reproductive performance (P>0.05). The presence of bleeding after insemination did not affect the farrowing rate and total number of piglets born for both treatments (P>0.05). The average time needed to carry out the PCAI was 1.47 minutes and the TAI was 4.04 minutes. The percentage of sperm present in the reflux was higher in TAI than the PCAI, but no correlation was found between litter size and the percentage of sperm in reflux (P>0.05) and the total number of piglets born (11.63 and 11.81) between TAI and PCAI treatments, respectively. Thus, it is possible to perform the post-cervical artificial insemination in gilts without causing a reduction in reproductive performance, using doses with a concentration of 1.5 x 109 sperm cells.(AU)

Longitud de vagina, hiato genital y cuerpo perineal en mujeres nulíparas

Objetivo: Estimar la longitud promedio de vagina, del hiato genital y cuerpo perineal en mujeres nulíparas. Diseño: Estudio descriptivo transversal con muestreo por conveniencia. Institución: Departamento de Ginecología y Obstetricia, Hospital Nacional Cayetano Heredia, Lima, Perú. Participantes: Mujeres nulíparas. Métodos: En 85 mujeres nulíparas atendidas en el Hospital entre enero y marzo 2014, en edad fértil, que habían iniciado relaciones coitales vaginales y que requerían evaluación ginecológica, se realizó medición del peso y talla. En posición de litotomía, se midió con un hisopo milimetrado la longitud total de la vagina, hiato genital y el cuerpo perineal. Las mediciones fueron realizadas por un solo examinador. La participación fue completamente voluntaria y con firma de consentimiento informado. Principales medidas de resultados: Longitud total de la vagina, hiato genital y el cuerpo perineal. Resultados: La media de la longitud total de vagina fue 8,1 ± 1,4 cm (DE), del hiato genital 2,2 ± 0,5 cm (DE) y del cuerpo perineal 2,3 ± 0,5 cm (DE). Conclusiones: Las medidas estimadas no difieren con resultados de estudios internacionales. Se requiere estudiar una mayor muestra de pacientes de las diferentes regiones para tener un estimado más representativo de estas medidas en pacientes nulíparas del Perú.

Objectives: To determine vaginal, genital hiatus and perineal body length in nulliparous women. Design: Cross-sectional descriptive study with convenience sample. Setting: Department of Obstetrics and Gynecology, Hospital Nacional Cayetano Heredia, Lima, Peru. Participants: Nulliparous women. Methods: From January through March 2014 in 85 nulliparous women in childbearing age who had coital sex and required gynecological evaluation, weight and height were obtained and length of vagina, genital hiatus and perineal body were measured with a graph swab in lithotomy position. Measurements were obtained by one single examiner. Participation was voluntary with signed informed consent. Main outcome measures: Length of vagina, genital hiatus and perineal body. Results: Average length of patients vagina was 8.1 ± 1.4 cm (SD), genital hiatus 2.2 ± 0.5 cm (SD), and perineal body 2.3 ± 0.5 cm (SD). Conclusions: Measures obtained did not differ from international studies. A broad population study is suggested to better estimate these measures in nulliparous Peruvian women.

Effect of intracervical anesthesia on pain associated with the insertion of the levonorgestrel-releasing intrauterine system in women without previous vaginal delivery: a RCT.

STUDY QUESTION: Is the pain associated with levonorgestrel-releasing intrauterine system (LNG-IUS) insertion reduced by intracervical anesthesia in women without previous vaginal birth? SUMMARY ANSWER: Intracervical anesthesia was not associated with reduced pain in women without previous vaginal birth. WHAT IS KNOWN ALREADY: The pain associated with the insertion of intrauterine contraceptives (IUCs) is a limiting factor for the use of these contraceptives by some women. No prophylactic pharmacological intervention has proven efficacy in relieving pain during or after the insertion of IUCs. However, previous studies included women with previous vaginal delivery, and injectable intracervical anesthesia was not evaluated in any of these studies. STUDY DESIGN, SIZE, DURATION: This was a randomized, open, parallel-group clinical trial that evaluated 100 women without previous vaginal delivery who wished to use the LNG-IUS for the first time. These women were evaluated immediately after LNG-IUS insertion and then 2 h and 6 h later. PARTICIPANTS/MATERIALS, SETTING, METHODS: The 100 women were randomized into two groups: (i) use of a non-steroidal anti-inflammatory drug (NSAID) (ibuprofen, 400 mg) 1 h prior to LNG-IUS insertion; or (ii) 2% lidocaine intracervical injection 5 min prior to LNG-IUS insertion. The women were evaluated immediately after LNG-IUS insertion and then 2 h and 6 h after insertion. Two pain scales were used (the visual analogue scale and the facial pain scale) in addition to assessing the ease of insertion (as rated by the provider) and the level of discomfort during the procedure (as rated by the patient). Multivariate logistic regression was performed to analyze the predictors associated with moderate/severe pain. MAIN RESULTS AND THE ROLE OF CHANCE: The pain and discomfort associated with LNG-IUS insertion, and the ease of insertion of the LNG-IUS did not differ between the groups. Nulliparity was more associated with moderate/severe pain [adjusted odds ratio (OR): 3.1 (95% confidence interval (CI): 1.3-7.80]. Injectable intracervical anesthesia use reduced the risk of moderate/severe pain by 40% [adjusted OR: 0.6 (95% CI: 0.2-1.4)]. The difference between the mean pain score in the intracervical anesthesia group and the NSAID group was <10%; thus, the effect size of the intervention was not significant. LIMITATIONS, REASONS FOR CAUTION: Intracervical anesthesia was compared with an oral medication in this study. Intracervical injection of a saline solution or even a dry needling as the placebo for a double-blind study could be a more adequate control; however, this approach was not a protocol approved by the institutional review board. Considering that the majority of the insertions were easy (>80% in both groups), the results may not be extrapolated to difficult insertions with moderate/severe pain where local anesthesia may have a role. WIDER IMPLICATIONS OF THE FINDINGS: The findings can be generalized to most insertions in nulliparous women or in those without a previous vaginal delivery. There is currently no evidence to recommend the routine use of prophylactic intracervical anesthesia prior to LNG-IUS insertion; there is no evidence that this treatment reduces insertion-related pain. STUDY FUNDING/COMPETING INTERESTS: RAF and CSV give occasional lectures for Bayer Healthcare. This study received funding from the National Institute of Hormones and Women's Health, National Council for Scientific and Technological Development (CNPq). TRIAL REGISTRATION NUMBER: NCT02155166.

Effects of ß-glucan polysaccharide revealed by the dominant lethal assay and micronucleus assays, and reproductive performance of male mice exposed to cyclophosphamide.

ß-glucan is a well-known polysaccharide for its chemopreventive effect. This study aimed to evaluate the chemopreventive ability of ß-glucan in somatic and germ cells through the dominant lethal and micronucleus assays, and its influence on the reproductive performance of male mice exposed to cyclophosphamide. The results indicate that ß-glucan is capable of preventing changes in DNA in both germ cells and somatic ones. Changes in germ cells were evaluated by the dominant lethal assay and showed damage reduction percentages of 46.46% and 43.79% for the doses of 100 and 150 mg/kg. For the somatic changes, evaluated by micronucleus assay in peripheral blood cells in the first week of treatment, damage reduction percentages from 80.63-116.32% were found. In the fifth and sixth weeks, the percentage ranged from 10.20-52.54% and -0.95-62.35%, respectively. Besides the chemopreventive efficiency it appears that the ß-glucan, when combined with cyclophosphamide, is able to improve the reproductive performance of males verified by the significant reduction in rates of post-implantation losses and reabsorption in the mating of nulliparous females with males treated with cyclophosphamide.

Misoprostol for intrauterine device insertion in nulliparous women: a randomized controlled trial.

OBJECTIVE: To examine the effects of preprocedure misoprostol on intrauterine device (IUD) placement in nulliparous women. STUDY DESIGN: In this randomized controlled double-blind trial at the University of New Mexico reproductive health clinic, nulliparous women requesting an IUD were randomized to 400 mcg of buccal misoprostol or placebo 2-8 hours before insertion. Primary outcomes included pain on a 10-cm visual analog scale and women's perception of the value of delaying insertion for an effective medication. Provider ease of insertion and need for adjunctive insertion measures were also assessed, on a visual analog scale. Participants indicated maximum pain after IUD insertion, pain level they would tolerate to avoid delay in IUD insertion, and preference for IUD insertion without delay if an effective medication was available. RESULTS: Of 85 women enrolled, 3 were ineligible; 42 were randomized to misoprostol and 40 to placebo. There were no differences between groups in worst insertion pain, (5.8 ± 2.0 vs 5.9 ± 2.0, P = .94), provider ease of insertion (2.2 ± 2.2 vs 2.5 ± 2.2; P = .54) or adjunctive measures (14% vs 25%; P = .27). The groups were willing to tolerate the same mean pain (4.9 ± 2.5 vs 5.7 ± 2.4, P = .18) to avoid waiting for medication. The majority of women (85%) preferred to wait for an effective medication. CONCLUSION: Misoprostol for nulliparous women did not decrease pain or improve the ease of insertion of an IUD. Most women were willing to wait for a medication that decreases pain, indicating a need to pursue alternatives for pain control with IUD insertion.