SIRTI and cortisol in unexplained infertile females; a cross sectional study,in Karachi Pakistan

ObjectiveTo explore a disparity in anti-oxidants (SIRT1) and pro-oxidants (cortisol) levels as a plausible cause of unexplained infertility in females.MethodologyIt was a cross sectional study in which 342 females with unexplained infertility were recruited from ACIMC outpatient clinic: 135 infertile cases and 207 fertile controls. Biochemical estimation of serum cortisol and SIRT1 was performed using Enzyme Linked Immuno Sorbent Assay. Statistical comparisons were performed using Student-t test and Mann-Whitney U test. Associations between circulating hormone levels and infertility were determined using Spearman's rank correlation. Associations were considered significant where value of p was less than 0.05.ResultsThe stress hormones profile of case and control demonstrated that the antioxidant SIRT1 was significantly lower in infertile females when compared with the fertile (p =< 0.001) while (the oxidant) Cortisol showed a contrast of results with higher values of in infertile females when compared with fertile counterparts (p =< 0.01). There was a strong negative association observed between SIRT1 and cortisol serum level (r = 0.244, p < 0.001).ConclusionChronic stress causes oxidative stress that is depicted by a decrease in antioxidant levels in infertile females.     

Bone densitometry status and its associated factors in peri and post menopausal females: A cross sectional study from a tertiary care centre in India

Objective

Osteoporosis is a skeletal disorder characterized by diminished bone strength that increases the risk of fracture at instances of trivial trauma. Asians have a lower bone mass than the west. The present study was designed to add data from India on women above the age of 40 years with respect to low bone mineral density (BMD) and its associated high risk factors.

Current practices in treatment of female genital fistula: a cross sectional study

Background

In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs) constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up.

Methods

Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation.

Results

Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme.

Conclusions

Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other interventions to ensure the supply of sufficient quality maternity services and to address other non-financial barriers to demand. If these conditions are met, voucher and HEF schemes can be further scaled up under close monitoring and evaluation.     

Obstetrician-initiated counseling and testing for HIV infection: a cross sectional study

Abstract

Objective: To assess the practice of provider-initiated counseling and testing (PICT) for HIV infection by Nigerian Obstetricians and estimate missed opportunities at the gynecological and family planning clinics.

Methods: Online cross-sectional survey of members of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) over a 4-week period using SurveyMonkey®. Frequencies were used to present responses of participants.

Results: There were 201 (29%) respondents. Participants’ mean age was 46?±?7.2 (SD) years and majority (93.3%) held consultant positions. Most respondents (92.2%) cared for HIV-infected pregnant women with dedicated HIV counselors (77.4%), and in dedicated counseling rooms (71%). Majority (75.7%) had been trained on HIV management in pregnancy and 95.3% routinely counseled and tested women attending the booking antenatal clinic. Fourteen per cent (14%) and 16% of respondents conducted routine counseling and testing for women attending the gynecological and family planning clinics, respectively, for the first time. For every 100 women tested at the antenatal clinic, 317 women were missed at each of the two clinics.

Conclusions: PICT of HIV infection in Nigeria has focused on pregnancy. To eliminate new HIV infections in children, PICT should be routine at the gynecological and family planning clinics.     

Adaptation to maternal role and infant development: a cross sectional study

Objective: To assess the correlation between adaptation to maternal role (AMR) and infant development.

Background: Maternal role is an important key in infant’s care and development. Previous findings demonstrated an inconsistency in the effect of the mother’s adaptation on each domain of infant’s development.

Methods: This cross-sectional study was conducted on 260 healthy mothers and healthy infants attending health centres affiliated to Shahid Beheshti University of Medical Sciences in Tehran in 2016. Data were collected using the ‘AMR in Iranian Primiparous Women Questionnaire’ and the ‘Ages and Stages Questionnaire’ (ASQ). The correlation between adaptation to maternal role and infant development was assessed using partial correlation analysis adjusted for age and gender.

Results: In all 14 infants had developmental delay giving a prevalence rate of 5.4%. The mean AMR score was 123.9 (SD =13.1) and there was no significant correlation between the AMR total score and infant development (r = 0.06, p = 0.27). However, significant correlation were observed between some aspects of adaptation to maternal role and infant development such as the ‘support and consolidation of the couple’s relationship’ and ‘communication’ (p = 0.04); the ‘concern and anxiety’ subscale and ‘gross motor skills’ (p = 0.03), the ‘attachment to the child’ subscale and ‘personal-social development’ (p = 0.02) and the ‘emotional development’ subscale with ‘personal-social development’ domain (p = 0.004).

Conclusion: The findings suggest that correlation exists between some aspects of adaptation to maternal role and infant development.     

Maternal risk factors associated with fetal death during antenatal care in low-resource tertiary hospitals

BACKGROUND: Data on maternal characteristics that could predict antepartum fetal death in women receiving antenatal care in resource-constrained settings are limited. Aims: To identify maternal sociodemographic and clinical risk factors for antepartum fetal death among women receiving antenatal care in a developing country setting. METHODS: Case-control analyses of risk factors in the occurrence of singleton fetal death before labour at two university hospitals in south-west Nigeria over 4-5 years. A total of 46 cases and 184 controls were compared for 31 sociodemographic and clinical risk factors. Unconditional multivariate logistic regression analysis was applied to determine independent risk factors. Level of significance was set at P < 0.05. RESULTS: The incidence of antepartum fetal death among women receiving antenatal care was 10.8 per 1000 total births during the period. Significant risk factors at univariate level include proteinuria, pregnancy-induced hypertension, pre-existing hypertension, reduced weight gain per week, previous antepartum fetal death, antepartum haemorrhage, previous miscarriage, symphysiofundal height-gestational age disparity = 4 cm and perception of reduced fetal movements. The independent risk factors were proteinuria (adjusted OR 4.23, CI: 1.57-11.42), pregnancy-induced hypertension (adjusted OR 8.24, CI: 3.01-22.51) and perceived reduction in fetal movements (adjusted OR 7.17, CI: 1.57-45.76). CONCLUSIONS: The identified factors should serve as potential targets for antenatal interventions to prevent antepartum fetal death in these institutions. Awareness of these factors should stimulate appropriate risk assessment geared towards the prevention of antepartum fetal deaths by clinicians in these centres and centres in similar setting.     

Men's knowledge and awareness of maternal, neonatal and child health care in rural Bangladesh: a comparative cross sectional study

ABSTRACT: BACKGROUND: The status of men's knowledge of and awareness to maternal, neonatal and child health care are largely unknown in Bangladesh and the effect of community focused interventions in improving men's knowledge is largely unexplored. This study identifies the extent of men's knowledge and awareness on maternal, neonatal and child health issues between intervention and control groups. METHODS: This cross sectional comparative study was carried out in six rural districts of Bangladesh in 2008. BRAC health programme operates 'improving maternal, neonatal and child survival' intervention in four of the above-mentioned six districts. The intervention comprises a number of components including improving awareness of family planning, identification of pregnancy, providing antenatal, delivery and postnatal care, newborn care, under-5 child healthcare, referral of complications and improving clinical management in health facilities. In addition, communities are empowered through social mobilization and advocacy on best practices in maternal, neonatal and child health. Three groups were identified: intervention (2 years exposure); transitional (6 months exposure) and control. Data were collected by interviewing 7,200 men using a structured questionnaire. RESULTS: Men prefer to gather in informal sites to interact socially. Overall men's knowledge on maternal care was higher in intervention than control groups, for example, advice on tetanus injection should be given during antenatal care (intervention = 50%, control = 7%). There were low levels of knowledge about birth preparedness (buying delivery kit = 18%, arranging emergency transport = 13%) and newborn care (wrapping = 25%, cord cutting with sterile blade = 36%, cord tying with sterile thread = 11%) in the intervention. Men reported joint decision-making for delivery care relatively frequently (intervention = 66%, control = 46%, p < 0.001). CONCLUSION: Improvement in men's knowledge in intervention district is likely. Emphasis of behaviour change communications messages should be placed on birth preparedness for clean delivery and referral and on newborn care. These messages may be best directed to men by targeting informal meeting places like market places and tea stalls.     

High caesarean rates in Madras (India): a population-based cross sectional study

Objective To estimate the population caesarean section rate in urban India.
Design Population-based cross sectional study.
Setting Madras City (Chennai), India.
Sample Seven hundred and eighty resident women who delivered in Madras between June 1997 and May 1999.
Methods Cluster sampling was done using streets as cluster units. Thirty clusters were selected from 1255 clusters by the probability proportion to size method and 26 women were selected randomly from each cluster.
Main outcome measures Total and primary caesarean rates.
Results Total population caesarean section rate was 32.6% (95% CI 27–38) and primary caesarean section rate was 25% (95% CI 20–30). Total caesarean section rates in the public, charitable and private sectors were 20%, 38% and 47%, respectively. Private sector deliveries had an odds ratio of 2.4 (95% CI 1.5, 3.8) of a primary caesarean section delivery in comparison with the public sector after adjustment for parity, age at delivery of mother and educational status.
Conclusions Forty-seven percent of births by caesarean section in the private sector is alarming and could implicate private sector care as the main contributing factor behind the high population caesarean section rates. Policymakers should urgently institute systems for accountability and ethical practice and regularly monitor all medical interventions, before large scale exploitation of the rural markets begins.     

Maternal congenital cardiac disease: outcomes of pregnancy in a single tertiary care center

OBJECTIVE: To evaluate contemporary perinatal and cardiac outcomes of pregnancies in women with major structural congenital heart disease. METHODS: Obstetric, neonatal, and cardiac outcomes were abstracted retrospectively from medical records of all women with congenital cardiac disease delivering at our institution from 2000-2007 and compared by type of structural defect. Predictors of adverse cardiac or obstetric events were identified. RESULTS: Over the 7-year study period, 74 deliveries occurred in 69 women with congenital heart disease, median age 28 years. There were three right-obstructive defects, 14 left-obstructive defects, four right-regurgitant defects, 19 conotruncal defects, 19 shunts, and four miscellaneous lesions. There were 21 adverse cardiac events in 15 pregnancies (20.2%); these were defined as maternal death, congestive heart failure, myocardial infarction, stroke, the need for urgent cardiac intervention, or arrhythmia requiring treatment. There were 44 adverse obstetric events in 34 pregnancies (45.9%), defined as preterm delivery, stillbirth, preeclampsia, small for gestational age, or neonatal intensive care unit admission. Patients with shunt morphology were more likely to experience adverse obstetric and cardiac outcomes. CONCLUSION: Pregnancy in women with underlying major congenital heart defects poses increased risks to both mother and fetus. Nonetheless, favorable maternal and neonatal outcomes occur in the majority of patients.     

Differences in pre-conception and pregnancy healthy lifestyle advice by maternal BMI: Findings from a cross sectional survey

ObjectiveBeing underweight at pregnancy commencement is associated with a range of adverse maternal and infant outcomes, as is being overweight or obese, yet it is an aspect of maternal health which has been relatively neglected by healthcare professionals and researchers. We aimed to investigate differences in pre-pregnancy and pregnancy healthy lifestyle advice routinely offered by relevant healthcare professionals, including midwives and GPs, to women across three different BMI categories – underweight, normal, and overweight or obese.DesignA cross-sectional study nested in an antenatal survey of pregnant women.SettingAntenatal clinics of three National Health Service (NHS) hospitals in London, UK.ParticipantsPregnant women at any gestation of pregnancy were invited to participate in the study whilst attending a routine antenatal scan appointment.MeasurementsMain outcomes of interest were whether women had sought and/or had been offered healthy lifestyle advice by relevant healthcare professionals before or during the index pregnancy and whether the advice offered had included weight management, tobacco smoking cessation and alcohol intake. Other outcomes included alcohol consumption and tobacco smoking before and during the index pregnancy.FindingsA total of 1173 women completed the survey, with pre-pregnancy BMI data available for 918 (78.3%) women, 632 (69%) of whom were of normal weight, 232 (25%) were overweight or obese, and 54 (6%) were underweight. Overall, 253 (28%) of these women reported they had sought pre-conception advice. Women with a low BMI were offered pre-pregnancy and pregnancy healthy lifestyle advice of a similar content to women with a normal BMI, whereas women with a high BMI were more likely to be offered specific pre-conception and pregnancy advice on healthy BMI (respectively OR 2.55; 95% CI 1.64–3.96: OR 1.79; 95% CI 1.26–2.54), pre-conception healthy diet (OR 1.58; 95% CI 1.06–2.37), reducing alcohol consumption (OR 1.63; 95% CI 1.06–2.51) and smoking cessation (OR 1.62; 95% CI 1.05–2.50). For all women, reported alcohol consumption during pregnancy was lower than pre-conception, but within each BMI group around half of the women reported consuming alcohol at some time during their pregnancy.Key conclusionsWomen with a low BMI are no more likely than women with a normal BMI to be advised by health professionals about a healthy lifestyle or a healthy weight for their height before or during pregnancy. In contrast women with a high BMI are more likely to receive such advice. Provision of pre-conception care could provide opportunity to advise women across the weight spectrum of the importance of adopting a healthy lifestyle for optimal pregnancy outcomes, as well as consider management of any pre-existing medical conditions.Implications for practiceHealthy lifestyle advice, including alcohol consumption and smoking cessation, should be offered to women who are underweight before and during pregnancy as well as to women who are overweight or obese, to improve adherence to recommendations to optimise maternal and infant outcomes. Advice should also be tailored to reflect women’s ethnic background, which could be an important influence on lifestyle behaviour and weight management. The potential clinical benefit of routine provision of pre-conception care, particularly for women who have a high risk of a poorer pregnancy outcome due to weight status or other medical complications, needs to be explored.     

Depressive symptoms among immigrant and Canadian born mothers of preterm infants at neonatal intensive care discharge: a cross sectional study

Background

Mothers of preterm infants are considered at higher risk for depressive symptoms, higher than for mothers of healthy term infants. Predictors of depressive symptoms in mothers of preterm infants are not yet well established. Immigrant mothers of term infants have higher prevalence of depressive symptoms than Canadian born mothers but the relative prevalence for immigrant mothers of preterm infants is unknown. This study had two aims: (i) to investigate the prevalence of depressive symptoms in immigrant as compared to Canadian born mothers of preterm infants, and (ii) to determine what factors are associated with depressive symptoms in mothers of preterm infants.

Methods

This is a multi-site, cross sectional study of mothers whose preterm infants required hospitalization in neonatal intensive care unit (NICU). Consecutive eligible mothers (N = 291) were recruited during the week prior to their infant’s NICU discharge. Mothers completed a self-administered questionnaire booklet of validated psychosocial/cultural measures including the Center for Epidemiological Studies Depression Scale (CES-D), Parental Stressor Scale:NICU, General Functioning Subscale of the McMaster Family Assessment Device, Social Support Index, and Vancouver Index of Acculturation; and demographic characteristics questions. Infant characteristics included gestational age, birth weight, sex, singleton/multiple birth, and Score for Neonatal Acute Physiology-II.

Results

Immigrant mothers (N = 107), when compared to Canadian born mothers (N = 184), reported more depressive symptoms, poorer family functioning, less social support, and less mainstream acculturation. Hierarchical regression for a subsample of 271 mothers indicated that single parent status, high stress, poorer family functioning, and less social support were associated with increased depressive symptoms and accounted for 39% of the variance on the CES-D. Immigrant status did not contribute significantly to the final regression model.

Conclusions

Immigrant mothers of preterm infants are at increased risk for depressive symptoms. For immigrant and Canadian born mothers of preterm infants hospitalized in NICU and particularly for single mothers, interventions to reduce stress and increase family functioning and social support may reduce depressive symptoms. Given the effects of depression on maternal health and functioning, such an intervention may improve child outcomes.

     

The baby-friendly hospital initiative and breastfeeding at birth in Brazil: a cross sectional study

Background

Breastfeeding in the first hour after birth is important for the success of breastfeeding and in reducing neonatal mortality. Government policies are being developed in this direction, highlighting the accreditation of hospitals in the Baby-Friendly Hospital (BFH) initiative. The aim of this study was to analyze the association between delivery in a BFH (main exposure), compared to non BFH, and timely initiation of breastfeeding (outcome).

Methods

Data came from the “Birth in Brazil” survey, a nationwide hospital-based study of postpartum women and their newborns, coordinated by the Oswaldo Cruz Foundation. A sample of 22,035 mothers/babies was analyzed through a hierarchical theoretical model on three levels, and all analyzes considered the complex sample design. Odds ratios were obtained by logistic regression, with a 99 % CI.

Results

Among all births, 40 % occurred in hospitals accredited or in accreditation process for the BFHI and 52 % of women underwent caesarean section. In the final model, at the distal level, mothers less than 35 years old, and those who lived in the North Region, had a higher chance of timely initiation of breastfeeding. At the intermediate level, prenatal care in the public sector and advice on breastfeeding during pregnancy were directly associated with the outcome. At the proximal level, being born in a Baby-Friendly Hospital and vaginal delivery increased the chance of timely initiation of breastfeeding, while prematurity and low birth weight reduced the chance of the outcome.

Conclusions

The chance of being breastfed in the first hour after birth in Baby-Friendly hospitals was twice as high as at non-accredited hospitals, which shows the importance of this initiative for timely initiation of breastfeeding.

     

Prevalence and patterns of female sexual dysfunction among overweight and obese premenopausal women in Upper Egypt; a cross sectional study

Objective

Obesity is a growing public health concern. Many reports link obesity to female sexuality. The purpose of this study is to assess the prevalence and patterns of female sexual dysfunction (FSD) among overweight and obese premenopausal women in Beni-Suef, Egypt.

Acute fatty liver of pregnancy in 3 tertiary care centers

OBJECTIVE: The purpose of this study was to determine the demographics, clinical presentation, and maternal and neonatal outcomes in patients who were diagnosed with acute fatty liver of pregnancy over a 10-year period. STUDY DESIGN: This was a multicenter retrospective study of women with the diagnosis of acute fatty liver of pregnancy. Records were reviewed for symptoms, laboratory findings, clinical course, and maternal and perinatal outcomes. RESULTS: Sixteen cases of acute fatty liver of pregnancy were identified. Three of the 16 cases had multiple gestations (18%). Eleven of the 16 cases were diagnosed in the antepartum period, and 5 cases were diagnosed within 4 days after delivery. Nausea and vomiting were the most common symptoms (75%). There were 2 maternal deaths (12.5%) and 3 fetal deaths (15%). CONCLUSION: We recommend that patients with persistent nausea, vomiting, or epigastric pain in the third trimester receive evaluation of liver enzymes, renal function, and a complete blood count to rule out the diagnosis of acute fatty liver of pregnancy.     

Quality assessment of ultrasonic foetal biometry during the IUGR Risk Selection (IRIS) trial: A cross sectional study

ObjectiveIntrauterine growth restriction is a major risk factor for perinatal morbidity and mortality. Ultrasonic foetal biometry is an important tool to monitor foetal growth. Therefore, the quality of these biometry scans is vital to achieve good diagnostic accuracy. We assessed the quality of foetal biometry during a nationwide trial and explored its association with sonographer's characteristics.MethodsFour scans from every sonographer (n = 154), performed at 29 and 35 weeks gestational age were collected. Two assessors scored these scans according to a national audit system. A quality score ≥ 65% was considered ‘adequate’.We compared the quality scores per scoring criterion (i.e. foetal head measurements, abdominal circumference and femur length with regard to magnification, correctness of the plane and calliper placement) and gestational age. We analysed the associations between characteristics of the sonographers and their scores. In a subsample of scans of 30 sonographers we determined the interrater agreement on the quality scores given by the two assessors independently.FindingsThe mean score was 81.3%. Thirteen sonographers (8.4%) failed to achieve ‘adequate quality’. Scores for femur length (83.8%) were significantly higher than those for head (77.9%) and abdominal circumference (78.6%) (both P < 0.05). Scores for correctness of the plane (73.4%) were lower than those for magnification (81.2%) and calliper placement (85.7%) (both P < 0.05). Gestational age did not affect the quality scores. Only the number of scans performed in the previous year was positively associated with the scores (β = 0.01; P < 0.05). The mean interrater difference in quality scoring was 11.1%, with 77.6% agreement on scans of ‘adequate quality’, but with no agreement on scans with ‘insufficient quality’.Key conclusions and implications for practiceMost sonographers achieved an ‘adequate quality’ score. Highest quality scores were attained for femur length, lowest quality scores for the correct plane. The number of scans one performs is associated with the quality scores, yet the minimum number of scans to perform for guaranteed quality still needs to be determined. Further research is needed to develop a standardized method to assess and maintain good ultrasonic foetal biometry quality.     

Effects of maternal transport on admission patterns at a tertiary care center

Major changes have occurred in the delivery of perinatal care during the last two decades. Documentation of perinatal regionalization statistics at Women and Infants Hospital of Rhode Island in Providence support the increasing proportion of low birth weight infants in the region being born at the tertiary care center, the decreasing number of neonatal transports in concert with an increasing number of maternal transports, and the increasing proportion of neonatal transports with birth weights greater than or equal to 2500 gm. Patterns of modern perinatal care are materially changing the delivery of health care at tertiary care facilities.     

Reference intervals for the cross sectional area of the umbilical cord during gestation

OBJECTIVE: To establish reference values for the sonographic cross-sectional area of the umbilical cord during gestation and to correlate them with fetal anthropometric parameters. METHODS: A cross-sectional study was performed involving 312 normal pregnant women at gestational ages 24-39 weeks. Measurement of the cross-sectional area of umbilical cord was performed on a plane adjacent to the insertion of the cord into fetal abdomen. The following anthropometric parameters were calculated: biparietal diameter, head circumference, abdominal circumference and femur length. A polynomial regression analysis identified the curves that were better adjusted to the average and standard deviation according to gestational age. Spearman correlation was used to evaluate the correlation of the cross-sectional area of umbilical cord with fetal anthropometric parameters. RESULTS: A statistically significant correlation was observed between the cord cross-sectional area and gestational age (r=0.376, P<0.001, CI 95%[0.276; 0.467]). CONCLUSIONS: The reference values of the cross-sectional area of umbilical cord increased according to gestational age until the 33rd week and are related to parameters of fetal growth.     

Laparotomy to laparoscopy: changing trends in the surgical management of ectopic pregnancy in a tertiary care teaching hospital

STUDY OBJECTIVE: To review the changing trends in the surgical management of ectopic pregnancy and to evaluate the effect of an ongoing training program for resident surgeons on the rate and success of laparoscopic surgery. DESIGN: Retrospective chart review (Canadian Task Force classification II-3). SETTING: University tertiary medical center. PATIENTS: One thousand forty-six patients with ectopic pregnancy treated at Jackson Memorial Hospital from January 1, 1995, through December 31, 2004. INTERVENTION: A formal, ongoing laparoscopic training program was established in 1999. MEASUREMENTS: The rate of laparoscopy, laparotomy, and conversion for each year was compared with the baseline year of 1995 and between the years before and after the establishment of the training program. RESULTS: Four hundred sixty-eight laparotomies and 578 laparoscopies were successfully completed. The laparoscopic approach rate has increased from 40.9% in 1995 to 86.3% in 2004. By year 2000 and thereafter, significantly more ectopic surgeries were approached through the laparoscope compared with in 1995 (p<.01). By 2000 and thereafter, significantly less conversions occurred compared with the baseline year of 1995 (4.0% vs 18.5%; p = .01). CONCLUSION: Laparoscopy became the primary approach for the management of ectopic pregnancy in part because of resident participation in an ongoing laparoscopy training program.     

Intimate partner violence and repeat induced abortion in Italy: A cross sectional study

Abstract

Objective To investigate the impact of intimate partner violence (IPV) on the risk of repeat induced abortion (RIA), we compared IPV history among women with and without previous induced abortion (IA).

Methods All consecutive women aged 18 years or more requiring IA in 12 Italian abortion clinics were eligible for inclusion in the study. They were asked to fill in an anonymous, self-developed questionnaire assessing sociodemographic data and their history of different types of violence and related risk factors.

Results The analysis included 1030 women, 624 (60.6%) of whom reported a previous IA. Past or current IPV was reported by 19.3%: 7.0% reported sexual violence, 11.3% physical abuse and 12.1% psychological abuse. Past or current IPV was reported by 22.3% of women with RIA and 14.8% of those undergoing their first IA (adjusted odds ratio 1.57, 95% confidence interval 1.07–2.30; p = 0.02). When we considered sexual, psychological and physical abuse separately, we found that any kind of abuse was more frequent in women with RIA than in women with no previous IA.

Conclusion This study underlines the impact of IPV on the risk of RIA and suggests the need for screening for IPV among women requiring abortion, in order to identify women at risk of RIA and to improve their general and reproductive health.

Chinese Abstract

摘要：

目的：为了研究亲密伴侣暴力对反复人工流产的影响,我们比较了既往有亲密伴侣暴力病人有无反复流产史。

方法：在意大利12所堕胎诊所需要行人工流产术的所有的18周岁及以上的妇女符合此研究的纳入标准,她们需要填写一份匿名的、自主研发的问卷,调查研究社会人口数据和既往的暴力性质及与此相关的影响因素。

结果：共有1030人纳入研究,其中的624（60.6%）既往有过人工流产史。目前的研究表明亲密伴侣暴力的发生率为19.3%,其中7.0%为性暴力,11.3%躯体虐待,12.1%为心理暴力。目前的研究提出,既往有过人工流产史的妇女中发生亲密伴侣暴力的概率是22.3%,第一次行人工流产的妇女中亲密伴侣暴力的发生率是14.8%（调整后OR=1.57,95%CI 1.07-2.30,P=0.02）。当我们将性、躯体、心理的虐待分开来考虑,发现不同形式的虐待在既往有人工流产史的妇女中的发生频率均高于在初次行人工流产的妇女的发生频率。

结论：这项研究强调了亲密伴侣暴力对反复人工流产的影响,建议在妇女需要行人工流产时调查有无亲密伴侣暴力的存在,从而识别有无反复人工流产的危险因素,并提高妇女的健康及生殖健康。

关键词：亲密伴侣暴力,人工流产, 流行病学,危险因素,性虐待