Fertility decision-making during the Zika virus epidemic in Brazil: Where is the decision?

BackgroundIn 2016, a Public Health Emergency of International Concern (PHEIC) was declared in response to the rise of microcephaly cases among newborns in Northeastern Brazil. A common reactionary measure by public health authorities was to recommend women postpone pregnancy to avoid the possible perinatal transmission of Zika virus (ZIKV).MethodsThe purpose of this study was to assess how women in Fortaleza, Brazil conceptualize pregnancy; experience facilitators and barriers to pregnancy avoidance; perceive the authorities’ recommendation to postpone pregnancy due to the ZIKV outbreak; and recall their experiences during the ZIKV epidemic. Qualitative methods, specifically a Rapid Anthropological Assessment (RAA), were utilized in this study. Data collection included semi-structured interviews, triangulated with observations and informal interviews with community members.ResultsThe sample included 35 women (18–39 years old) who exclusively utilized the national public health care system. Findings indicated that all participants perceived the ZIKV pregnancy-postponement recommendation to be counter-cultural to Brazilian social norms. Overall women’s self-perceived agency to prevent pregnancy was low due to social expectations and lack of trust for contraceptives. ZIKV prevention was not seen as a reason to utilize contraceptives. Interestingly, only women who self-perceived as more affluent were willing to attempt pregnancy prevention for educational, occupational, or financial opportunity.ConclusionPregnancy postponement as a response to a ZIKV epidemic ignores gaps in reproductive agency and defies social norms, making it unrealistic and counter-cultural. Future ZIKV health recommendations must be culturally aligned with the population, and address barriers and motivators for family planning.     

双胎妊娠两次经阴道宫颈环扎成功分娩一例并文献复习

宫颈机能不全是导致妊娠晚期反复流产和早产的主要原因之一。早产可增加围生期发病率与死亡率,给妊娠妇女及家庭带来严重心理和经济负担。目前在国内外,宫颈环扎术被推荐使用于单胎妊娠,对其在双胎妊娠中的应用报道较少,指征不明确。回顾分析1例双胎妊娠经2次宫颈环扎术获2名健康活婴的病例资料并进行文献复习,探讨宫颈环扎术在双胎妊娠中的应用。     

注射用甲磺酸胺银杏内酯B对围产期仔鼠生长及组织器官发育的影响

目的 观察注射用甲磺酸胺银杏内酯B(XQ-1H)对哺乳期仔鼠的一般生长状况以及对仔鼠组织器官发育的影响,研究其伴随的毒代动力学,为XQ-1H围产期安全性评价提供依据.方法 将108只受精SD大鼠随机均分为溶媒对照组和3个给药(20、10、5 mg·mL-1)实验组.对照组大鼠给予0.9％氯化钠溶液,实验组给药剂量分别为100、50、25 mg·kg-1 ·d-1.于妊娠期第15天开始给药,每天1次,连续给药至哺乳期结束(出生后第21天),于尾静脉注射,给药容积为5 mL·kg-1.实验组取3只孕鼠于妊娠20 d进行剖宫,取各给药组仔鼠进行解剖,检查XQ-1H是否可通过胎盘屏障进入仔鼠.仔鼠出生4d后,每窝留10只,各给药组选择2只剔除仔鼠进行解剖,检查XQ-1H是否可通过乳汁分泌进入仔鼠.给药组24只孕鼠于哺乳期结束时处死母鼠,观察指标包括仔鼠的一般观察、出生畸形、体重、摄食量及解剖后观察组织器官的发育情况.结果 XQ-1H可通过母体胎盘屏障,不可由哺乳通过乳汁传递给子代;与对照组相比,各给药组仔鼠一般生长状况未出现统计学差异;子代各组织器官发育良好,与对照组比较无统计学差异.结论 XQ-1H对子代生长及组织器官发育无不良影响.     

四川省眉山市农村老年女性生殖健康现状调查

目的:调查四川省眉山市农村60~75岁老年女性生殖健康现状,为本地区老年女性生殖健康促进提供依据。方法:采分层整群抽样抽取调查对象434名,采用自制调查表,结合临床检查工具进行生殖健康调查。SPSS13.0软件对数据进行描述性分析和Logistic回归影响因素分析。结果:71.1%(288/413)的调查对象患生殖系统疾病,多因素校正logistic回归结果显示,年龄大、文化程度低、个人收入低、未与子女同住是影响调查对象生殖健康的不利因素(P均0.05)。结论:应加强对调查地区农村老年女性的生殖健康干预,尤其应加强对70~75岁、文化程度较低、低收入且独居的老年人群的重点干预。     

天津地区育龄期女性不孕症流行病学调查

目的:调查天津地区育龄期女性不孕症患病率,探讨不孕症相关危险因素和生育力预测指标。方法:分层整群抽样1997名20~50岁育龄期女性进行不孕症的横断面调查。结果:天津地区育龄女性的不孕症患病率为5.96%,不同的年龄段、结婚年龄、流产史、肥胖、月经不规律及痛经史、男方因素、高应激状态等不孕症的患病率不同(P0.05)。不孕组抗苗勒管激素(AMH)水平高于对照组,差异有统计学意义(P0.05)。结论:天津地区育龄期女性不孕症的患病率与年龄、结婚年龄、盆腔炎性疾病、流产史、肥胖、月经史、男方因素、高应激状态及环境因素有关,AMH可以作为评估卵巢储备的一项指标。     

辅助生殖技术实施后随访系统建立

1978年人类第1例试管婴儿诞生至今,仅37年。作为一个新兴学科,辅助生殖技术还有许多问题值得研究。辅助生殖技术的很多数据,如妊娠率、种植率和活产率,不仅医疗机构和医务工作者关心,不孕不育夫妇也非常关心。临床实践表明,辅助生殖技术实施后建立随访系统意义重大。如何建立标准化的随访系统是值得关注的话题。随着技术不断发展,追求的目的也在改变,例如从妊娠率到生育一个健康孩子,从短期随访到长期随访,从表面的数字到发现数字后面的真实问题等。同时目前各国在辅助生殖技术实施后随访系统的建立还是存在差别的。介绍我国和国外辅助生殖技术实施后随访系统及其临床应用情况。     

肥胖与育龄期女性生殖功能研究进展

女性生殖功能受众多因素影响,肥胖是引起育龄期女性生殖能力降低的重要因素之一.育龄期肥胖女性可表现为月经紊乱,排卵障碍甚至不孕.肥胖与多囊卵巢综合征互为因果.肥胖影响辅助生殖技术的结局,使自然流产的风险增高,影响到妊娠的结局.避免超重及肥胖,积极控制多余体重,提高肥胖女性生育能力.     

Predictors of caregiver supportive behaviors towards reproductive health care for women with intellectual disabilities

Although many previous studies have begun to address the reproductive health needs of women with intellectual disabilities; however, the supportive behaviors of caregivers to assist their reproductive health is not well understood. Data from a cross-sectional survey of “2009 National Survey on Reproductive Health Care Needs and Health Education Strategies for Women with Intellectual Disabilities in Taiwan” were analyzed. Study sample consisted of 1152 caregivers who working in 32 disability institutions have been analyzed in the study. The results showed that the caregiver did not have adequate supportive behaviors towards reproductive health care for women with ID (mean score was 29.84 out of 60), particularly in the arrangement of preventive reproductive health services. We analyzed the potential significant variables in a multiple linear regression model to examine the factors which affect the caregiver's supportive behaviors of reproductive health for women with ID. The model revealed that the factor of respondent's gender, job category, working years in disability setting, helping experience of reproductive health for women with ID, perception of reproductive health knowledge, in-job training of reproductive health, perceived adequacy of public reproductive health service for the client, scores of reproductive health knowledge and reproductive health attitude were significantly correlated to their supportive behavioral score of reproductive health for women with ID. These factors can explain 23.6% of the variation of supportive behavioral score. The present study suggests the reproductive health interventions need to take into account the perspectives of health workers, caregivers and women, as well as the constraints they face in providing and receiving services, respectively.     

Variation of seizure frequency with ovulatory status of menstrual cycles

Purpose: To determine if seizure frequency differs between anovulatory and ovulatory cycles. Methods: The data came from the 3‐month baseline phase of an investigation of progesterone therapy for intractable focal onset seizures. Of 462 women who enrolled, 281 completed the 3‐month baseline phase and 92 had both anovulatory and ovulatory cycles during the baseline phase. Midluteal progesterone levels ≥5 ng/ml were used to designate cycles as ovulatory. Among the 92 women, average daily seizure frequency (ADSF) for all seizures combined and each type of seizure considered separately (secondary generalized tonic–clonic seizures – 2°GTCS, complex partial seizures – CPS, simple partial seizures – SPS) were compared between anovulatory and ovulatory cycles using paired t‐tests. A relationship between the proportional differences in ADSF and estradiol/progesterone (EP) serum level ratios between anovulatory and ovulatory cycles was determined using bivariate correlational analysis. Key Findings: ADSF was 29.5% greater for 2°GTCS during anovulatory than during ovulatory cycles. ADSF did not differ significantly for CPS or SPS or for all seizures combined. Proportional differences in anovulatory/ovulatory 2°GTCS ADSF ratios correlated significantly with differences in anovulatory/ovulatory EP ratios. Among the 281 women, the three seizure types did not differ in ovulatory rates, but EP ratios were greater for cycles with 2°GTCS than partial seizures only. Significance: Seizure frequency is significantly greater for 2°GTCS, but not CPS or SPS, during anovulatory cycles than ovulatory cycles. Because the proportional increases in 2°GTCS frequency during anovulatory cycles correlate with the proportional increases in EP level ratios, these findings support a possible role for reproductive steroids in 2°GTCS occurrence.