Prevention of unintended pregnancies by using emergency contraception: the differences between levonorgestrel and ulipristal acetate. A theoretical model using data from a survey on the use of emergency contraception in Spain, 2017

Objective: To estimate the differences in unintended pregnancies avoided using either levonorgestrel (LNG) or ulipristal acetate (UPA) emergency contraception (EC).

Design: Cross-sectional study.

Setting: Survey carried out in Spain.

Participants: 1000 Spanish women reporting unprotected sex in 2017.

Main measurements: EC use, reasons for not using EC, calculation of the number of unintended pregnancies avoided.

Results: 39% of Spanish women having had unprotected sex used EC. 61% of those women did not use EC and 11% did not know the existence of this resource. In 2017 the use of EC prevented 101,271 unintended pregnancies. If instead of using LNG every woman had used UPA another 15,979 additional pregnancies could have been prevented.

Conclusions: If all Spanish women having unprotected sex used EC we could expect a significant decrease in the number of unintended pregnancies and abortions. Using UPA instead of LNG would have a greater impact on that reduction with the corresponding benefit for women and society as a whole.     

Are non-pregnant women afraid of childbirth? Prevalence and predictors of fear of childbirth in students

Introduction: Fear of childbirth (FOC) has been mostly studied in peripartum women; however, it can be present in non-pregnant young women, and the question is whether it occurs even before pregnancy planning.

Objective: (1) to determine the prevalence of clinically significant FOC in non-pregnant female students, and (2) to investigate the role of anxiety sensitivity (AS), trait anxiety, childbirth pain expectancy, and sources of birth knowledge for FOC.

Methods: Non-pregnant female students (N?=?374) from different study programmes (health studies, social sciences and humanities, and biotechnical studies) participated in the study. They completed

Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ, version A), The State–Trait Anxiety

Inventory (STAI-T), Anxiety Sensitivity Index (ASI), the average expected labor pain, and sources

of information about childbirth.

Results: The results showed that 25.9% of students reported clinically significant FOC. FOC could be predicted by postponing pregnancy planning, the high expectancy of labor pain, high trait anxiety, and high physical dimension of AS. Students from health sciences reported a lower level of FOC, as opposed to social science and humanities’ students. Students reported receiving the most information about childbirth from family and the least from the professional books.

Conclusions: Fear of childbirth is highly prevalent in the sample of young nulliparous women with one in four women reporting clinically significant fear. The higher levels of the FOC could be predicted, by AS, trait anxiety, expected labor pain, and sources of knowledge about the childbirth. Implications of the findings are discussed.     

The relationship between pain at IUD insertion and negative perceptions,anxiety and previous mode of delivery

Objective: The aim of the study was to better understand the relationship between pain during intrauterine device (IUD) insertion and anxiety, negative perceptions of IUDs and previous mode of delivery, in parous women.

Methods: We conducted a prospective cohort study between June and September 2018 in 210 women who opted for IUD placement for contraception. Sixty-six women who had previously had only vaginal delivery under epidural analgesia were allocated to the epidural delivery group; 60 women who had previously had at least one vaginal delivery without epidural analgesia were allocated to the vaginal delivery group; and 84 women who had previously had only caesarean delivery were allocated to the caesarean delivery group. Participants’ levels of anxiety before insertion were measured using the Beck Anxiety Inventory; participants’ levels of pain (anticipated pain and pain at the various stages of IUD insertion and 15?min after the procedure) were assessed using a visual analogue scale.

Results: While the experience of caesarean delivery and pre-procedure anxiety were found to be associated with higher pain scores, the presence of negative perceptions of IUDs was the most significant predictor of pain during IUD insertion (p?<?.001). Experience of vaginal delivery under epidural analgesia was associated with lower pain scores at IUD insertion (p?<?.001).

Conclusion: Fear of IUD insertion pain, pre-procedure anxiety and negative perceptions of IUDs may lead women to anticipate or feel a higher level of pain. Patient education to correct negative perceptions of IUDs and counselling to inform women of the true benefits and risks of IUDs and lower pre-procedure anxiety are a suggested strategy to manage IUD insertion pain in parous women.     

Hypertensive disorders of pregnancy increase the risk of developing neovascular age-related macular degeneration in later life

Background: Hypertensive disorders of pregnancy (HDP) and short-term adverse outcomes have long been recognized; however, survivors remain at risk of long-term complications. We investigated whether HDP is associated with the development of choroidal neovascular age-related macular degeneration (CNV AMD).

Methods: We identified 31,454 women who experienced HDP based on Utah birth certificates and 62,908 unexposed women matched 2:1 to the exposed. Risk of CNV AMD was estimated using Cox models.

Findings: Women with HDP exhibited an 80% higher risk for early CNV AMD (age < 70 y; 95%CI 1.23–2.58).

Conclusion: Our findings may have implications forearlier CNV AMD screening and detection.     

Ultrasound characteristics and outcome of prenatally diagnosed fetal cholelithiasis

Aim: To investigate ultrasound characteristics and outcome in fetuses with cholelithiasis.

Materials and methods: We report a small case series of three patients with prenatally diagnosed fetal cholelithiasis. Ultrasound features, pregnancy outcome and neonatal follow-up are presented and discussed.

Results: Sonographic pattern associated to fetal cholelithiasis is variable. Pregnancy issue is globally good with no ominous fetal or neonatal events.

Conclusions: Prenatally diagnosed fetal cholelithiasis is a rare finding and doesn’t seem to carry an adverse effect on the pregnancy.     

Urinary neutrophil gelatinase-associated lipocalin is associated with preeclampsia in a cohort of Turkish women

Purpose: We investigated the optimal cut-off level for urinary neutrophil gelatinase-associated lipocalin (NGAL) in preeclamptic patients to confirm the diagnosis.

Methods: Urinary NGAL concentrations were measured by specific enzyme-linked immunosorbent assay (ELISA).

Results: Patients with preeclampsia had significantly higher urinary NGAL concentrations than controls (mean: 387 ng/ml vs. 188 ng/ml, respectively; P< 0.001). Using a cutoff value 252 ng/ml for urinary NGAL to confirm diagnosis of preeclampsia, sensitivity, and specificity were 92% and 91%, respectively.

Conclusion: Urinary NGAL concentrations were significantly elevated in women with preeclampsia versus normotensive controls.     

Prenatal diagnosis of intra hepatic arterio venous fistula: case report and review of the literature

Aim: To describe the prenatal features and management of a congenital intra hepatic fistula.

Material and methods: Case report

Results: Congenital intra hepatic fistula are extremely rare. The prenatal ultrasound seiology is described.

Conclusion: Prenatal diagnosis of these anomalies may improve pre and post natal management.     

Vaginal misoprostol before copper IUD insertion after previous insertion failure: a double-blind,placebo-controlled,parallel-group,randomised clinical trial

Objective: The aim of the study was to assess whether vaginal administration of misoprostol before copper intrauterine device (IUD) insertion increased the success of the procedure among parous women with previous insertion failure.

Methods: A single-centre, parallel-group, double-blind, placebo-controlled, randomised clinical trial was conducted at Ain Shams University Maternity Hospital, Cairo, Egypt, between October 2015 and August 2016. The study comprised 90 parous women undergoing TCu380A IUD insertion after a failed attempt. A computer-generated list of random numbers was used to assign participants to receive either misoprostol 200?μg or a placebo tablet, applied vaginally 10?h and 4?h prior to the second attempted IUD insertion, without ultrasound guidance. The primary outcome was the success of IUD insertion. Secondary outcomes were to establish the effect on insertion success of cervical dilation, cervical softening and previous mode of delivery.

Results: Forty-two women (93.3%) in the misoprostol group and 24 women (53.3%) in the placebo group had a successful IUD insertion (p?<?.001). Cervical dilation was required in 24 women in the misoprostol group and 44 women in the placebo group. Misoprostol application significantly increased insertion success in women with previous caesarean delivery (p?<?.001) but did not affect insertion success in women with previous vaginal delivery (p?=?.481).

Conclusion: Vaginal misoprostol before IUD insertion in parous women with previous insertion failure increased the rate of successful insertion, particularly in women with previous caesarean delivery.     

The reduction of melatonin levels is associated with the development of preeclampsia: a meta-analysis

Objective: The aim of this analysis was to demonstrate the association between melatonin levels and the development of preeclampsia.

Methods: Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using a random effects model.

Results: The pooled SMD between case and control was 1.40 (95% CI: 0.26, 2.55; P = 0.02). And the pooled SMD between mild PE and severe PE was 5.25 (95% CI: 1.5, 9.01; P = 0.006).

Conclusion: The meta-analysis illustrated that melatonin concentration was significantly lower in women with preeclampsia, and correlated with the severity of the disease.     

Haptotherapy as a new intervention for treating fear of childbirth: a randomized controlled trial

Objective: To evaluate the effect of haptotherapy on severe fear of childbirth in pregnant women.

Design: Randomized controlled trial.

Setting: Community midwifery practices and a teaching hospital in the Netherlands.

Population or Sample: Primi- and multigravida, suffering from severe fear of childbirth (N?=?134).

Methods: Haptotherapy, psycho-education via Internet and care as usual were randomly assigned at 20–24?weeks of gestation and the effects were compared at 36?weeks of gestation and 6?weeks and 6?months postpartum. Repeated measurements ANOVA were carried out on the basis of intention to treat. Since there were crossovers from psycho-education via Internet and care as usual to haptotherapy, the analysis was repeated according to the as treated principle.

Main outcome measures: Fear of childbirth score at the Wijma Delivery Expectancy/Experience Questionnaire.

Results: In the intention to treat analysis, only the haptotherapy group showed a significant decrease of fear of childbirth, F(2,99)?=?3.321, p?=?.040. In the as treated analysis, the haptotherapy group showed a greater reduction in fear of childbirth than the other two groups, F(3,83)?=?6.717, p?<?.001.

Conclusion: Haptotherapy appears to be more effective in reducing fear of childbirth than psycho-education via Internet and care as usual.     

The analysis of negative birth experiences of mothers: a qualitative study

Objective: The aim of this study is to analyse the factors associated with a negative childbirth experience from the perspective of the women who gave birth vaginally.

Background: A negative birth experience can pose a risk for both the maternal/newborn health and the health of the community by disturbing the physical and spiritual health of the woman/family.

Methods: This qualitative study was conducted with 11 mothers who gave birth vaginally assisted by midwives in a state hospital. The data were collected using in-depth interviews and analysed using the thematic analysis technique.

Results: The factors causing the women to have negative birth perceptions were analysed under four main themes: challenges/difficulties encountered, the inadequate communication of health professionals, embarrassment/privacy and inadequate hospital facilities. The mothers indicated that they had experienced their births negatively due to personal reasons such as the inability to cope with labour pain, inability to push, hospital policies such as interventions at birth and hunger. In addition, some of the participants stated that they had difficulty and felt embarrassed during vaginal examinations.

Conclusion: The sociocultural characteristics of mothers, hospital facilities and rules, medical and traditional practices at birth, inadequate empathic communication of health professionals and reproductive health policies can lead to negative childbirth experiences.     

Longitudinal assessment of D-dimer and plasminogen activator inhibitor type-1 plasma levels in pregnant women with risk factors for preeclampsia

Objective: Investigating D-Dimer/D-Di and plasminogen activator inhibitor type-1/PAI-1 levels throughout gestation in women with preeclampsia/PE risk factors.

Methods: D-Di and PAI-1 plasma levels were determined in 28 women at 12–19, 20–29, 30–34 and 35–40 weeks of gestation.

Results: D-Di was lower at 12–19 weeks and higher at 30–34 weeks in women who developed PE versus who did not develop it. D-Di increased throughout gestation in both groups, peaking earlier in pregnant women who developed PE versus who did not develop it. PA1-1 increased across gestation, but it didn’t differ between groups.

Conclusion: D-Di was able to discriminate these groups of women at 12–19 and 30–34 weeks of gestation.     

External validation of prognostic models for preeclampsia in a Dutch multicenter prospective cohort

Objective: To perform an external validation of all published prognostic models for first-trimester prediction of the risk of developing preeclampsia (PE).

Methods: Women <14 weeks of pregnancy were recruited in the Netherlands. All systematically identified prognostic models for PE that contained predictors commonly available were eligible for external validation.

Results: 3,736 women were included; 87 (2.3%) developed PE. Calibration was poor due to overestimation. Discrimination of 9 models for LO-PE ranged from 0.58 to 0.71 and of 9 models for all PE from 0.55 to 0.75.

Conclusion: Only a few easily applicable prognostic models for all PE showed discrimination above 0.70, which is considered an acceptable performance.     

Quality of life in Japanese couples during the transition to parenthood

Objective: This study aimed to examine the quality of life (QOL) in Japanese couples during the transition to parenthood with their first child.

Background: Relevant literature suggests that the health status of women drop during pregnancy and the postpartum period. However, less is known about their partner’s well-being during the transition to parenthood and little research has addressed the relationship between couples’ QOL across multiple domains.

Method: Participants included 9216 married Japanese men and women, including 3729 couples, who were expecting or raising their first child under the age of three. They independently completed questionnaires on baseline demographics and on WHOQOL-BREF.

Results: Men showed higher scores for psychological QOL, while women had higher scores for social and environment QOL. A significant interaction between gender and stage of transition to parenthood was found. The moderating effect of age between the stage and QOL was found for men on the physical and psychological domains. Couples’ QOL scores were weakly to moderately correlated.

Conclusion: Findings suggest that both men and women had lower QOL, with the exception of women’s physical QOL, after childbirth, but they showed different trends during the transition to parenthood across different domains of QOL.     

Protective effect of vitamin D supplementation in a rat modal of preeclampsia: a possible implication of chemerin

Background: Preeclampsia (PE) is a disorder of pregnancy associated with vitamin D (VD) deficiency. Chemerin is an adipokine significantly increased in preeclampsia and is regulated by VD.

Objectives: To determine whether VD supplementation would protect against development of PE through Chemerin reduction

Methods: PE was induced in albino rats by injection of 12.5 mg of deoxycorticosterone (DOCA). Rats were randomly divided into normal pregnant, PE group, VD supplemented PE group.

Results: VD supplementation decreased systolic blood pressure, proteinuria and decreased serum Chemerin level.

Conclusion: VD treatment reduced Chemerin level, and blood pressure in DOCA rat model of PE.     

Circulating HO-1 levels are not associated with plasma sFLT-1 and GTn HMOX1 polymorphism in preeclampsia

Objectives: We aimed to assess the plasma HO-1 level and its interrelationship with the plasma sFLT-1 level in preeclamptic and healthy pregnant women with different variants of microsatellite polymorphism (GTn) located in the promoter region of the HMOX-1 gene.

Methods: HO-1 and sFLT-1 were measured by ELISA. HMOX1 genotyping was performed using fragment analysis.

Results: We found similar and higher levels of plasma HO-1 and sFLT-1, respectively, in preeclampsia. Similar genotypes and alleles frequencies were found in both groups and the absence of modulation of HO-1 levels by genotypes were observed.

Conclusion: The plasma HO-1 levels are not increased in preeclampsia women and neither related to sFLT-1 levels and GT_n polymorphism.     

Cardiac function and tadalafil used for treating fetal growth restriction in pregnant women without cardiovascular disease

Background: The aim of the present study was to evaluate tadalafil for the treatment of fetal growth restriction (FGR) and the cardiac function in pregnant women without cardiovascular disease who used tadalafil for this reason.

Materials and methods: We examined nine pregnant women without cardiovascular disease who were using tadalafil to treat FGR. Maternal heart rate, systolic blood pressure (BP), and echocardiographic findings were assessed before and after tadalafil use.

Results: Diastolic BP was lower after compared to that before using tadalafil, but the difference was not significant. Echocardiographic findings were not significantly different before and after tadalafil use.

Conclusions: Tadalafil did not adversely affect pregnant women without cardiovascular disease and was considered acceptable for use since it did not affect the mother’s cardiac function.     

Influence of early-life factors on the development of endometriosis

Objective: Our aim was to study the association between early-life factors and the development of endometriosis.

Methods: This case–control study included 440 women with surgically confirmed endometriosis (cases) and 880 women without endometriosis (controls). Information on early-life factors was ascertained retrospectively by in-person interviews with participants and their mothers. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between endometriosis and maternal and paternal characteristics and foetal and infant exposures were estimated using unconditional logistic regression, adjusting for frequency matching and confounding variables.

Results: We observed that women who were not breastfed as infants had twice the risk of endometriosis compared with women who were breastfed (adjusted OR 2.0; 95% CI 1.6, 4.5). Our data suggested an increased endometriosis risk with neonatal vaginal bleeding (adjusted OR 1.9; 95% CI 1.2, 4.3) and paternal smoking (adjusted OR 1.8; 95% CI 1.1, 4.9). Although the CIs included the null hypothesis value, caesarean section (adjusted OR 1.7; 95% CI 1.0, 3.5) and prematurity (adjusted OR 1.4; 95% CI 0.8, 3.7) were probably associated with the incidence of endometriosis.

Conclusions: Some early-life factors including breastfeeding, neonatal vaginal bleeding and paternal smoking were associated with subsequent, surgically confirmed endometriosis in this cohort of Chinese women.     

Evaluation of late adolescent pregnancies: Is late adolescence a risk factor for preterm labor?

Study objective: We evaluated effect of late adolescence during pregnancy and its confounding factors on neonatal and maternal results.

Objective: The aim of the present study is to evaluate the effect of late adolescence on maternal, perinatal outcomes and preterm labor.

Methods: This retrospective study was carried out on 172 late adolescents and 160 adult women who delivered in a tertiary center. The demographic features, obstetrical and neonatal properties of the patients were analyzed.

Results: Marital status, education levels, preeclampsia–eclampsia, gestational diabetes mellitus (GDM), urinary tract infections during pregnancy, intrauterine growth restriction, bleeding in last trimester, postpartum hemorrhage, perinatal mortality incidence, and mode of delivery for both groups were similar. Regular antenatal follow up and hemoglobin levels during admission to hospital were low in late adolescents. Anemia during pregnancy, preterm labor incidence was high for late adolescents compared with adults. When a logistic regression analysis was made for preterm labor, lack of antenatal follow up, urinary tract infection during pregnancy and history of still birth was risk factors for preterm labor rather than age.

Conclusion: We assume that regular antenatal follow up can reduce preterm labor among late adolescents.     

Israeli and British women's wellbeing and eating behaviours in pregnancy and postpartum

Objectives: The study had two main objectives: (a) track changes in self-esteem, eating behaviours and body satisfaction from early pregnancy to 24 months postpartum and (b) to compare changes by context (Israel vs. UK) and maternal body mass index (BMI).

Background: High maternal BMI is associated with negative body image and restrained eating, which are experienced differently across cultures.

Methods: 156 pregnant women were recruited from Israel and the UK. Seventy-three women were followed up every six months from early postpartum and until 24 months following birth. Women completed questionnaires assessing self-esteem (RSEQ), body image (BIS/BIDQ) and eating behaviours (DEBQ) and self-reported weights and heights so that BMI could be calculated.

Results: Women with higher BMI had higher levels of self-esteem and were less satisfied with their body. Healthy-weight women were more likely to lose all of their retained pregnancy weight compared to overweight and obese women. Self-esteem, body image and eating behaviours remained stable from pregnancy until 24 months postpartum. No significant differences were found for any measure by context.

Conclusion: BMI was the strongest predictor of self-esteem and body dissatisfaction and a higher BMI predicted less weight loss postpartum.