Mycoplasma hominis peritonitis after oocyte donation

We report the case of a young, immunocompetent, non-pregnant woman diagnosed with acute abdomen 3 weeks after an ultrasound-guided transvaginal oocyte retrieval (TVOR). Peritoneal fluid, obtained during exploratory laparoscopy, yielded Mycoplasma hominis as the sole pathogen. The patient's symptoms and signs improved after 24-hour treatment with intravenous clindamycin, ampicillin and gentamycin. Complete resolution was achieved with oral doxycycline for 14 days.

Community perceptions, beliefs and factors determining family planning uptake among men and women in Ekiti State, Nigeria: finding from a descriptive exploratory study

OBJECTIVES

To examine family planning through the community's perception, belief system and cultural impact; in addition to identifying the determining factors for family planning uptake.

DESIGN

A descriptive exploratory study.

SETTING

Three communities were selected from three local government areas, each in the three senatorial districts in Ekiti State.

PARTICIPANTS

The study was conducted among young unmarried women in the reproductive age group who were sexually active as well as married men and women in the reproductive age group who are currently living with their partners and were sexually active.

MAIN OUTCOME MEASURES

Eight focus group discussions were conducted in the community in 2019 with 28 male and 50 female participants. The audio recordings were transcribed, triangulated with notes and analysed using QSR NVivo V.8 software. Community perception, beliefs and perceptions of the utility of family planning, as well as cultural, religious and other factors determining family planning uptake were analysed.

RESULTS

The majority of the participants had the perception that family planning helps married couple only. There were diverse beliefs about family planning and mixed reactions with respect to the impact of culture and religion on family planning uptake. Furthermore, a number of factors were identified in determining family planning uptake-intrapersonal, interpersonal and health system factors.

CONCLUSION

The study concluded that there are varied reactions to family planning uptake due to varied perception, cultural and religious beliefs and determining factors. It was recommended that more targeted male partner engagement in campaign would boost family planning uptake.

Womb to rent: the ethical and legal implications of surrogacy in Ireland

BACKGROUND

Surrogacy is a form of assisted human reproduction whereby a surrogate woman carries a pregnancy for a commissioning couple or individual. There are two types of surrogacy, traditional and gestational. Worldwide we have seen a rapid increase in the use of surrogacy. Despite this, there is a lack of consensus internationally on the laws governing surrogacy. In Ireland, surrogacy remains largely unregulated. Currently, there is no specific legislation for surrogacy. This review aims to discuss its current regulatory status and associated ethical issues.

AIMS

On surrogacy from an Irish legal perspective, this study is to (i) demonstrate the lack of legislation, (ii) describe the Health Bill 2022 and (iii) examine the challenges surrounding surrogacy and Irish case law. On surrogacy from an Irish ethical perspective, this study is to (iv) discuss the ethical issues surrounding autonomy, (v) discuss the ethical issues surrounding non-maleficence, (vi) discuss the ethical issues surrounding justice and (vii) evaluate ethical issues specific to commercial surrogacy: (1) child welfare and (2) commodification and exploitation of children and women's bodies.

CONCLUSION

Surrogacy has raised several ethical issues. There are issues surrounding autonomy of the surrogate and commissioning couple, child welfare, exploitation and commodification, non-maleficence and justice. There are also significant legal concerns with surrogacy. It is neither legal nor illegal in Ireland. This creates challenges for the commissioning couple particularly in terms of custody of the child.

Midwives' experience of telehealth and remote care: a systematic mixed methods review

INTRODUCTION

Increasing the midwifery workforce has been identified as an evidence-based approach to decrease maternal mortality and reproductive health disparities worldwide. Concurrently, the profession of midwifery, as with all healthcare professions, has undergone a significant shift in practice with acceleration of telehealth use to expand access. We conducted a systematic literature review to identify and synthesize the existing evidence regarding how midwives experience, perceive and accept providing sexual and reproductive healthcare services at a distance with telehealth.

METHODS

Five databases were searched, PubMed, CINHAL, PsychInfo, Embase and the Web of Science, using search terms related to 'midwives', 'telehealth' and 'experience'. Peer-reviewed studies with quantitative, qualitative or mixed methods designs published in English were retrieved and screened. Studies meeting the inclusion criteria were subjected to full-text data extraction and appraisal of quality. Using a convergent approach, the findings were synthesized into major themes and subthemes.

RESULTS

After applying the inclusion/exclusion criteria, 10 articles on midwives' experience of telehealth were reviewed. The major themes that emerged were summarized as integrating telehealth into clinical practice; balancing increased connectivity; challenges with building relationships via telehealth; centring some patients while distancing others; and experiences of telehealth by age and professional experience.

CONCLUSIONS

Most current studies suggest that midwives' experience of telehealth is deeply intertwined with midwives' experience of the response to COVID-19 pandemic in general. More research is needed to understand how sustained use of telehealth or newer hybrid models of telehealth and in-person care are perceived by midwives.

Effectiveness of metformin to pregnant women with PCOS to reduce spontaneous abortion and gestational diabetes mellitus: a protocol for an overview of reviews

INTRODUCTION

Polycystic ovary syndrome (PCOS) is a globally prevalent endocrinological disorder and has been associated with poor pregnancy outcomes, including a higher rate of gestational diabetes and miscarriage. Metformin is among the drugs investigated to improve the prognosis of pregnant women with PCOS.

OBJECTIVE

To conduct an overview of systematic reviews examining the effects of metformin versus placebo or no intervention throughout pregnancy among pregnant women with a preconception PCOS diagnosis to reduce the incidence of miscarriage and gestational diabetes.

METHODS AND ANALYSIS

We will perform an overview of systematic reviews by searching Embase, PubMed, Virtual Health Library, Cochrane Central Register of Controlled Trials, Trip Database, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature from inception to 17 August 2023. Language, publication status and year indexed or published filters will not be applied. Two reviewers will independently screen and select papers, assess their quality, evaluate their risk of bias and collect the data. The included reviews will be summarised narratively. The quality and risk of bias of the systematic review and meta-analysis studies included will be assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews, Second Version) and ROBIS (Risk of Bias in Systematic Reviews), respectively.

ETHICS AND DISSEMINATION

This overview of reviews will analyse data from systematic reviews on the use of metformin for prepregnancy diagnosis of PCOS to reduce adverse outcomes. As there will be no primary data collection, a formal ethical analysis is unnecessary. The study outcomes will be submitted to a peer-reviewed journal and presented at conferences.

PROSPERO REGISTRATION NUMBER

CRD42023441488.

Upregulated α-actinin-1 impairs endometrial epithelial cell adhesion by downregulating NEBL in recurrent implantation failure

Poor endometrial receptivity results in embryo implantation failure. Acquisition of endometrial receptivity involves substantial structural alterations in the cytoskeleton and plasma membrane of epithelial cells, which facilitate embryo adhesion. However, the underlying molecular mechanism remains largely unknown. In this study, we identified that α-actinin-1 (ACTN1) was significantly downregulated in the mid-secretory phase of the endometrium compared with other phases; however, ACTN1 significantly increased in women with recurrent implantation failure (RIF). In Ishikawa and human endometrial epithelial cells (HEECs), ACTN1 overexpression significantly decreased NEBL levels, enhanced F-actin fiber levels, and caused a notable impairment in blastocyst adhesion, which mimicked the process of embryo adhesion. However, NEBL overexpression notably restored adhesion. Moreover, NEBL expression was reduced in patients with RIF compared with that in controls. Finally, our data showed that ACTN1 upregulation impaired endometrial receptivity in women with RIF, possibly by regulating NEBL expression and subsequent cell-adhesion capability.

Laparoscopic resection of a salpingectomy stump remnant during early pregnancy: the diagnostic challenge posed in diagnosing a heterotopic stump pregnancy

In this report, we present a case of a woman admitted in her first trimester of pregnancy with significant intraperitoneal haemorrhage from a left tubal stump remnant occurring concurrent to a viable intrauterine pregnancy. The patient was resuscitated and treated successfully with laparoscopic removal of her stump remnant to achieve haemostasis. However, despite extensive investigation, the pathology of her haemorrhagic stump remained inconclusive. Stump ectopic pregnancy is an established phenomenon, although it presents a diagnostic challenge when occurring as a heterotopic pregnancy. Further, persisting trophoblastic tissue is a rare but established feature of incomplete removal of ectopic pregnancy post salpingectomy. Here, we discuss challenges of diagnosis in such cases and present a case report of a presumed stump remnant heterotopic pregnancy from spontaneous conception.

Endometriosis-associated spontaneous major haemoperitoneum in pregnancy

Spontaneous haemoperitoneum in pregnancy (SHiP) related to endometriosis is a rare and life-threatening complication. We report a case of a patient presenting to our department with major haemoperitoneum at 23+3 weeks of gestation due to a large rectovaginal endometriotic nodule. The patient required a midline laparotomy to evacuate 1 L of haemoperitoneum and achieve haemostasis. A large rectovaginal nodule was seen bleeding and was packed with haemostatic material and a large swab. After 24 hours, the swab was removed and haemostasis was confirmed. The patient was monitored very closely by a multidisciplinary team and the pregnancy was allowed to continue to try and achieve a better outcome for the baby and at 28 weeks of gestation, a girl was delivered in good condition via caesarean section.

High imperforate transverse vaginal septum with vaginal cicatrisation: a surgical tribulation

An early adolescent girl was referred to us with cryptomenorrhoea, and pelvic pain consistent with obstructed menstruation. Originally presumed to be a case of imperforate hymen, she was referred to our centre after two failed surgical misadventures at correcting the obstruction. MRI revealed a haematometrocolpos, high transverse complete vaginal septum and an occluded vagina. She underwent a laparoscopic drainage of the collection, septal resection and a vaginoplasty with an absorbable Interceed graft. Postoperative recovery was smooth and she was sent with instructions to use a vaginal mould daily. Successful surgical treatment requires precise preoperative planning with MRI. A vaginal-assisted laparoscopic approach turned out to be advantageous in resecting the septum to a large extent due to the associated cicatrised vagina. The use of Interceed, a novel mould and harnessing system, ensured a favourable postoperative outcome by bolstering patient motivation due to its less challenging technique of use.

Pantoea agglomerans bacteraemia after uterine artery embolisation: an unusual pathogen

A woman in her 40s presented to the emergency department (ED) with a 3-week history of nausea, vomiting and diarrhoea. Blood cultures were positive for Serratia and Pantoea agglomerans spp. One month before her ED visit, she underwent targeted uterine artery embolisation with particles by an interventional radiologist. Uterine artery embolisation is considered a safe alternative to surgical removal of fibroids or hysterectomy. The patient was initially treated with targeted antibiotics for a large infected uterine fibroid but ultimately required a hysterectomy for source control. To our knowledge, this is the first documented case of P. agglomerans infecting a uterine fibroid.

Knowledge, attitude and practice on ovarian reserve function among women of childbearing age: a prospective cross-sectional study in Chongqing and surrounding regions

OBJECTIVES

To evaluate the knowledge, attitudes and practice (KAP) on ovarian reserve function among women of childbearing age in Chongqing and surrounding regions, China.

DESIGN

Cross-sectional study.

SETTING

Chongqing and surrounding regions, China.

PARTICIPANTS

Women of childbearing age (18-48 years) by convenience sampling.

PRIMARY AND SECONDARY OUTCOME MEASURES

The demographic characteristics of the respondents and their KAP on ovarian reserve function were collected by administering 38-item questionnaires.

RESULTS

A total of 510 valid questionnaires were collected. The mean knowledge score of all respondents was 7.56±2.03 (possible range: 0-10), the mean attitude score was 29.12±3.98 (possible range: 8-40) and the mean practice score was 23.45±3.58 (possible range: 6-30). The multivariable analysis showed knowledge level (OR 1.175, 95% CI 1.049 to 1.317, p=0.002), attitude level (OR 1.249, 95% CI 1.167 to 1.337, p<0.001) and eating habits (self-cooked vs eating out, OR 1.958, 95% CI 1.201 to 3.190, p=0.007) were independently associated with better practice level. The structural equation modelling analysis showed that knowledge had a direct influence on attitude (β=0.487, p=0.030) and practice (β=0.312, p=0.012) and an indirect influence on practice (β=0.213, p=0.016). Attitude had a direct influence on practice (β=0.438, p=0.007). The total influence of knowledge on practice was significant (β=0.525, p=0.012).

CONCLUSIONS

The women living in Chongqing and surrounding regions had good knowledge, moderate attitude and good practice towards ovarian reserve function. The knowledge aspect can be further improved by education, which in turn might also improve practice among women of childbearing age.

Criteria for implementing artificial intelligence systems in reproductive medicine

This review article discusses the integration of artificial intelligence (AI) in assisted reproductive technology and provides key concepts to consider when introducing AI systems into reproductive medicine practices. The article highlights the various applications of AI in reproductive medicine and discusses whether to use commercial or in-house AI systems. This review also provides criteria for implementing new AI systems in the laboratory and discusses the factors that should be considered when introducing AI in the laboratory, including the user interface, scalability, training, support, follow-up, cost, ethics, and data quality. The article emphasises the importance of ethical considerations, data quality, and continuous algorithm updates to ensure the accuracy and safety of AI systems.

Association of metabolic-dysfunction associated steatotic liver disease with polycystic ovary syndrome

Non-alcoholic fatty liver disease (NAFLD), which has a prevalence of over 25% in adults, encompasses a wide spectrum of liver diseases. Metabolic-dysfunction associated steatotic liver disease (MASLD), the new term for NAFLD, is characterized by steatotic liver disease accompanied by cardiometabolic criteria, showing a strong correlation with metabolic diseases. Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disease affecting 4-21% of women of reproductive age. Numerous studies have indicated that NAFLD and PCOS often occur together. However, as MASLD is a new term, there is still a lack of reports describing the effects of MASLD on the development of PCOS. In this review article, we have summarized the complex and multifaceted connections between MASLD and PCOS. Understanding the pathogenesis and treatment methods could not only guide the clinical prevention, diagnosis, and treatment of PCOS in patients with MASLD, but also increase the clinical attention of reproductive doctors to MASLD.

LncRNA SNHG5 adversely governs follicular growth in PCOS via miR-92a-3p/CDKN1C axis

Small nucleolar RNA host genes (SNHGs) have been implicated in various biological processes, yet their involvement in polycystic ovary syndrome (PCOS) remains elusive. Specifically, SNHG5, a long non-coding RNA implicated in several human cancers, shows elevated expression in granulosa cells (GCs) of PCOS women and induces PCOS-like features when overexpressed in mice. In vitro, SNHG5 inhibits GC proliferation and induces apoptosis and cell-cycle arrest at G0/G1 phase, with RNA-seq indicating its impact on DNA replication and repair pathways. Mechanistically, SNHG5 acts as a competing endogenous RNA by binding to miR-92a-3p, leading to increased expression of target gene CDKN1C, which further suppresses GC proliferation and promotes apoptosis. These findings elucidate the crucial role of SNHG5 in the pathogenesis of PCOS and suggest a potential therapeutic target for this condition. Additional investigations such as large-scale clinical studies and functional assays are warranted to validate and expand upon these findings.

Can an integrated intervention package including peer support increase the proportion of health facility births? A cluster randomised controlled trial in Northern Uganda

OBJECTIVE

To assess the effect of an integrated intervention package compared with routine government health services on the frequency of health facility births.

SETTING

Three subcounties of Lira district in Northern Uganda.

DESIGN

A cluster randomised controlled trial where a total of 30 clusters were randomised in a ratio of 1:1 to intervention or standard of care.

PARTICIPANTS

Pregnant women at ≥28 weeks of gestation.

INTERVENTIONS

Participants in the intervention arm received an integrated intervention package of peer support, mobile phone messaging and birthing kits during pregnancy while those in the control arm received routine government health services ('standard of care').

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the proportion of women giving birth at a health facility in the intervention arm compared with the control arm. Secondary outcomes were perinatal and neonatal deaths.

RESULTS

In 2018-2019, 995 pregnant women were included in 15 intervention clusters and 882 in 15 control clusters. The primary outcome was ascertained for all except one participant who died before childbirth. In the intervention arm, 754/994 participants (76%) gave birth at a health facility compared with 500/882 (57%) in the control arm. Participants in the intervention arm were 35% more likely to give birth at a health facility compared with participants in the control arm, (risk ratio 1.35 (95% CI 1.20 to 1.51)) and (risk difference 0.20 (95% CI 0.13 to 0.27)). Adjusting for baseline differences generated similar results. There was no difference in secondary outcomes (perinatal or neonatal mortality or number of postnatal visits) between arms.

CONCLUSION

The intervention was successful in increasing the proportion of facility-based births but did not reduce perinatal or neonatal mortality.

TRIAL REGISTRATION NUMBER

NCT02605369.

Genomic aspects in reproductive medicine

Infertility is a complex disease characterized by extreme genetic heterogeneity, compounded by various environmental factors. While there are exceptions, individual genetic and genomic variations related to infertility are typically rare, often family-specific, and may serve as susceptibility factors rather than direct causes of the disease. Consequently, identifying the cause of infertility and developing prevention and treatment strategies based on these factors remain challenging tasks, even in the modern genomic era. In this review, we first examine the genetic and genomic variations associated with infertility, and subsequently summarize the concepts and methods of preimplantation genetic testing in light of advances in genome analysis technology.

Outpatient paracentesis for the management of ovarian hyperstimulation syndrome: study protocol for the STOP-OHSS randomised controlled trial

INTRODUCTION

Ovarian hyperstimulation syndrome (OHSS) is the most significant short-term complication of pharmacological ovarian stimulation. Symptoms range from mild abdominal discomfort to rare complications such as renal failure, thromboembolism and respiratory distress syndrome.Currently, clinical practice typically involves monitoring the patient until the condition becomes severe, at which point they are admitted to hospital, where drainage of ascitic fluid (paracentesis) may take place. Preliminary studies have indicated that earlier outpatient paracentesis may reduce the progression of OHSS and prevent hospitalisation in women.

METHODS AND ANALYSIS

This UK, multicentre, pragmatic, two-arm, parallel-group, adaptive (group sequential with one interim analysis), open-label, superiority, confirmatory, group sequential, individually randomised controlled trial, with internal pilot will assess the clinical and cost-effectiveness and safety of outpatient paracentesis versus conservative management (usual care) for moderate or severe OHSS. 224 women from 20 National Health Service and private fertility units will be randomised (1:1) and followed up for up to 13.5 months. The primary outcome is the rate of OHSS related hospital admission of at least 24 hours within 28 days postrandomisation. The primary analysis will be an intention to treat with difference in hospitalisation rates as measure of treatment effect. Secondary outcomes include time to resolution of symptoms, patient satisfaction, adverse events and cost-effectiveness. A qualitative substudy will facilitate the feasibility of recruitment. Participant recruitment commenced in June 2022.

ETHICS AND DISSEMINATION

London-Southeast Research Ethics Committee approved the protocol (reference: 22/LO/0015). Findings will be submitted to peer-reviewed journals and abstracts to relevant national and international conferences, as well as being disseminated to trial participants and patient groups.

TRIAL REGISTRATION NUMBER

ISRCTN71978064.

Integration of cervical cancer screening into healthcare facilities in low- and middle-income countries: a scoping review protocol

BACKGROUND

Cervical cancer is the fourth most common malignancy in women, with 90% of deaths in low- and middle-income countries. Integrating cervical cancer screening services into healthcare facilities is crucial for overcoming the disease. Thus, this review aims to map existing evidence and identify barriers and facilitators in low- and middle-income countries.

METHODS

The scoping review will employ a five-step framework as proposed by Arksey and O'Malley. These are (1) formulating the research questions, (2) identifying relevant studies, (3) selecting eligible studies, (4) charting the data, and (5) collating, summarising and reporting the results. Five databases (MEDLINE, Maternity and Infant Care, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) will be systematically searched. Grey literature will also be searched. Data will be extracted, charted, synthesised and summarised.

ETHICS AND DISSEMINATION

This review does not require ethics approval. Findings will be disseminated through peer-reviewed publications, policy briefs and conference presentations.

Does Health & Her app use improve menopausal symptoms? A longitudinal cohort study

OBJECTIVES

The Health & Her app provides menopausal women with a means of monitoring their symptoms, symptom triggers and menstrual periods, and enables them to engage in a variety of digital activities designed to promote well-being. This study aimed to examine whether sustained weekly engagement with the app is associated with improvements in menopausal symptoms.

DESIGN

A pre-post longitudinal cohort study.

SETTING

Analysed data collected from Health & Her app users.

PARTICIPANTS

1900 women who provided symptom data via the app across a 2-month period.

PRIMARY AND SECONDARY OUTCOME MEASURES

Symptom changes from baseline to 2 months was the outcome measure. A linear mixed effects model explored whether levels of weekly app engagement influenced symptom changes. Secondary analyses explored whether app-usage factors such as total number of days spent logging symptoms, reporting triggers, reporting menstrual periods and using in-app activities were independently predictive of symptom changes from baseline. Covariates included hormone replacement therapy use, hormonal contraceptive use, present comorbidities, age and dietary supplement use.

RESULTS

Findings demonstrated that greater engagement with the Health & Her app for 2 months was associated with greater reductions in symptoms over time. Daily use of in-app activities and logging symptoms and menstrual periods were each independently associated with symptom reductions.

CONCLUSIONS

This study demonstrated that greater weekly engagement with the app was associated with greater reductions in symptoms. It is recommended that women be made aware of menopause-specific apps, such as that provided by Health & Her, to support them to manage their symptoms.

INvestigational Study Into Transplantation of the Uterus (INSITU): a cross-sectional survey among women with uterine factor infertility in the UK assessing background, motivations and suitability

IMPORTANCE

The study summarises the selection prescreen criteria currently used in the UK for a uterus transplant and highlights the number of women who are suitable to proceed.

OBJECTIVES

To assess the demographics, motivations, reasons and suitability among women with absolute uterine factor infertility (AUFI) to undergo uterine transplantation (UTx).

DESIGN

A cross-sectional survey.

SETTING

An electronic questionnaire was sent via email to women with AUFI who had previously been referred to the UTx research team or approached the Womb Transplant UK Charity. The questions assessed suitability to undergo UTx based on demographic information, perceptions to adoption and surrogacy and reasons why UTx was preferable. Responses were assessed against the study selection criteria.

PARTICIPANTS

Women with AUFI.

RESULTS

210 women completed the questionnaire. The most common aetiology of AUFI in our cohort was Mayer-Rokitansky-Küster-Hauser (68%; n=143) whereas 29% (n=62) had previously undergone hysterectomy. 63% (n=132) of the cohort had previously considered adoption, 5% (n=11) had attempted it and 2 (1%) had successfully adopted. The most common reason cited to undergo UTx over adoption was to experience gestation (n=63; 53%), while 37% (n=44) wanted a biologically related child. 76% (n=160) of participants had previously considered surrogacy, 22 (10%) had attempted it and 2 (1%) had successfully become mothers using a surrogate. The most common reason to undergo UTx over surrogacy was to experience gestation (n=77; 54%). 15% (n=21) were concerned about the legal implications, 14% (n=20) identified the financial cost as a barrier and 8% (n=12) could not consider it due to religious reasons. On adhering to the selection criteria, 65 (31%) women were suitable to proceed with the trial.

CONCLUSION

The study demonstrates that implementing commonly used selection criteria for a UTx led to an attrition rate of more than two-thirds of women who requested to initially undergo the process. As more studies present outcomes following UTx, critical assessment of the selection criteria currently used is warranted to ensure potential recipients are not being unnecessarily excluded.

TRIAL REGISTRATION NUMBER

NCT02388802.

Preconceptual administration of doxycycline in women with recurrent miscarriage and chronic endometritis: protocol for the Chronic Endometritis and Recurrent Miscarriage (CERM) trial, a multicentre, double-blind, placebo-controlled, adaptive randomised trial with an embedded translational substudy

INTRODUCTION

Recurrent miscarriage is a common condition with a substantial associated morbidity. A hypothesised cause of recurrent miscarriage is chronic endometritis (CE). The aetiology of CE remains uncertain. An association between CE and recurrent miscarriage has been shown. This study will aim to determine if preconceptual administration of doxycycline, in women with recurrent miscarriages, and CE, reduces first trimester miscarriages, increasing live births.

METHODS AND ANALYSIS

Chronic Endometritis and Recurrent Miscarriage is a multicentre, double-blind adaptive trial with an embedded translational substudy. Women with a history of two or more consecutive first trimester losses with evidence of CE on endometrial biopsy (defined as ≥5 CD138 positive cells per 10 mm2) will be randomised to oral doxycycline or placebo for 14 days. A subset will be recruited to a mechanistic substudy in which microbial swabs and preintervention/postintervention endometrial samples will be collected. Up to 3062 women recruited from 29 National Health Service (NHS) hospital sites across the UK are expected to be screened with up to 1500 women randomised in a 1:1 ratio. Women with a negative endometrial biopsy (defined as <5 CD138 positive cells per 10 mm2) will also be followed up to test validity of the tool. The primary outcome is live births plus pregnancies ≥24 + 0 weeks gestation at the end of the trial, in the first or subsequent pregnancy. Secondary clinical outcomes will also be assessed. Exploratory outcomes will assess the effect of doxycycline treatment on the endometrial microbiota, the differentiation capacity of the endometrium and the senescent profile of the endometrium with CE.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the NHS Research Ethics Committee Northwest-Haydock (19/NW/0462). Written informed consent will be gained from all participants. The results will be published in an open-access peer-reviewed journal and reported in the National Institute for Health and Care Research journals library.

TRIAL REGISTRATION NUMBER

ISRCTN23947730.

Factors associated with continuation of hormonal contraceptives among married women of reproductive age in Gilgit, Pakistan: a community-based case-control study

OBJECTIVE

This study aimed to determine the factors associated with continuation of hormonal contraceptive methods among married women of Gilgit, Pakistan at least 6 months after their initiation.

DESIGN

Unmatched case-control study.

SETTING

Community settings of Gilgit, Pakistan from 1 April 2021 to 30 July 2021.

PARTICIPANTS

The cases were married women of reproductive age who, at the time of interview, were using a hormonal method of contraception for at least 6 months continuously, and controls were married women of reproductive age who had used a hormonal method in the past and currently were using a non-hormonal method for at least 6 months.

PRIMARY AND SECONDARY OUTCOME MEASURES

OR for continuation of hormonal contraceptive.

RESULTS

The factors significantly associated with continuous use of hormonal contraceptive methods for our sample from Gilgit were the family planning centre's distance from home (adjusted OR (AOR) 6.33, 95% CI 3.74 to 10.71), satisfaction with current method used (AOR 3.64, 95% CI 2.06 to 6.44), visits to the family planning centre to avail services (AOR 1.86, 95% CI 1.07 to 3.45) and relatively older age of women (AOR 1.07, 95% CI 1.02 to 1.12). In addition, women with formal education (AOR 0.27, 95% CI 0.12 to 0.6) were less likely to use a modern contraceptive method.

CONCLUSION

Continuation of using a hormonal method was associated with easy access to family planning centres, satisfaction with the current method and frequent visits to the family planning centres. Continuation of using a hormonal method was also seen in women with low education status. The importance of the presence of family planning centres near residential areas cannot be emphasised more. This does not only provide easy access to family planning methods, but also reassure women of continuation of modern methods when they face any unpleasant effects while using these.

Group A Streptococcal Endometritis and Toxic Shock causing Septic Pelvic Thrombophlebitis and Septic Pulmonary Emboli

Group A Streptococcus (GAS) in the setting of postpartum endometritis can have severe and life-threatening complications. We report a rare case of septic pulmonary emboli that we surmised to have originated from septic pelvic thrombosis in the setting of GAS toxic shock syndrome (TSS) secondary to postpartum endometritis and intrauterine demise. Although the patient had source control with hysterectomy, she continued to have new septic emboli to the lungs seen on CT scans. CT scan of the pelvis demonstrated several filling defects in the renal and pelvic veins. The patient eventually responded well to anticoagulation in addition to antibiotics, which is similar to cases of Lemierre's syndrome. Additionally, we would like to bring attention to how important radiological findings can be missed if there is lack of interspecialty communication about the patient's clinical situation.

Klinefelter syndrome presenting as metastatic bilateral breast cancer: missed diagnostic opportunities

Klinefelter syndrome (KS) is the most common cause of primary hypogonadism in male patients; however, the diagnosis of KS is frequently delayed or missed. This delay can lead to undesirable outcomes for patients, especially considering that individuals with KS have a higher risk of developing specific malignancies, including breast cancer, non-Hodgkin's lymphoma and mediastinal germ cell tumours. We present a case of a male patient in his 60s, where the established diagnosis of metastatic bilateral breast cancer prompted us to investigate and subsequently confirm a diagnosis of KS. This case highlights the diagnostic challenges of KS and emphasises the unfavourable consequences of a delayed diagnosis. We aim to raise awareness and enhance physicians' understanding of KS and its non-reproductive manifestations, with a view to promote early recognition and improve patient outcomes.

Intrauterine device migration into the bladder leading to stones formation

An intrauterine device (IUD) is a popular method of contraception mainly used in developing countries. Perforation is one of the most serious but a rare complication secondary to the insertion of an IUD, while perforation into the intravesical organs such as the bladder is even more rare. A 30-year-old multipara in early 30s, with two previous caesarean sections (CS) and one curettage, was found to have her IUD puncturing the bladder during a cystoscopy procedure to remove her bladder stones. Transvesical migration of an IUD is an uncommon complication with a high rate of calculi formation, which is thought to be caused by the IUD's lithogenic potential. Imaging approaches such as ultrasound and pelvic X-rays are considered imperative in the accurate diagnosis. Any migrated IUD should be removed regardless of location. Prompt and continual monitoring of women using an IUD is essential and in a case where the IUD has migrated, the removal using the endoscopic approach is a safe and effective method.

Prediction of postpartum prediabetes by machine learning methods in women with gestational diabetes mellitus

Early onset of type 2 diabetes and cardiovascular disease are common complications for women diagnosed with gestational diabetes. Prediabetes refers to a condition in which blood glucose levels are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. Currently, there is no accurate way of knowing which women with gestational diabetes are likely to develop postpartum prediabetes. This study aims to predict the risk of postpartum prediabetes in women diagnosed with gestational diabetes. Our sparse logistic regression approach selects only two variables - antenatal fasting glucose at OGTT and HbA1c soon after the diagnosis of GDM - as relevant, but gives an area under the receiver operating characteristic curve of 0.72, outperforming all other methods. We envision this to be a practical solution, which coupled with a targeted follow-up of high-risk women, could yield better cardiometabolic outcomes in women with a history of GDM.

GDF15 deficiency hinders human trophoblast invasion to mediate pregnancy loss through downregulating Smad1/5 phosphorylation

Growth differentiation factor 15 (GDF15) belongs to the Transforming growth factor β(TGF-β) superfamily. The decrease of GDF15 in the serum of pregnant women was associated with miscarriage. Both IHC and ELISA assays showed that GDF15 in trophoblast tissue and serum of pregnant women who miscarried was significantly lower than in those who had a live birth. GDF15 deficiency was associated with embryo resorption in GDF15 knockout mice through CRIPSR editing. In addition, the migration and invasion ability of HTR-8/SVneo and JEG-3 cells were promoted by GDF15. Mechanistically, GDF15 increased Smad1/5 phosphorylation, resulting in upregulating SNAI1/2, VIMENTIN and downregulating E-CADHERIN. A dual-luciferase reporter assay confirmed that Smad-binding elements (SBE) and/or GC-rich motifs were activated and target genes such as SNAI1/2, SERPINE1, and TIMP3 were transcriptionally regulated by GDF15/Smad5 signaling. Therefore, our data revealed a crucial role of GDF15 on invasion of trophoblast by upregulating the activity of TGF-β/Smad1/5 pathway.

Risk factors and health consequences of experiencing reproductive coercion: a scoping review protocol

INTRODUCTION

Reproductive coercion (RC) describes behaviours that interfere with an individual's reproductive autonomy and decision-making. RC can be a form of intimate partner violence and overlaps with other forms of gender-based violence, such as sexual violence. Health settings are well placed to identify and intervene to support patients experiencing RC, however, the lack of conceptual clarity on RC means that health providers are not easily able to identify those at risk of experiencing RC. To facilitate appropriate identification and development of interventions, there is a need to understand the risk factors related to experiencing RC and associated health consequences.

AIM

To assess the current scope of evidence in relation to risk factors and health consequences of experiencing RC.

METHODS AND ANALYSIS

Eligible articles for inclusion in the scoping review will be original peer-reviewed literature that describe risk factors and health consequences of any type of RC. Studies on humans published in English since 2010 will be included. The proposed scoping review will be conducted in accordance with the JBI Methodology. This protocol is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Five electronic databases, OVID Medline, CINAHL, Scopus, PsychINFO and Embase, will be searched for relevant literature from 1 January 2010 to 23 January 2023. Two reviewers will individually screen and review articles for eligibility, and conflicts will be resolved by a third reviewer. Data will be charted and reported using a tool developed for the purpose of this review.

ETHICS AND DISSEMINATION

Findings will be disseminated in publications and presentations to relevant stakeholders. Ethical approval is not required as data from publicly available literature sources will be used. Available evidence will be mapped across the breadth of eligible studies to identify associated risk factors and health consequences of RC.

Epidemiology of emergency and elective caesarean section and its association with early neonatal mortality in sub-Saharan African countries

INTRODUCTION

Investigating elective and emergency caesarean section (CS) separately is important for a better understanding of birth delivery modes in the sub-Saharan Africa (SSA) region and identifying bottlenecks that prevent favourable childbirth outcomes in SSA. This study aimed at evaluating the prevalences of both CS types, determining their associated socioeconomic factors and their association with early neonatal mortality in SSA.

METHODS

SSA countries Demographic and Health Surveys data that had collected information on the CS' timing were included in our study. A total of 21 countries were included in this study, with a total of 155 172 institutional live births. Prevalences of both CS types were estimated at the countries' level using household sampling weights. Multilevel models were fitted to identify associated socioeconomic factors of both CS types and their associations with early neonatal mortality.

RESULTS

The emergency CS prevalence in SSA countries was estimated at 4.6% (95% CI 4.4-4.7) and was higher than the elective CS prevalence estimated at 3.4% (95% CI 3.3-3.6). Private health facilities' elective CS prevalence was estimated at 10.2% (95% CI 9.3-11.2) which was higher than the emergency CS prevalence estimated at 7.7% (95% CI 7.0-8.5). Conversely, in public health facilities, the emergency CS prevalence was estimated at 4.0% (95% CI 3.8-4.2) was higher than the elective CS prevalence estimated at 2.7% (95% CI 2.6-2.8). The richest women were more likely to have birth delivery by both CS types than normal vaginal delivery. Emergency CS was positively associated with early neonatal mortality (adjusted OR=2.37, 95% CI 1.64-3.41), while no association was found with elective CS.

CONCLUSIONS

Findings suggest shortcomings in pregnancy monitoring, delivery preparation and postnatal care. Beyond antenatal care (ANC) coverage, more attention should be put on quality of ANC, postnatal care, emergency obstetric and newborn care for favourable birth delivery outcomes in SSA.

Polycystic ovary syndrome: pathophysiology and therapeutic opportunities

Polycystic ovary syndrome is characterised by excessive levels of androgens and ovulatory dysfunction, and is a common endocrine disorder in women of reproductive age. Polycystic ovary syndrome arises as a result of polygenic susceptibility in combination with environmental influences that might include epigenetic alterations and in utero programming. In addition to the well recognised clinical manifestations of hyperandrogenism and ovulatory dysfunction, women with polycystic ovary syndrome have an increased risk of adverse mental health outcomes, pregnancy complications, and cardiometabolic disease. Unlicensed treatments have limited efficacy, mostly because drug development has been hampered by an incomplete understanding of the underlying pathophysiological processes. Advances in genetics, metabolomics, and adipocyte biology have improved our understanding of key changes in neuroendocrine, enteroendocrine, and steroidogenic pathways, including increased gonadotrophin releasing hormone pulsatility, androgen excess, insulin resistance, and changes in the gut microbiome. Many patients with polycystic ovary syndrome have high levels of 11-oxygenated androgens, with high androgenic potency, that might mediate metabolic risk. These advances have prompted the development of new treatments, including those that target the neurokinin-kisspeptin axis upstream of gonadotrophin releasing hormone, with the potential to lessen adverse clinical sequelae and improve patient outcomes.

Longitudinal assessment of bacterial vaginosis prior to and during incident pregnancy: an observational study in Kenyan adolescent girls and young women

OBJECTIVE

To determine bacterial vaginosis (BV) status at multiple time points among adolescent girls and young women (AGYW) and assess the impact of pregnancy on their BV status.

DESIGN

Longitudinal cohort study.

SETTING

Thika, Kenya.

PARTICIPANTS

AGYW aged 16-20 years enrolled prior to first sex or reporting only a single lifetime partner.

MAIN OUTCOME MEASURES

The primary outcome was relative risk (RR) of BV during pregnancy compared with before pregnancy by analysing longitudinal trends in BV over time. BV risk was estimated using Poisson regression models.

RESULTS

A total of 121 AGYW became pregnant in the parent cohort and had BV results before, during or after pregnancy. Point prevalence of BV was 11.0% at visits >12 months pre-pregnancy, 13.0% at 3-12 months pre-pregnancy, 22.1% at <3 months pre-pregnancy and 13.4% during pregnancy. Compared with visits during pregnancy, RR of BV was 1.65 (95% CI: 1.00 to 2.71; p=0.05) at visits <3 months pre-pregnancy, 0.97 (95% CI: 0.62 to 1.52; p=0.90) at visits 3-12 months pre-pregnancy and 0.82 (95% CI: 0.44 to 1.53; p=0.53) at visits 12 months pre-pregnancy. An adjusted analysis including age, income, residence, date of first sex, recent sexual activity and positive sexually transmitted infection test resulted in small changes in risk estimates, with adjusted RR of BV of 1.66 (95% CI: 1.04 to 2.67; p=0.04) at visits <3 months pre-pregnancy compared with visits during pregnancy.

CONCLUSIONS

BV risk during pregnancy was lower than during the immediate pre-pregnancy period. Hormonal changes in pregnancy may reduce BV.

Effect of caesarian section delivery on breastfeeding initiation in Nigeria: logit-based decomposition and subnational analysis of cross-sectional survey

OBJECTIVES

This study investigates caesarian section (CS) and vaginal delivery disparity, impact and contributions to timely initiation of breastfeeding (TIBF) to guide evidence-based strategy for improved breastfeeding practice.

DESIGN AND SETTINGS

A cross-sectional (population-based) analysis of 19 101 non-missing breastfeeding data from the 2018 Nigerian Demographic Health Survey collected via a two-stage stratified-random sampling across the 37 states in the 6 geopolitical-zones of Nigeria.

PARTICIPANTS

Complete responses from reproductive-age women (15-49 years) who had at least a childbirth in the last 5 years prior to the 2018 survey.

MAIN OUTCOME MEASURES

TIBF, that is, breastfeeding initiation within the first hour of newborn life is the outcome, CS is the exposure variable and explanatory factors were classified as; socio-demographic and obstetrics.

METHODS

Descriptive statistics were reported and graphically presented. Bivariate χ2 analysis initially assessed the relationship. Crude and adjusted logistic regression evaluated the likelihood and significance of multivariable association. Multivariate decomposition further quantified predictors' contribution and importance. Statistical analysis was performed at a 95% confidence level in Stata V.17.

RESULTS

44.1% and 20.2% of women with vaginal and CS delivery observed TIBF, respectively. Odds of TIBF were five times lower in women with CS delivery (adjusted OR 'AOR'=0.21: 95% CI=0.16 to 0.26). TIBF odds increase among women who used skilled prenatal provider (AOR=1.29: 95% CI=1.15 to 1.45), had hospital delivery (AOR=1.34: 95% CI=1.18 to 1.52) and in rich wealth class (AOR=1.44: 95% CI=1.29 to 1.60), respectively. Rural residency, unwanted pregnancy and large child size at birth however reduces the odds. Partial skin-to-skin contacts contributed to about 54% (p<0.05) of the negative effect. TIBF is highest in Kano (3.4%) and lowest in Taraba (0.02%) with topmost impact in Bayelsa state (crude OR 'COR'=63.9: 95% CI=28.2 to 144.9).

CONCLUSIONS

CS exposure reduced the odds of TIBF by fivefolds. Hence, the adverse effect of CS exposure on TIBF. Skin-to-skin contact can reduce the negative effect of CS on TIBF. Early mother-child contact peculiar to CS women is critical for improved breastfeeding practice.

Effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis: a systematic review

OBJECTIVES

To evaluate the efficacy of antituberculosis therapy on pregnancy outcomes in infertile women with genital tuberculosis.

DESIGN

Systematic review.

DATA SOURCES

We searched in PubMed/MEDLINE, CENTRAL and EMBASE up to 15 January 2023. Additionally, we manually search the reference lists of included studies.

ELIGIBILITY CRITERIA

We included randomised controlled trials (RCT), non-RCTs (non-RCT) and cohort studies that evaluated the effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis compared with not receiving antituberculosis treatment or receiving the treatment for a shorter period.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data. We used Cochrane Risk of Bias 1.0 and Risk Of Bias In Non-randomised Studies tools for risk of bias assessment and meta-analysis was not performed. We used Grading of Recommendations, Assessment, Development and Evaluations approach to assess the certainty of the evidence.

RESULTS

Two RCTs and one non-RCT were included. The antituberculosis regimens were based on isoniazid, rifampicin, pyrazinamide and ethambutol for 6-12 months. In women without structural damage, very low certainty of evidence from one RCT showed that the antituberculosis treatment may have little to no effect on pregnancy, full-term pregnancy, abortion or intrauterine death and ectopic pregnancy, but the evidence is very uncertain. In women with structural damage, very low certainty of evidence from one non-RCT showed that the antituberculosis treatment may reduce the pregnancy rate (297 fewer per 1000, 95% CI -416 to -101), but the evidence is very uncertain. In addition, very low certainty of evidence from one RCT compared a 9-month vs 6-month antituberculosis treatment regimen showed similar effects between the schemes, but the evidence is very uncertain. Two RCTs reported that no adverse events of antituberculosis treatment were noted or were similar in both groups.

CONCLUSION

The effect of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis is very uncertain.

PROSPERO REGISTRATION NUMBER

CRD42022273145.

OHVIRA syndrome: hysteroscopy and intraoperative sonography - a value addition in the management

We report a postpubertal case of obstructed hemivagina and ipsilateral renal agenesis syndrome who presented with dysmenorrhoea and light menstrual flow. Imaging modalities confirmed the diagnosis after which vaginal septal incision and drainage was performed. In addition, we also performed vaginoscopy using hysteroscope, both preincision and postincision and drainage, to visualise the vagina and to exclude any communication between two hemivaginas. Completeness of drainage was ensured by performing intraoperative sonography. In a few instances, communication (fistula or microperforation) between the two hemivaginas would result in spontaneous haematocolpos decompression, mimicking normal menstrual flow and often delaying diagnosis. The role of direct visualisation under hysteroscopy should be emphasised in such cases. We postulate that hysteroscopy and intraoperative sonography may aid in better diagnostic and therapeutic management in such cases.

Quality of care from the perspective of people obtaining abortion: a qualitative study in four countries

OBJECTIVE

This qualitative study aimed to identify person-centred domains that would contribute to the definition and measurement of abortion quality of care based on the perceptions, experiences and priorities of people seeking abortion.

METHODS

We conducted interviews with people seeking abortion aged 15-41 who obtained care in Argentina, Bangladesh, Ethiopia or Nigeria. Participants were recruited from hospitals, clinics, pharmacies, call centres and accompaniment models. We conducted thematic analysis and quantified key domains of quality identified by the participants.

RESULTS

We identified six themes that contributed to high-quality abortion care from the clients' perspective, with particular focus on interpersonal dynamics. These themes emerged as participants described their abortion experience, reflected on their interactions with providers and defined good and bad care. The six themes included (1) kindness and respect, (2) information exchange, (3) emotional support, (4) attentive care throughout the process, (5) privacy and confidentiality and (6) prepared for and able to cope with pain.

CONCLUSIONS

People seeking abortion across multiple country contexts and among various care models have confirmed the importance of interpersonal care in quality. These findings provide guidance on six priority areas which could be used to sharpen the definition of abortion quality, improve measurement, and design interventions to improve quality.

Preconception contraceptive use and miscarriage: prospective cohort study

Objectives

To evaluate the association between preconception contraceptive use and miscarriage.

Design

Prospective cohort study.

Setting

Residents of the United States of America or Canada, recruited from 2013 until the end of 2022.

Participants

13 460 female identified participants aged 21-45 years who were planning a pregnancy were included, of whom 8899 conceived. Participants reported data for contraceptive history, early pregnancy, miscarriage, and potential confounders during preconception and pregnancy.

Main outcome measure

Miscarriage, defined as pregnancy loss before 20 weeks of gestation.

Results

Preconception use of combined and progestin-only oral contraceptives, hormonal intrauterine devices, copper intrauterine devices, rings, implants, or natural methods was not associated with miscarriage compared with use of barrier methods. Participants who most recently used patch (incidence rate ratios 1.34 (95% confidence interval 0.81 to 2.21)) or injectable contraceptives (1.44 (0.99 to 2.12)) had higher rates of miscarriage compared with recent users of barrier methods, although results were imprecise due to the small numbers of participants who used patch and injectable contraceptives.

Conclusions

Use of most contraceptives before conception was not appreciably associated with miscarriage rate. Individuals who used patch and injectable contraceptives had higher rates of miscarriage relative to users of barrier methods, although these results were imprecise and residual confounding was possible.

Analysing medical predictors for the outcome of infertility treatment: a 5-year follow-up survey

PURPOSE

For many couples, bearing children is a common life goal; however it cannot always be fulfilled. Undergoing infertility treatment does not always guarantee pregnancies and live births. Couples experience miscarriages and even discontinue infertility treatment. Significant medical predictors for the outcome of infertility treatment have yet to be fully identified.

METHODS

To further our understanding, a cross-sectional 5-year follow-up survey was undertaken, in which 95 women and 82 men that have been treated at the Women's Hospital of Heidelberg University participated. Binary logistic regressions, parametric and non-parametric methods were used for our sample to determine the relevance of biological (infertility diagnoses, maternal and paternal age) and lifestyle factors (smoking, drinking, over- and underweight) on the outcome of infertility treatment (clinical pregnancy, live birth, miscarriage, dropout rate). In addition, chi-square tests were used to examine differences in the outcome depending on the number of risk factors being present.

RESULTS

In the binary logistic regression models for clinical pregnancies, live births and drop outs were statistically significant only for the maternal age, whereas the maternal and paternal BMI, smoking, infertility diagnoses and infections showed no significant predicting effect on any of the outcome variables. A correlation between the number of risk factors and the outcome of infertility treatment could not be excluded.

CONCLUSION

The results confirm that maternal age has an effect on infertility treatment, whereas the relevance of other possible medical predictors remains unclear. Further large-scale studies should be considered to increase our knowledge on their predictive power.

Drug exposure during pregnancy in primary care: an algorithm and observational study from SIDIAP database, Catalunya, Spain

OBJECTIVES

To develop an algorithm to identify pregnancy episodes in women at childbearing age using SIDIAP (Information System for the Improvement of Research in Primary Care) data (Catalunya, Spain).To describe drugs dispensed during gestation.

DESIGN

Construction of an algorithm to identify all pregnancy episodes occurred from January 2011 to June 2020 in women aged 12-50. The variables used to create the algorithm include first day of last menstrual period, reasons for pregnancy termination and diagnoses registered in the primary healthcare records. Population-based cohort study including the pregnancy episodes identified by the algorithm.

SETTING

Catalonia, Spain.

PARTICIPANTS

All women aged 12-50 with at least one pregnancy episode occurred during January 2011-June 2020.

INTERVENTIONS

No interventions performed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Identification of pregnancy episodes through an algorithm and description of drug exposure.

RESULTS

We identified 327 865 pregnancy episodes in 250 910 people with a mean age of 31.3 years. During the study period, 83.4% of the episodes were exposed to at least one drug. The most frequent groups dispensed were iron preparations (48% of pregnancy episodes), iodine therapy (40.2%), analgesics and antipyretics (28%), penicillins (19.8%), vitamin B12 plus folic acid (19.7%) and non-steroidal anti-inflammatory drugs (NSAIDs, 15.1%). The supplements were more frequently dispensed at least twice, and the drugs for acute conditions were mainly dispensed only once during the pregnancy episode.

CONCLUSIONS

We developed an algorithm to automatically identify the pregnancy periods in SIDIAP.We described prescription drugs used during pregnancy. The most used ones were supplements, analgesics, NSAID or antibiotics.SIDIAP might be an efficient database to study drug safety during pregnancy and the consequences of drug use in the offspring.

TRIAL REGISTRATION NUMBER

EUPAS37675.

Nuclear transfer improves the developmental potential of embryos derived from cytoplasmic deficient oocytes

Embryo development after fertilization is largely determined by the oocyte quality, which is in turn dependent on the competence of both the cytoplasm and nucleus. Here, to improve the efficiency of embryo development from developmentally incompetent oocytes, we performed spindle-chromosome complex transfer (ST) between in vitro matured (IVM) and in vivo matured (IVO) oocytes of the non-human primate rhesus monkey. We observed that the blastocyst rate of embryos derived from transferring the spindle-chromosome complex (SCC) of IVM oocytes into enucleated IVO oocytes was comparable with that of embryos derived from IVO oocytes. After transferring the reconstructed embryos into the uterus of surrogate mothers, two live rhesus monkeys were obtained, indicating that the nuclei of IVM oocytes support both the pre-and post-implantation embryo development of non-human primates.

Changing clinical significance of oocyte maturity grades with advancing female age advances precision medicine in IVF

In current IVF practice, metaphase-2 (M2) oocytes are considered most efficient in producing good quality embryos. Maximizing their number at all ages is standard clinical practice, while immature germinal vesicle (GV) oocytes are mostly automatically discarded. We present preliminary evidence that oocyte maturity grades with advancing age significantly change in their abilities to produce good quality embryos, with M2 oocytes significantly declining, GV oocytes improving, and M1 oocytes staying the same. These data contradict the over-40-year-old dogma that oocyte grades functionally do not change with advancing age, supporting potential changes to current IVF practice: (1) Stimulation protocols and timing of oocyte retrieval can be adjusted to a patient's age and ovarian function. (2) In older and younger women with prematurely aging ovaries, GV oocytes may no longer be automatically discarded. (3) In some infertile women, rescue in vitro maturation of immature oocytes may delay the need for third-party egg donation.

Acute lower limb ischaemia secondary to aortic compression from uterine fibroid

A woman in her early 50s with uncontrolled diabetes mellitus and a huge uterine fibroid presented to the emergency department with diabetic ketoacidosis and bilateral acute lower limb ischaemia. Vascular and advanced imaging studies confirmed distal aortic compression by a huge uterine fibroid, resulting in extensive lower limb arterial thrombosis. After resuscitation, the patient underwent emergency hysterectomy, thromboembolectomy and amputation of the right leg. She remained critically ill and died of fulminant sepsis and multiorgan failure 10 days later. This case reports the effects of external vascular compression by a large pelvic mass.

Effectiveness of oestrogen pretreatment in patients with expected poor ovarian response (POSEIDON groups 3 and 4) undergoing GnRH antagonist protocol: study protocol for a randomised controlled trial

INTRODUCTION

Women characterised by diminished ovarian reserve are considered to have poor ovarian response (POR) according to Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria. Patients in this population often have a poor prognosis for treatment with assisted reproductive technology. In previous studies, oestrogen pretreatment before ovarian stimulation has been shown to have a beneficial effect. However, recent studies presented conflicting conclusions. This study aims to evaluate the effectiveness of oestrogen pretreatment in patients with expected POR (POSEIDON groups 3 and 4) undergoing gonadotrophin releasing hormone antagonist (GnRH-ant) protocol.

METHODS AND ANALYSIS

A prospective superiority randomised parallel controlled trial will be conducted at a tertiary university-affiliated hospital. A total of 316 patients will be randomly divided into two groups at a ratio of 1:1. In the intervention group, oral oestrogen pretreatment will be administered from day 7 after ovulation until day 2 of the next menstrual cycle. Afterwards, a flexible GnRH-ant protocol will be initiated. The control group will receive no additional intervention beyond routine ovarian stimulation. The primary outcome is the number of oocytes retrieved. Secondary outcomes include the total number of retrieved metaphase II oocytes, average daily dose of gonadotropin, total gonadotropin dose and duration of ovarian stimulation, cycle cancellation rate, top quality embryos rate, blastocyst formation rate, embryo implantation rate, clinical pregnancy rate, early miscarriage rate and endometrial thickness on trigger day. All data will be analysed according to the intention-to-treat and per-protocol principles.

ETHICS AND DISSEMINATION

The ethical approval has been confirmed by the reproductive ethics committee of the affiliated hospital of Shandong University of Traditional Chinese Medicine (SDUTCM/2022.9.20). In addition, written informed consent will be obtained from all the participants before the study. The results will be disseminated via publications.

TRIAL REGISTRATION NUMBER

ChiCTR2200064812.

Factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City, Northern Uganda: a facility-based cross-sectional study

OBJECTIVE

This study aimed at assessing factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City.

DESIGN

A cross-sectional study.

SETTINGS

The study was conducted in health facilities offering ANC services in Lira City, Northern Uganda.

PARTICIPANTS

The study was among 368 pregnant mothers attending their first ANC in the three selected facilities (Lira Regional Referral Hospital, Ober Health Center IV and Pentecostal Assembly of God Mission Health Center IV) in Lira City.

PRIMARY AND SECONDARY OUTCOME MEASURES

Level of first ANC attendance within 12 weeks of pregnancy and associated factors.

RESULTS

Early ANC attendance was 36.1%. Women who were: unmarried (adjusted OR (aOR): 0.40, 95% CI: 0.16 to 0.99), took >2 hours to reach a health facility (aOR: 0.21, 95% CI: 0.07 to 0.62), or not visited by village health teams or healthcare workers at home (aOR: 0.33, 95% CI: 0.12 to 0.92) were less likely to attend their first ANC early. On the other hand, women who were: not knowing first that ANC guides parents on infant care (aOR: 2.22, 95% CI: 1.06 to 4.67); pregnant without consent of spouse (aOR: 4.29, 95% CI: 1.75 to 10.55); attending ANC from a private facility (aOR: 2.89, 95% CI: 1.27 to 6.15); and having two to three healthcare workers present at the ANC clinic (aOR: 1.79, 95% CI: 1.03 to 3.13) were more likely to attend ANC early.

CONCLUSIONS

Despite the fact that the WHO recommends that all women begin ANC within 12 weeks after conception, Lira City in Northern Uganda had a low overall incidence of timely ANC initiation. Being unmarried, distance to reach a health facility, and being visited by village health teams or healthcare workers at home were all linked to timely ANC commencement. As a result, intervention efforts should concentrate on the highlighted determinants in order to promote ANC initiation in Lira City, Northern Uganda. This can be accomplished by providing information and education to the community on the timing and necessity of ANC in Northern Uganda.

Teen pregnancy involvement among African, Caribbean and Black adolescent boys and girls: a scoping review protocol

INTRODUCTION

African, Caribbean and Black (ACB) adolescents are disproportionately affected by teen pregnancy in North America. Teen pregnancy poses risks to the quality of life of adolescent boys and girls, including physical, psychosocial and socioeconomic risks. Our review aims to explore this public health concern for ACB adolescents within North America. We aim to identify and analyse available evidence on the incidence and prevalence of, associated factors of and interventions to curtail teen pregnancy involvement (TPI) among ACB adolescent boys and girls in North America. This review will explore TPI, rather than teen pregnancy, to ensure a review of men' involvement in teen pregnancy outcomes.

METHODS AND ANALYSES

Health literature databases such as CINAHL, OVID (Medline and Embase) and CAB direct. Searches will be conducted for evidence published from 2001 to October 2021. Search results will be exported to Covidence for subsequent steps of the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines will be used to ensure reproducibility and transparency. We will include all study designs focused on ACB boys and girls between 10 and 19 years old, residing in North America. Studies with a mixed racial sample will be included if sample consists of greater than 50% ACB individuals.

ETHICS AND DISSEMINATION

TPI is a public health concern with socioeconomic and health consequences for ACB teens in North America. A scoping review such as this will provide direction for healthcare practice, policy changes, education and further research in reducing the incidence of TPI in North America. Study results will be disseminated via presentations at conferences, at target populations, communities and organisations and publications via peer-reviewed journals. As knowledge generated from this scoping review will stem from previously published evidence, an ethical approval is not needed.

Patient and professional perspectives about using in vitro fertilisation add-ons in the UK and Australia: a qualitative study

OBJECTIVES

In vitro fertilisation (IVF) add-ons are additional procedures offered alongside an IVF cycle with the aim of improving live birth rates. They are controversial because of the paucity of evidence to support their efficacy and safety, alongside the additional financial cost they often pose to patients. Despite this, they are popular. However, there is limited qualitative research regarding their use. The aims of the VALUE Study were to understand the decision-making process surrounding using or recommending add-ons; report sources of information for add-ons; and explore concerns for safety and effectiveness when considering their use.

DESIGN

'VALUE' is a qualitative semistructured interview study using inductive thematic analysis of anonymised transcriptions.

SETTING

Participants were recruited from a broad geographical spread across the UK and Australia from public and private clinical settings.

PARTICIPANTS

Patients (n=25) and health professionals (embryologists (n=25) and clinicians (n=24)) were interviewed. A purposive sampling strategy was undertaken. The sampling framework included people having state-subsidised and private cycles, professionals working in public and private sectors, geographical location and professionals of all grades.

RESULTS

Patients often made decisions about add-ons based on hope, minimising considerations of safety, efficacy or cost, whereas professionals sought the best outcomes for their patients and wanted to avoid them wasting their money. The driving forces behind add-on use differed: for patients, a professional opinion was the most influential reason, whereas for professionals, it was seen as patient driven. For both groups, applying the available evidence to individual circumstances was very challenging, especially in the sphere of IVF medicine, where the stakes are high.

CONCLUSIONS

There is scope to build on the quality of the discourse between patients and professionals. Patients describe valuing their autonomy with add-ons, but for professionals, undertaking informed consent will be critical, no matter where they sit on the spectrum regarding add-ons.

TRIAL REGISTRATION

osf.io/vnyb9.

Effectiveness of laparoscopic niche resection versus expectant management in patients with unexplained infertility and a large uterine caesarean scar defect (uterine niche): protocol for a randomised controlled trial (the LAPRES study)

INTRODUCTION

A uterine niche is a defect at the site of the uterine caesarean scar that is associated with gynaecological symptoms and infertility. Promising results are reported in cohort studies after a laparoscopic niche resection concerning reduction of gynaecological symptoms in relation to baseline and concerning pregnancy outcomes. However, randomised controlled trials to study the effect of a laparoscopic niche resection on reproductive outcomes in infertile women are lacking. This study will answer the question if laparoscopic niche resection in comparison to expectant management improves reproductive outcomes in infertile women with a large uterine niche.

METHODS AND ANALYSIS

The LAPRES study is a randomised, non-blinded, controlled trial, including 200 infertile women with a total follow-up of 2 years. Women with the presence of a large niche in the uterine caesarean scar and unexplained infertility of at least 1 year or failed IVF will be randomly allocated to a laparoscopic niche resection within 6 weeks or to expectant management for at least 9 months. A large niche is defined as a niche with a depth of >50% of the myometrial thickness and a residual myometrium of ≤3 mm on transvaginal ultrasound. Those receiving expectant management will be allowed to receive fertility therapies, including assisted reproductive techniques, if indicated. The primary outcome is time to ongoing pregnancy, defined as a viable intrauterine pregnancy at 12 weeks' gestation. Secondary outcome measures are time to conception leading to a live birth, other pregnancy outcomes, received fertility therapies after randomisation, menstruation characteristics, patient satisfaction, quality of life, additional interventions, and surgical and ultrasound outcomes (intervention group). Questionnaires will be filled out at baseline, 6, 12 and 24 months after randomisation. Ultrasound evaluation will be performed at baseline and at 3 months after surgery.

ETHICS AND DISSEMINATION

The study protocol was approved by the medical ethics committee of the Amsterdam University Medical Centre. (Ref. No. 2017.030). Participants will sign a written informed consent before participation. The results of this study will be submitted to a peer-reviewed journal for publication. TRIAL REGISTRATION NUMBER DUTCH TRIAL REGISTER REF NO NL6350 : http://www.trialregister.nl.

Physical violence during pregnancy in sub-Saharan Africa: why it matters and who are most susceptible?

OBJECTIVE

The study assessed the prevalence of physical violence against pregnant women and its associated factors in sub-Saharan Africa (SSA).

DESIGN

We analysed cross-sectional data of 108971 women in sexual unions from the most recent Demographic and Health Surveys of 26 countries in SSA. The predictors of physical violence were examined using a multilevel binary logistic regression. All the results were presented as adjusted odds ratios (aORs) with their corresponding 95% confidence intervals (CIs).

SETTING

Twenty-six countries in SSA.

PARTICIPANTS

108 971 women who had ever been pregnant.

OUTCOME MEASURE

Physical violence during pregnancy.

RESULTS

Physical violence was identified in 6.0% of pregnant women in SSA. The highest prevalence (14.0%) was reported in South Africa, while Burkina Faso recorded the lowest (2.1%). Women who had primary (aOR=1.26, 95% CI=1.15, 1.38) and secondary education (aOR=1.15, 95% CI=1.01,1.32); those who were cohabiting (aOR=1.21, 95% CI=1.11, 1.32); those who were working (aOR=1.17, 95% CI=1.08, 1.28); and those whose partners had primary (aOR=1.15, 95% CI=1.04, 1.28) and secondary education (aOR=1.14, 95% CI=1.01, 1.28) were more likely to experience physical violence during pregnancy compared with those who had no formal education; those who were married; those who were not working, and those whose partners had no formal education, respectively. Moreover, women whose partners consumed alcohol (aOR=2.37, 95% CI=2.20, 2.56); those who had parity of four or more (aOR=2.06, 95% CI=1.57, 2.72); and those who perceived intimate partner violence (IPV) as a culturally accepted norm (aOR=1.55, 95% CI=1.44, 1.67) had higher odds of experiencing physical violence during pregnancy compared to those whose partners did not consume alcohol, those with parity zero, and those who did not perceive IPV as culturally accepted, respectively. On the contrary, women who were aged 35-39, those who were of the richest wealth index, and those in rural areas had reduced odds of experiencing physical violence during pregnancy.

CONCLUSION

Based on the findings, community leaders are encouraged to liaise with law enforcement agencies to strictly enforce laws on gender-based violence by prosecuting perpetrators of IPV against pregnant women as a deterrent. Also, intensifying education on what constitutes IPV and the potential consequences on the health of pregnant women, their children, and their families will be laudable. Improving the socioeconomic status of women may also help to eliminate IPV perpetration against women at their pregnancy stage.