Estudiantes universitarias nuligestas en edad fértil y su postura acerca de posibles vías del parto / Nuligest university students of childbearing age and their position about possible ways of delivery

Resumen Introducción: Tanto a nivel sudamericano como mundial, el incremento de la tasa de cesáreas electivas ha sido abrumante. Esto se considera un problema de salud pública, ya que el parto vaginal es la vía más fisiológica para el nacimiento y trae beneficios de salud para la madre y el recién nacido, tanto inmediatos como a futuro. Objetivo: Evaluar la postura de mujeres nuligestas en edad fértil acerca de las vías del parto a través de sus conocimientos, percepciones y preferencias. Método: Estudio de corte transversal. Se aplicó una encuesta a estudiantes universitarias para la recopilación de datos mediante SPSS, y análisis con prueba de diferencias de proporciones y de χ2. Resultados: 210 mujeres encuestadas. Un 80% de ellas desconoce la menor morbilidad infantil asociada a un parto vaginal, más de la mitad estima una ventaja de la cesárea que evite el dolor y un gran porcentaje desconoce los riesgos médicos asociados a la cesárea. Conclusiones: Existe un alto nivel de desconocimiento respecto a beneficios, riesgos y consecuencias de las diferentes vías del parto.

Abstract Introduction: Both in South America and worldwide, the increase in the rate of elective caesarean sections has been overwhelming. This is considered a public health problem, since vaginal delivery is the most physiological route for birth and brings health benefits for the mother and the newborn, immediately and in the future. Objective: To evaluate the position of nulliparous women of childbearing age regarding the delivery pathways through their knowledge, perceptions, and preferences. Method: Cross-sectional study with an analytical component. A survey was applied to university students for data collection through SPSS, and analysis was made with the difference of proportions and χ2 test. Results: 210 women surveyed; 80% of them are unaware of the lower infant morbidity associated with a vaginal delivery, more than a half estimate an advantage of a cesarean section that it avoids pain, and a large percentage are unaware of the medical risks associated with cesarean sections. Conclusions: There is a high level of ignorance regarding the benefits, risks and consequences of the different delivery routes.

Anemia y obesidad central en mujeres de edad fértil en Perú: Un estudio de base poblacional / Anemia and central obesity in women of childbearing age in Peru: A population-based study

Introducción: La anemia y obesidad son problemas de salud pública. La OMS propuso el uso del índice de masa corporal para el diagnóstico de obesidad, sin embargo, la precisión para evaluar indirectamente la diferencia entre los compartimentos de grasa visceral y tejido magro es baja, surgiendo medidas como la circunferencia de cintura e índice cintura-estatura con mayor precisión para determinar la grasa visceral mediante la obesidad abdominal. Objetivos: Evaluar la asociación entre anemia y obesidad central en mujeres de edad fértil. Metodología: Estudio analítico – transversal, basado en un análisis secundario de la Encuesta Demográfica y de Salud Familiar del año 2019 en Perú. La muestra fue 11 590 mujeres de edad fértil. El análisis estadístico se realizó en el programa Stata 16.0. Para determinar la asociación entre las variables de estudio, se calculó la razón de prevalencia (RP) con sus IC al 95% mediante modelos lineales generalizados (GLM) con la familia de Poisson, cruda y ajustada. Se consideró un nivel de significancia <0.05 como estadísticamente significativo. Resultados: El 20.27% de las mujeres en edad fértil estaban anémicas y 25.31% tenían obesidad. La prevalencia de obesidad central según circunferencia abdominal e índice cintura-estatura fue de 79.36% y 87 % respectivamente. Se encontró que las mujeres de zona urbana tenían más anemia que las provenientes de zona rural (p=0.048). La razón de prevalencia de anemia tiende a disminuir conforme aumentan los niveles de IMC: peso normal (RP 0.89, p=0.80), sobrepeso (RP 0.74, p=0.48) y obesidad (RP 0.65, p =0.33). No se encontró asociación entre anemia y obesidad central, según la circunferencia abdominal (RP 0.91, p=0.33), e índice cintura-estatura (RP 1,01, p=0.916). Conclusión: Ocho de cada 10 mujeres tienen obesidad central y dos de cada 10 anemia.(AU)

Introduction: Anemia and obesity are public health is-sues. The WHO proposed the use of the Body Mass Index forthe diagnosis of obesity. However, the precision to indirectlyevaluate the difference between visceral fat and lean tissuecompartments is low, emerging measures such as waist circumference and waist-to-height index, that are more accurateto determine visceral fat through abdominal obesity.Objectives: To evaluate the association between anemiaand central obesity in women of reproductive age. Methodology: A cross-sectional analytical study, based ondata from the survey “Demographic and Family Health for theyear 2019”. The sample was 11,590 women of reproductiveage. Statistical analysis was performed in Stata 16.0. To de-termine the association between the study variables, the chi-square test and the Wald test were used. Results: It was found that 20.27% of women of repro-ductive age had anemia and 25.31% had obesity. Theprevalence of central obesity through to abdominal circum-ference and waist-to-height ratio was 79.36% and 87%, respectively. It was found that the only variable associatedwith the presence of anemia was the urban area (p=0.048). Finally, the trend was observed that the prevalence of ane-mia decreases as the body mass index increases: low weight(27.26%), normal weight (22.5%), overweight (19.65%)and obesity (17.95%). Conclusion: Conclusive results were not found betweencentral obesity and anemia.(AU)

Knowledge of Fertile Period and Its Determinants Among Women of Childbearing age in Ethiopia: A Multilevel Analysis Based on 2016 Ethiopian Demographic and Health Survey.

Background: The knowledge of the fertile period is one of the science techniques used to delay pregnancy. Although it is a highly effective method, most women lack correct knowledge about it and end up with unintended pregnancies and undergo through unsafe abortion, which is among the leading factors for maternal death. Therefore, this study is aimed to assess the knowledge about fertile period and its determinant factors among reproductive age women in Ethiopia. Methods: The data were extracted from the 2016 national cross-sectional Ethiopian Demographic and Health Survey. The data were collected using a two-stage cluster design. Descriptive statistics were used to summarize the study findings. The determinants of knowledge about fertile period were analyzed using a multilevel binary logistic regression model. Results: A total of 15,683 women were included. From this, 23.6% (95% CI: 23-24) had knowledge about fertile period. Age group of 20-24 years, 25-29 years, 30-34 years, 35-39 years, 40-44 years, and 45-49 years; accomplishment of primary education, secondary education, and higher education; partner high level of education; wealth status of poorer, middle, richer, and richest; a person listened to radio < once a week; and a person who watch TV at least once in a week and who ever heard about family planning; internet usage in the last 12 months, being protestant religion follower; and community family planning message exposure were significantly associated with knowledge about fertile period. Conclusion: The number of reproductive age women who know about fertile period is low in Ethiopia. Age above 19 years, respondent's education attainment from primary to higher education, partner high level of education, being from poorer to richest wealth status, listening to radio, watching TV, ever heard of FP, internet usage in the last 12 months, being protestant religion follower, and community family planning exposure were significantly associated with good knowledge about fertile period.

Universal SARS-CoV-2 polymerase chain reaction screening and assisted reproductive technology in a coronavirus disease 2019 pandemic epicenter: screening and cycle outcomes from a New York City fertility center.

OBJECTIVE: To evaluate the prevalence of coronavirus disease 2019 (COVID-19) and efficacy of a universal screening program in patients undergoing controlled ovarian stimulation (COS). DESIGN: Single-center retrospective cohort study. SETTING: Academic fertility center in an epicenter of the COVID-19 pandemic. PATIENT(S): All patients undergoing COS from June 17, 2019, to February 28, 2021. INTERVENTION(S): Universal COVID-19 screening starting June 17, 2020, with SARS-CoV-2 polymerase chain reaction testing within 5 days of oocyte retrieval, patient-reported symptom screening, and temperature monitoring. MAIN OUTCOMES MEASURE(S): The primary outcome was the number of positive COVID-19 cases in patients undergoing COS cycles. The secondary outcomes were cycle outcomes compared with before COVID-19 COS cycles, adverse outcomes in COVID-canceled cycles, and center-specific COVID-19 detection rates compared with New York City cases. RESULT(S): From June 17, 2020, to February 28, 2021, 1,696 COS cycles were initiated with only seven positive COVID-19 cases for an overall positivity rate of 0.4%. When compared with before COVID cycles from June 17, 2019, to February 28, 2020, the volume of COS cycles were higher, while the overall cycle cancelation rate was lower during COVID-19. Cycle outcomes including oocyte yield and blast utilization rates were unchanged from pre-COVID cycles. Cases of COVID-19, while very low, occurred more frequently during surges in New York City rates. CONCLUSION(S): Assisted reproductive technology can be performed during the COVID-19 pandemic utilizing frequent universal screening and safe practices with low SARS-CoV-2 positivity, low cycle cancelation rates, and positive patient outcomes.

Caracterización de la población femenina con riesgo preconcepcional del municipio Arroyo Naranjo / Characterization of the Female Population with Preconception Risk of Arroyo Naranjo Municipality

Introducción: El riesgo reproductivo preconcepcional es la probabilidad que tiene una mujer no gestante de sufrir daño, ella o su producto, si se involucra en el proceso reproductivo. Objetivo: Caracterizar a la población femenina de 15 a 49 años de edad que presentan riesgo preconcepcional del municipio Arroyo Naranjo. Método: Se realizó un estudio descriptivo de corte transversal. El universo se constituyó de 603 mujeres en edad fértil pertenecientes al Consultorio No. 2 del Policlínico Párraga, municipio Arroyo Naranjo en el período 2015 -2016. La muestra fue de 160 mujeres que presentaban riesgo preconcepcional seleccionadas por la técnica de muestra no probabilística por criterio intencional (muestreo intencional). Se aplicó un cuestionario para recopilar los datos, con previo consentimiento informado, se revisaron las historias clínicas individuales, familiares y las tarjetas de riesgo preconcepcional. Se estudiaron las variables: edad, estado nutricional, hábitos tóxicos, uso de anticonceptivos, paridad, periodo intergénesico, las enfermedades crónicas asociadas.Los datos fueron procesados estadísticamente y, realizado el resumen, se expresaron en valores de frecuencia y porcentaje. Resultados: Los factores de riesgo preconcepcional que más influyeron fueron: la edad entre 15 y 19 años, el asma, la malnutrición por exceso, el periodo intergenésico mayor de 2 años, las multíparas y el hábito de fumar. El método anticonceptivo más utilizado fue el dispositivo intrauterino, Conclusiones: Se evidenció que con una adecuada dispensarización y seguimiento se puede garantizar que se arribe a la reproducción en condiciones óptimas(AU)

Introduction: Preconception reproductive risk is the probability that a non-pregnant woman has of suffering harm, on herself or her offspring, if she is involved in the reproductive process. Objective: To characterize the female population aged 15-49 years who present preconception risk. Method: A descriptive and cross-sectional study was carried out. The universe consisted of 603 women of childbearing age from the family medical office 2 of Párraga Polyclinic, Arroyo Naranjo Municipality (Havana, Cuba), in the period 2015-2016. The sample consisted of 160 women who presented preconception risk and selected using the nonprobabilistic sampling technique by intentional criteria (intentional sampling). A questionnaire was applied to collect data, with prior informed consent. Individual and family medical records and preconception risk cards were reviewed. The variables studied were age, nutritional status, toxic habits, use of contraceptives, parity, intergenic period, and associated chronic diseases. The data were statistically processed and, after the summary, they were expressed in frequency and percentage values. Results: The preconception risk factors that most influenced were age between 15 and 19 years, asthma, malnutrition in excess. The most used contraceptive method was the intrauterine device. Conclusions: It was evidenced that with adequate dispenzarization and follow-up, it can be guaranteed that reproduction be reached in optimal conditions(AU)

Reparación de fístula vesicovaginal mediante técnica laparoscópica / Repair of vesicovaginal fistula by laparoscopic technique

RESUMEN Objetivos: Describir la experiencia de 43 pacientes con fístula vesicovaginal (FVV) y la reparación con técnica laparoscópica entre 2009 y 2020, analizar su comportamiento y evolución. Métodos: Análisis de 43 pacientes diagnosticadas de FVV supratrigonales secundarias a histerectomías, la mismas que fueron resueltas laparoscópicamente. Resultados: La FVV es una complicación que se presenta en mujeres de edad media a menudo en periodo fértil, y claramen-te demostrado con el antecedente de cirugía o procedimiento ginecológico. Las pacientes fueron diagnosticadas de fístula vesicovaginal, las mismas que fueron intervenidas quirúrgicamente mediante técnica laparoscópica. El tiempo operatorio promedio fue de 172 minutos. Ninguna paciente requirió trans-fusión sanguínea y el tiempo de hospitalización promedio fue de 3,7 días. No se presentaron complicaciones ni recidivas, con un seguimiento promedio de 12 meses. Conclusión: La reparación laparoscópica de la fístula vesicovaginal es una técnica segura, poco invasiva y reproducible en manos entrenadas.Palabras claves: Fístula vesicovaginal, reparación laparoscópica

ABSTRACT Objectives: To describe the experience of 43 patients with Vesicovaginal Fistula (VVF) and laparoscopic repair between 2009 and 2020, and analyze its behavior and evolution. Methods: Analysis of 43 patients diagnosed with supratrigonal VVF secondary to hysterectomies, which were resolved laparoscop-ically. Results: The VVF is a complication that happen in middle-aged women often fertile period, and clearly demonstrated by the history of surgery or gynecological procedure. The patients were diagnosed with vesicovaginal fistula, they were operated on by laparoscopic technique. Mean operative time was 172 minutes. No patient required blood transfusion and the mean hospital stay was 3.7 days. No complications or relapses, with an average follow up of 12 months. Conclusion: Laparoscopic repair of VVF is a safe, minimally invasive and reproducible in trained hands

Hormônios e mulheres na menopausa / Hormones and women in menopause / Hormonas y mujeres en la menopausia

O término do ciclo fértil das mulheres está historicamente atrelado a sua capacidade reprodutiva, demarcando de maneira significativa o início do processo de envelhecimento. O climatério, momento de transição entre o período fértil e a menopausa (que é a última menstruação), é percebido em nossa sociedade como uma questão médica. O objetivo deste artigo é analisar como os hormônios, considerados produtos atuantes em dinâmicas humanas, agenciam modos de subjetivação entre mulheres que passam pela menopausa na nossa sociedade, que valoriza a produtividade e a juventude. Nesta pesquisa, inspirada na cartografia de controvérsias proposto por Bruno Latour, foram analisados sete vídeos disponibilizados no Youtube pela indústria farmacêutica Bayer que abordavam direta ou indiretamente a "reposição hormonal" para mulheres. Identificamos que as mudanças hormonais na velhice são compreendidas como um desequilíbrio, causador de calores, problemas de libido, osteoporose, problemas cardíacos, secura vaginal etc. Tais percepções levam à busca por soluções médicas, como a reposição hormonal, para que o corpo alcance novamente o equilíbrio perdido com o envelhecimento. Concluímos que os hormônios são prescritos pelos médicos com a promessa de as mulheres se manterem jovens e sexualmente atraentes para seus parceiros do sexo masculino dentro de uma perspectiva que reitera o machismo e a heteronormatividade na sociedade.(AU)

Historically, the end of women' fertile years is intrinsically associated with their reproductive capacity, marking the beginning of their aging process. In our society, the climacteric (transition period between fertility and menopause, consisting of the last menstruation) is perceived as a medical question. Thus, this article aimed to discuss how hormones, considered as active products in human dynamics, act as subjectivation modes among women who undergo menopause in a society such as ours, which values youth and productivity. Inspired by Bruno Latour's cartography of controversies, this research analyzed seven videos made available by the Bayer pharmaceutical company on YouTube, approaching "hormone replacement" for women either directly or indirectly. The results indicate that age-related hormonal changes are understood as an imbalance that triggers hot flashes, decreased libido, osteoporosis, heart diseases, and vaginal dryness. Such understanding drives the search for medical interventions aiming to regain the body balance lost with aging. Thus, doctors prescribe hormones under the guise of keeping women young and sexually attractive to their male partners, reiterating a logic of machismo and heteronormativity within our society.(AU)

El final del ciclo fértil femenino históricamente relacionado a la capacidad reproductiva marca de manera significativa el inicio del proceso de envejecimiento de las mujeres. El climatérico, momento de transición entre el período fértil a la menopausia caracterizado por la última menstruación, es percibido por nuestra sociedad como una cuestión médica. El objetivo de este artículo es analizar cómo las hormonas, consideradas como productos activos en la dinámica humana, actúan en los modos de subjetivación entre las mujeres, que atraviesan la menopausia, en una sociedad que valora la productividad y la juventud. En esta investigación, inspirada en la cartografía de controversias propuesta por Bruno Latour, se analizaron siete vídeos disponibles en YouTube por la industria farmacéutica de Bayer, los cuales plantean directa o indirectamente la terapia de "reemplazo hormonal" para las mujeres. Se identificó que los cambios hormonales en las personas mayores se entienden como un desequilibrio que provocaría calores, problemas en la libido, osteoporosis, problemas cardíacos, sequedad vaginal, etc. Tales hallazgos implican en la búsqueda de orientación médica para que el cuerpo alcance de nuevo el equilibrio perdido con el envejecimiento. Se concluye que las hormonas son prescriptas por médicos con la promesa de que las mujeres seguirán siendo jóvenes y sexualmente atractivas para su pareja masculina, dentro de una perspectiva que reitera el machismo y la heteronormatividad de nuestra sociedad.(AU)

Weight management over the reproductive years for adult women with obesity

This chapter addresses the management of weight related to three phases of a woman's reproductive years ­ precon­ception, during pregnancy and postpartum ­ for adult wom­en with obesity. Although these reproductive periods are addressed separately, it is important to consider that these phases represent the continuum of weight management over the reproductive years in women with obesity. During these time periods, women frequently access the healthcare system, thus providing clinicians with health promotion opportunities which may have positive impacts on the short- and long-term health of both the woman and her children. Discussion of the obstetric and anesthetic management for women with obesity during pregnancy is beyond the scope of this clinical practice guideline.

Intra-uterine insemination for unexplained subfertility.

BACKGROUND: Intra-uterine insemination (IUI) is a widely-used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive than in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treatment with OH is the increase in multiple pregnancy rates. OBJECTIVES: To determine whether, for couples with unexplained subfertility, the live birth rate is improved following IUI treatment with or without OH compared to timed intercourse (TI) or expectant management with or without OH, or following IUI treatment with OH compared to IUI in a natural cycle. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two trials registers up to 17 October 2019, together with reference checking and contact with study authors for missing or unpublished data. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing IUI with TI or expectant management, both in stimulated or natural cycles, or IUI in stimulated cycles with IUI in natural cycles in couples with unexplained subfertility. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, quality assessment and data extraction. Primary review outcomes were live birth rate and multiple pregnancy rate. MAIN RESULTS: We include 15 trials with 2068 women. The evidence was of very low to moderate quality. The main limitation was very serious imprecision. IUI in a natural cycle versus timed intercourse or expectant management in a natural cycle It is uncertain whether treatment with IUI in a natural cycle improves live birth rate compared to treatment with expectant management in a natural cycle (odds ratio (OR) 1.60, 95% confidence interval (CI) 0.92 to 2.78; 1 RCT, 334 women; low-quality evidence). If we assume the chance of a live birth with expectant management in a natural cycle to be 16%, that of IUI in a natural cycle would be between 15% and 34%. It is uncertain whether treatment with IUI in a natural cycle reduces multiple pregnancy rates compared to control (OR 0.50, 95% CI 0.04 to 5.53; 1 RCT, 334 women; low-quality evidence). IUI in a stimulated cycle versus timed intercourse or expectant management in a stimulated cycle It is uncertain whether treatment with IUI in a stimulated cycle improves live birth rates compared to treatment with TI in a stimulated cycle (OR 1.59, 95% CI 0.88 to 2.88; 2 RCTs, 208 women; I2 = 72%; low-quality evidence). If we assume the chance of achieving a live birth with TI in a stimulated cycle was 26%, the chance with IUI in a stimulated cycle would be between 23% and 50%. It is uncertain whether treatment with IUI in a stimulated cycle reduces multiple pregnancy rates compared to control (OR 1.46, 95% CI 0.55 to 3.87; 4 RCTs, 316 women; I2 = 0%; low-quality evidence). IUI in a stimulated cycle versus timed intercourse or expectant management in a natural cycle In couples with a low prediction score of natural conception, treatment with IUI combined with clomiphene citrate or letrozole probably results in a higher live birth rate compared to treatment with expectant management in a natural cycle (OR 4.48, 95% CI 2.00 to 10.01; 1 RCT; 201 women; moderate-quality evidence). If we assume the chance of a live birth with expectant management in a natural cycle was 9%, the chance of a live birth with IUI in a stimulated cycle would be between 17% and 50%. It is uncertain whether treatment with IUI in a stimulated cycle results in a lower multiple pregnancy rate compared to control (OR 3.01, 95% CI 0.47 to 19.28; 2 RCTs, 454 women; I2 = 0%; low-quality evidence). IUI in a natural cycle versus timed intercourse or expectant management in a stimulated cycle Treatment with IUI in a natural cycle probably results in a higher cumulative live birth rate compared to treatment with expectant management in a stimulated cycle (OR 1.95, 95% CI 1.10 to 3.44; 1 RCT, 342 women: moderate-quality evidence). If we assume the chance of a live birth with expectant management in a stimulated cycle was 13%, the chance of a live birth with IUI in a natural cycle would be between 14% and 34%. It is uncertain whether treatment with IUI in a natural cycle results in a lower multiple pregnancy rate compared to control (OR 1.05, 95% CI 0.07 to 16.90; 1 RCT, 342 women; low-quality evidence). IUI in a stimulated cycle versus IUI in a natural cycle Treatment with IUI in a stimulated cycle may result in a higher cumulative live birth rate compared to treatment with IUI in a natural cycle (OR 2.07, 95% CI 1.22 to 3.50; 4 RCTs, 396 women; I2 = 0%; low-quality evidence). If we assume the chance of a live birth with IUI in a natural cycle was 14%, the chance of a live birth with IUI in a stimulated cycle would be between 17% and 36%. It is uncertain whether treatment with IUI in a stimulated cycle results in a higher multiple pregnancy rate compared to control (OR 3.00, 95% CI 0.11 to 78.27; 2 RCTs, 65 women; low-quality evidence). AUTHORS' CONCLUSIONS: Due to insufficient data, it is uncertain whether treatment with IUI with or without OH compared to timed intercourse or expectant management with or without OH improves cumulative live birth rates with acceptable multiple pregnancy rates in couples with unexplained subfertility. However, treatment with IUI with OH probably results in a higher cumulative live birth rate compared to expectant management without OH in couples with a low prediction score of natural conception. Similarly, treatment with IUI in a natural cycle probably results in a higher cumulative live birth rate compared to treatment with timed intercourse with OH. Treatment with IUI in a stimulated cycle may result in a higher cumulative live birth rate compared to treatment with IUI in a natural cycle.

Comparison of woman-picked, expert-picked, and computer-picked Peak Day of cervical mucus with blinded urine luteinising hormone surge for concurrent identification of ovulation.

BACKGROUND: Previous research has demonstrated that women instructed in fertility awareness methods can identify the Peak Day of cervical mucus discharge for each menstrual cycle, and the Peak Day has high agreement with other indicators of the day of ovulation. However, previous studies enrolled experienced users of fertility awareness methods or were not fully blinded. OBJECTIVE: To assess the agreement between cervical mucus Peak Day identified by fertile women without prior experience on assessing cervical mucus discharge with the estimated day of ovulation (1 day after urine luteinising hormone surge). METHODS: This study is a secondary analysis of data from a randomised trial of the Creighton Model FertilityCareTM System (CrM), conducted 2003-2006, for women trying to conceive. Women who had no prior experience tracking cervical mucus recorded vulvar observations daily using a standardised assessment of mucus characteristics for up to seven menstrual cycles. Four approaches were used to identify the Peak Day. The referent day was defined as one day after the first identified day of luteinising hormone (LH) surge in the urine, assessed blindly. The percentage of agreement between the Peak Day and the referent day of ovulation was calculated. RESULTS: Fifty-seven women with 187 complete cycles were included. A Peak Day was identified in 117 (63%) cycles by women, 185 (99%) cycles by experts, and 187 (100%) by computer algorithm. The woman-picked Peak Day was the same as the referent day in 25% of 117 cycles, within ±1 day in 58% of cycles, ±2 days in 84%, ±3 days in 87%, and ±4 days in 92%. The ±1 day and ± 4 days' agreement was 50% and 90% for the expert-picked and 47% and 87% for the computer-picked Peak Day, respectively. CONCLUSIONS: Women's daily tracking of cervical mucus is a low-cost alternative for identifying the estimated day of ovulation.

Exposure to predator models during the fertile period leads to higher levels of extra-pair paternity in blue tits.

The perceived risk of predation can affect breeding behaviour and reduce reproductive success in prey species. Individuals exposed to predators may also adopt different mating tactics with potential consequences for the distribution of paternity in socially monogamous species that engage in extra-pair copulations. We experimentally increased perceived predation risk during the fertile period in blue tits Cyanistes caeruleus. Every morning between nest completion and the onset of egg laying, we presented a model of either a predator or a non-predator (control) near active nestboxes. Broods from pairs exposed to predators had higher levels of extra-pair paternity than control broods. This mainly resulted from a higher proportion of extra-pair offspring in broods with at least one extra-pair young. Females exposed to predators first emerged from the nestbox later in the morning, stayed away from the nestbox for longer and were less likely to be visited at the nest by their social mate, but we detected no behavioural differences once the model was removed. Our results suggest that the higher rates of extra-pair paternity resulted from the disruption of morning routines, which may have inhibited within-pair copulations or increased opportunities for females to engage in extra-pair copulations. We conclude that the perceived risk of predation can have substantial effects on levels of extra-pair paternity.

La anticoncepción en la mujer obesa / Contraception in obese women

La creciente prevalencia de mujeres obesas en edad fértil es una crisis de salud pública y social. La anticoncepción es un tema clave en mujeres con obesidad. Las mujeres obesas tienen una actividad sexual similar a las mujeres de peso normal y en ellas se considera que el uso de anticoncepción es menos eficaz, teniendo mayor riesgo de embarazo no deseado. Debido a una variedad de alteraciones del metabolismo, la obesidad es un factor de riesgo cardiovascular que puede aumentar, cuando se combina con la anticoncepción hormonal. Todos estos factores deben considerarse al elegir un método anticonceptivo en una mujer obesa. El objetivo de esta revisión es evaluar el riesgo-beneficio de cada tipo de anticoncepción disponible y la problemática de anticoncepción después de la cirugía bariátrica, proporcionando al médico una guía práctica sobre el uso de píldoras anticonceptivas orales en mujeres obesas

The increasing prevalence of obese women of childbearing age is a public and social health crisis. Contraception is a key issue in women with obesity. Obese women have a sexual activity no different from women of normal weight, and the use of contraception is considered less effective, as there is a higher risk of having an unwanted pregnancy. Due to a variety of metabolic disorders, obesity is a cardiovascular risk factor that can increase when combined with hormonal contraception. All these factors should be considered when choosing a contraceptive method in an obese woman. The objective of this review is to evaluate the risk-benefit of each type of available contraception, and the problem of contraception after bariatric surgery, in order to provide doctors with a practical guide on the use of oral contraceptive pills in obese women

Is there a difference toward strength, muscular endurance, anaerobic power and hormonal changes between the three phase of the menstrual cycle of active girls? / ¿Existe diferencia entre fuerza y resistencia muscular, potencia anaeróbica y cambios hormonales entre las tres fases del ciclo menstrual de las jóvenes activas?

BACKGROUND: Menstrual cycles are affected by the concentration of estrogen and progesterone hormones affecting the individual's functional and physical factors. Aims: The purpose of this study was to investigate the difference (and relationship) toward strength, muscular endurance, anaerobic power and hormonal changes between the three (follicular, ovulation, luteal) phases of the menstrual cycle of active young girls. METHODS: Twenty young girls were selected randomly and purposefully in the age group from 20 to 30. Hormonal changes in follicle-stimulating hormone (FSH), luteinizing hormone (LH), one repetition maximum (1RM or strength) of upper body and lower body, and muscular endurance test with 60% 1RM of upper body and lower body in the three phases of the menstrual cycle were measured. Also, running-based anaerobic sprint test (RAST) was used to estimate anaerobic power. RESULTS: The results of this study showed that there was no significant difference between muscular strength and endurance in the three phases of the menstrual cycle (upper and lower body muscle strength: P = 0.13, P = 0.23; muscular endurance: P = 0.33, P = 0.5, respectively). Also, the results indicated no significant difference in anaerobic power in the three phases of the menstrual cycle (P = 0.45). In contrast, there was a significant difference between LH and FSH levels in the menstrual cycle phases (P = 0.001). CONCLUSIONS: The different phases of the menstrual cycle practically do not limit the physical and physiological performance of active young girls, and girls can participate in sports activities without worrying about a drop in performance

ANTECEDENTES: Los ciclos menstruales son afectados por la concentración de estrógeno y progesterona, que afectan a los factores funcional y físico del individuo. OBJETIVO: El objetivo de este estudio fue investigar la diferencia (y relación) entre fuerza y resistencia muscular, potencia anaeróbica y cambios hormonales entre las tres fases (folicular, ovulación, lútea) del ciclo menstrual de las jóvenes activas. MÉTODOS: Se seleccionaron veinte chicas intencionada y aleatoriamente del grupo de edad comprendido entre 20 y 30 años. Se midieron los cambios hormonales de la hormona folículo-estimulante (FSH), la hormona luteinizante (LH), una repetición máxima (1RM o fuerza) del tren superior y el tren inferior, y la prueba de resistencia muscular con un 60% de 1RM del tren superior y el tren inferior en las tres fases del ciclo. Se utilizó también la prueba de carrera anaeróbica en sprint (RAST) para calcular la potencia anaeróbica. RESULTADOS: Los resultados de este estudio reflejaron que no existía diferencia significativa entre fuerza y resistencia muscular en las tres fases del ciclo menstrual (fuerza muscular de los trenes superior e inferior: p = 0,13, p = 0,23, y resistencia muscular: p = 0,33, p = 0,5, respectivamente). Los resultados indicaron también que no existía diferencia significativa en cuanto a potencia anaeróbica en las tres fases del ciclo menstrual (p = 0,45). Por contra, existía una diferencia significativa entre los niveles de LH y FSH en las fases del ciclo menstrual (p = 0,001). CONCLUSIONES: Las diferentes fases del ciclo menstrual no limitan prácticamente el desempeño físico y fisiológico de las jóvenes activas, pudiendo participar las chicas en actividades deportivas sin preocuparse acerca de la caída de rendimiento

Ovulatory Shifts in Sexual Desire But Not Mate Preferences: An LH-Test-Confirmed, Longitudinal Study.

The presented data are part of a longitudinal within-subject study designed to examine ovulatory shifts in human sexuality in a diverse German sample using validated questionnaires. The final sample consists of 78 individuals (76 female, 2 agender) who declared to be mainly or exclusively attracted to males. Questionnaires were completed anonymously online at three cycle phases. Following the gold standard, the fertile window was calculated through the reverse cycle day method and confirmed via urinary tests detecting luteinizing hormone. The questionnaire included the Sexual Desire Inventory, Dresdner Body Image Inventory, the Revised Sociosexual Orientation Inventory, and an adjective list to measure mate preferences. One hundred eighty-four questionnaires were included in the data analysis using linear mixed models. Findings support previous research reporting heightened sexual desire and an improved body image during the fertile window. No shifts were found for mate preference or sociosexual orientation, thus adding to a growing body of literature contesting parts of the ovulatory shift hypothesis.

Estimating six-cycle efficacy of the Dot app for pregnancy prevention.

OBJECTIVE: To assess six-cycle perfect and typical use efficacy of Dynamic Optimal Timing (Dot), an algorithm-based fertility app that identifies the fertile window of the menstrual cycle using a woman's period start date and provides guidance on when to avoid unprotected sex to prevent pregnancy. STUDY DESIGN: We are conducting a prospective efficacy study following a cohort of women using Dot for up to 13 cycles. Study enrollment and data collection are being conducted digitally within the app and include a daily coital diary, prospective pregnancy intentions and sociodemographic information. We used data from the first six cycles to calculate life-table failure rates. RESULTS: We enrolled 718 women age 18-39 years. Of the 629 women 18-35 years old, 15 women became pregnant during the first six cycles for a typical use failure rate of 3.5% [95% CI 1.7-5.2]. All pregnancies occurred with incorrect use, so we did not calculate a perfect use failure rate. CONCLUSIONS: These findings are promising and suggest that the 13-cycle results will demonstrate high efficacy of Dot. IMPLICATIONS: While final 13-cycle efficacy results are forthcoming, 6-cycle results suggest that Dot's guidance provides women with useful information for preventing pregnancy.

Tos crónica en mujer de edad fértil / Chronic cough in a woman of childbearing age

Entre los síntomas respiratorios, la tos crónica en un problema que afecta la calidad de vida. En mujeres de edad fértil se observó que los síntomas respiratorios varían significativamente en el transcurso del ciclo menstrual, la tos muestra un pico en ascenso antes y después de la mitad del ciclo menstrual, sobre todo en pacientes con diagnóstico previo de asma. Comprender el rol de las hormonas sexuales en las enfermedades respiratorias, en la última década representa un avance en su fisiopatología

Can apps and calendar methods predict ovulation with accuracy?

OBJECTIVE: The accuracy of prediction of ovulation by cycle apps and published calendar methods was determined by comparing to true probability of ovulation. METHODS: A total of 949 volunteers collected urine samples for one entire menstrual cycle. Luteinizing hormone was measured to assign surge day, enabling probability of ovulation to be determined across different cycle lengths. Cycle-tracking apps were downloaded. As none provided their methodology, four published calendar-based methods were also examined: standard days, rhythm, alternative rhythm and simple calendar method. The volunteer ovulation data was applied to the app/calendar methods to determine their accuracy. RESULTS: Mean cycle length was 28 days (range: 23-35); 34% of women believed they had a 28-day cycle, but only 15% did. No LH surge was seen for 99 women. Most likely day of ovulation for a 28-day cycle was day 16 (21%). Accuracy of ovulation prediction was no better than 21% by the apps. The standard days and rhythm methods were most likely to predict ovulation (70% and 89%, respectively) but had very low accuracy. CONCLUSIONS: Ovulation day varies considerably for any given menstrual cycle length, thus it is not possible for calendar/app methods that use cycle-length information alone to accurately predict the day of ovulation. National Clinical Trial Code: NCT01577147. Registry website: www.clinicaltrials.gov .

Diagnóstico y tratamiento de las trombofilias en edad fértil / Diagnosis and treatment of thrombophilias of childbearing age

INTRODUCCIÓN: El embarazo se caracteriza por ser un estado protrombótico, con aumento del potencial procoagulante, disminución de la actividad anticoagulante y de la actividad fibrinolítica. A esto se le suma la estasis venosa de miembros inferiores por compresión del útero sobre los grandes vasos venosos pelvianos, aumento de la capacitancia venosa, aumento de la resistencia a la insulina y del perfil lipídico protrombótico. Existe asociación entre la trombofilia y la ocurrencia de trombosis venosa profunda. Adicionalmente, las trombofilias tanto hereditarias como adquiridas se han asociado a resultados adversos en los embarazos, tales como abortos espontáneos, muerte fetal tardía, preeclampsia, restricción en el crecimiento intrauterino (RCIU) y desprendimento placentario. ESTRATEGIA DE BÚSQUEDA: Se realizó una búsqueda no sistemática de la evidencia para responder a los interrogantes clínicos. Los sitios de búsqueda incluyeron bases de datos electrónicas (PUBMED, Cochrane library, TripDatabase, Epistemonikos), Agencias de Evaluación de Tecnologías Sanitarias, organismos elaboradores de Guías de Práctica Clínica y sumários electrónicos de alta calidad. Se recuperó adicionalmente información relevante proveniente de las citas de los trabajos encontrados mediante la estrategia inicial. Se utilizaron como criterios de inclusión estudios de investigación secundarios (Guías de Práctica Clínica y Consensos de Sociedades Científicas, Revisiones Sistemáticas, Informes de Evaluación de Tecnologías Sanitarias) que analizaran información sobre métodos diagnósticos y/o tratamiento de las trombofilias; complicaciones obstétricas y maternas tanto de la patología como de su tratamiento. RESULTADOS: Se seleccionaron 10 estudios considerados pertinentes. CONCLUSIONES: Existe evidencia escasa sobre cuatro puntos relevantes: si la presencia de trombofilias hereditarias y/o adquiridas se asocia con resultados adversos en los embarazos, qué subgrupo de pacientes es el que se puede beneficiar con la realización de pruebas de diagnóstico, si el tratamiento anticoagulante que se indica a partir de este diagnóstico mejora los resultados en salud de los embarazos; y si el tratamiento anticoagulante es razonablemente seguro para su indicación en las mujeres que reciban el diagnóstico de trombofilias. Estas preguntas no quedan respondidas con suficiente confianza a partir de este informe ultrarrápido, en donde no fue posible realizar una búsqueda exhaustiva ni sistemática de evidencia. Por otro lado, la calidad de la evidencia no fue evaluada de manera formal debido a la necesidad de una respuesta en un lapso breve de tiempo. Sin embargo se puede afirmar que, por el diseño de los estudios incluidos, es para la mayoría de los casos, baja. El punto en el que más coincidencia se encuentra es que las pruebas diagnósticas deben ser limitadas a un grupo seleccionado de pacientes (historia personal de aborto recurrente, de eventos tromboembólicos, o historia familiar de primer grado), y no deben ser solicitadas de rutina a mujeres en edad fértil, ni a mujeres con un antecedente de aborto, ni a mujeres que tengan hasta dos intentos de fertilización asistida fallidos. Y aún en estos grupos seleccionados el tratamiento posterior con anticoagulación se encuentra cuestionado. En caso de trombofilias hereditarias, el tratamiento con heparina de bajo peso molecular no mostró mejorar la tasa de nacidos vivos en comparación com pacientes que no recibieron HBPM. En cambio en el caso de Sindrome antifosfolipídico los estudios sí mostraron mejores resultados en cuanto a tasa de nacidos vivos em mujeres que recibieron HBPM en comparación con las que no lo recibieron. Todos los estudios en los que se basa este efecto fueron de bajo número de participantes, por los que estos datos deben interpretarse con cautela. Sobre cuáles son los estudios que deberían solicitarse, no se observa concordancia entre los hallados en las recomendaciones nacionales e internacionales y los propuestos en el artículo 6 del proyecto de ley recibido. Se efectuó una búsqueda sobre cada uno de los métodos mencionados en el artículo 6. Para ninguno de ellos se encontró recomendación a favor de incluirlos. La mayoría de los trabajos incluidos coincide en recomendar como pruebas diagnósticas al factor V de Leiden y a la mutación del gen de la protrombina em caso de trombofilias hereditarias; y a los anticuerpos antifosfolipídicos en el caso de trombofilias adquiridas. Debido a la relevancia de este tema en relación a su impacto en el sistema de salud, a que existen estudios heterogéneos con resultados contradictorios, y a que la evidencia es de calidad incierta, se recomienda complementar esta revisión rápida con la elaboración de Recomendaciones basadas en evidencia, a través de um Informe de Evaluación de Tecnología Sanitaria y/o una Guía de Práctica Clínica, que incluyan la valoración de la calidad de la evidencia existente y sínteses cuantitativa de los datos hallados.

Pregnancy risk during menstrual cycle: misconceptions among urban men in India.

BACKGROUND: In India, where men take most decisions in the family, it is useful that they have adequate knowledge about pregnancy risks during women's menstrual cycles. Since traditional contraceptive methods are still employed by a large population in India, the knowledge regarding the pregnancy risk during the menstrual cycle is indispensable. This research paper attempts to assess the knowledge among urban men in Uttar Pradesh, India about the fertile window of the menstrual cycle; it also attempts to discover the rationales behind the misconceptions about the concept. METHODS: This study utilizes the baseline data of the Measurement, Learning, and Evaluation project for the Urban Reproductive Health Initiative in Uttar Pradesh. Descriptive Statistics has been used to assess the prevalence of knowledge among urban men regarding the concept. Using the Discriminant Analysis, we also investigate the rationales behind the misconceptions among urban men about the concept. RESULTS: Only one-fifth of the men have the correct knowledge about the concept. Further, we find that education, societal perception, caste, and spousal discussion about the reproductive issues are the primary factors affecting the knowledge about the pregnancy risk during the menstrual cycle. CONCLUSIONS: There is an urgent need for sex education in the region to make the urban men more educated about the reproductive process of women; this may reduce unwanted births and abortion due to an unwanted pregnancy as well. The study promotes the higher education and motivates couples to discuss the reproductive health issues among them. In this manner, we can provide better reproductive health to the women of urban India.

Association Between the Fertile Period and Live Birth Post-Kidney Transplantation: A Retrospective Single-Center Cohort Study.

BACKGROUND: Despite restoration of fertility after kidney transplantation, the benefit is limited in female kidney recipients. Our objective is to determine the reasons for this discrepancy. METHODS: We evaluated 315 women who underwent kidney transplantation from 1983 to 2015 (a median of age at transplantation [10th-90th percentile] of 32 years [7-55 years]); 230 recipients between the ages of 15 to 49 years old as of March 2016 were observed. RESULTS: We experienced 10 abortions and 21 live births from our 23 recipients and 2 abortions and 7 live births in 7 recipients from other transplant center. The live birth rate was 8.9 per 1000 female transplant recipients of childbearing age. Seven recipients received either treatments of artificial insemination or in vitro fertilization. Average age at pregnancy was 33.2 ± 3.2 years old, and the fertile period post-transplantation was longer in recipients with live births than those without live births (14.1 ± 7.1 vs 9.9 ± 7.3 years, P < .05). In 42.9% of recipients with live birth, pregnancy-induced hypertension was observed in the last trimester. The gestational age and the average birth weight were 32.8 ± 5.0 months and 2184 ± 632 g, respectively. During follow-up of 14.5 years, there was one case of graft loss, which is a rate of 2.5 per 1000 female recipients. CONCLUSION: Although pregnancy complications are often observed in kidney recipients, graft survival is less influenced by pregnancy. Importantly, kidney disease at childbearing age disrupts pregnancy even after kidney transplantation.