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Sample records for clinical pregnancy rates

  1. Periodontal treatment during pregnancy decreases the rate of adverse pregnancy outcome: a controlled clinical trial

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    Adriana Campos Passanezi Sant'Ana

    2011-04-01

    Full Text Available OBJECTIVES: The aim of this study was to evaluate the effects of non-surgical treatment of periodontal disease during the second trimester of gestation on adverse pregnancy outcomes. MATERIAL AND METHODS: Pregnant patients during the 1st and 2nd trimesters at antenatal care in a Public Health Center were divided into 2 groups: NIG - "no intervention" (n=17 or IG- "intervention" (n=16. IG patients were submitted to a non-surgical periodontal treatment performed by a single periodontist consisting of scaling and root planning (SRP, professional prophylaxis (PROPH and oral hygiene instruction (OHI. NIG received PROPH and OHI during pregnancy and were referred for treatment after delivery. Periodontal evaluation was performed by a single trained examiner, blinded to periodontal treatment, according to probing depth (PD, clinical attachment level (CAL, plaque index (PI and sulcular bleeding index (SBI at baseline and 35 gestational weeks-28 days post-partum. Primary adverse pregnancy outcomes were preterm birth (0.05 at IG and worsening of all periodontal parameters at NIG (p<0.0001, except for PI. Signifcant differences in periodontal conditions of IG and NIG were observed at 2nd examination (p<0.001. The rate of adverse pregnancy outcomes was 47.05% in NIG and 6.25% in IG. Periodontal treatment during pregnancy was associated to a decreased risk of developing adverse pregnancy outcomes [OR=13.50; CI: 1.47-123.45; p=0.02]. CONCLUSIONS: Periodontal treatment during the second trimester of gestation contributes to decrease adverse pregnancy outcomes.

  2. Periodontal treatment during pregnancy decreases the rate of adverse pregnancy outcome: a controlled clinical trial

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    SANT’ANA, Adriana Campos Passanezi; de CAMPOS, Marinele R.; PASSANEZI, Selma Campos; de REZENDE, Maria Lúcia Rubo; GREGHI, Sebastião Luiz Aguiar; PASSANEZI, Euloir

    2011-01-01

    Objectives The aim of this study was to evaluate the effects of non-surgical treatment of periodontal disease during the second trimester of gestation on adverse pregnancy outcomes. Material and Methods Pregnant patients during the 1st and 2nd trimesters at antenatal care in a Public Health Center were divided into 2 groups: NIG – "no intervention" (n=17) or IG- "intervention" (n=16). IG patients were submitted to a non-surgical periodontal treatment performed by a single periodontist consisting of scaling and root planning (SRP), professional prophylaxis (PROPH) and oral hygiene instruction (OHI). NIG received PROPH and OHI during pregnancy and were referred for treatment after delivery. Periodontal evaluation was performed by a single trained examiner, blinded to periodontal treatment, according to probing depth (PD), clinical attachment level (CAL), plaque index (PI) and sulcular bleeding index (SBI) at baseline and 35 gestational weeks-28 days post-partum. Primary adverse pregnancy outcomes were preterm birth (0.05) at IG and worsening of all periodontal parameters at NIG (ppregnancy outcomes was 47.05% in NIG and 6.25% in IG. Periodontal treatment during pregnancy was associated to a decreased risk of developing adverse pregnancy outcomes [OR=13.50; CI: 1.47-123.45; p=0.02]. Conclusions Periodontal treatment during the second trimester of gestation contributes to decrease adverse pregnancy outcomes. PMID:21552714

  3. Teen clinics: missing the mark? Comparing pregnancy and sexually transmitted infections rates among enrolled and non-enrolled adolescents.

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    Shaw, Souradet Y; Metge, Colleen; Taylor, Carole; Chartier, Mariette; Charette, Catherine; Lix, Lisa; Santos, Rob; Sarkar, Joykrishna; Nickel, Nathan C; Burland, Elaine; Chateau, Dan; Katz, Alan; Brownell, Marni; Martens, Patricia J

    2016-06-21

    In Manitoba, Canada, school-based clinics providing sexual and reproductive health services for adolescents have been implemented to address high rates of sexually transmitted infections (STIs) and pregnancies. The objectives of this population-based study were to compare pregnancy and STI rates between adolescents enrolled in schools with school-based clinics, those in schools without clinics, and those not enrolled in school. Data were from the PATHS Data Resource held in the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy. Adolescents aged 14 to 19 between 2003 and 2009 were included in the study. Annualized rates of pregnancies and positive STI tests were estimated and Poisson regression models were used to test for differences in rates amongst the three groups. As a proportion, pregnancies among non-enrolled female adolescents accounted for 55 % of all pregnancies in this age group during the study period. Pregnancy rates were 2-3 times as high among non-enrolled female adolescents. Compared to adolescents enrolled in schools without school-based clinics, age-adjusted STI rates were 3.5 times (p pregnancies and STIs were observed among non-enrolled adolescents. Although provision of reproductive and health services to in-school adolescents should remain a priority, program planning and design should consider optimal strategies to engage out of school youth.

  4. Pregnancy rate after endometrial injury in couples with unexplained infertility: A randomized clinical trial.

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    Parsanezhad, Mohammad Ebrahim; Dadras, Nasrin; Maharlouei, Najmeh; Neghahban, Leila; Keramati, Peghah; Amini, Madihe

    2013-11-01

    Unexplained infertility is still a challenging issue as to its causes, appropriate management and treatment. Evidence implicates early embryopathy or implantation failure as likely causes. This study aims to investigate the effect of local endometrial injury on pregnancy rate in selected unexplained infertile patients. This was a randomized clinical trial conducted in Shiraz University Infertility Clinic of Ghadir Hospital. A total of 217 women with unexplained infertility aged 23-35 years old were randomly divided into two study groups through block randomization. After superovulation by clomiphene-citrate and gonadotropins and when the dominant follicles reached 18-20 mm, patients were randomly assigned to undergo endometrial local injury at posterior uterine wall by piplle endometrial sampling (n=114) or mock pipette biopsy (n=103) during pre-ovulatory days (when spontaneous urinary LH surge was detected). Then all the patients were instructed to follow a regularly timed intercourse. The pregnancy rate was significantly higher in the endometrial injury group compared to the control group [17/114 (14.9%) vs. 6/103 (5.8%) (OR: 2.83 95% CI: 1.07-7.49, p=0.03]. The abortion rate was comparable between two groups (17.64% vs. 14.28%; p=0.701). Local mechanical injury of the endometrium can enhance the uterine receptivity and facilitates the embryo implantation. This simple, easy, and cost effective procedure is worth considering in selective unexplained infertility patients who implantation failure is the likely causes of infertility before complex treatments. This procedure may help reduce psychological tensions and high expenses imposed through such interventions. Registration ID in IRCT: IRCT2012082510657N1.

  5. Measuring outcomes in fertility trials: can we rely on clinical pregnancy rates?

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    Clarke, Jane F.; van Rumste, Minouche M. E.; Farquhar, Cindy M.; Johnson, Neil P.; Mol, Ben W. J.; Herbison, Peter

    2010-01-01

    Objective: To assess whether the estimates of treatment effect in randomized clinical trials (RCTs) in reproductive medicine differ when either clinical pregnancy or live birth is used as the outcome measure. Design: Metaanalysis. Setting: We analyzed RCTs in reproductive medicine found in

  6. Lapse in embryo transfer training does not negatively affect clinical pregnancy rates for reproductive endocrinology and infertility fellows.

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    Kresowik, Jessica; Sparks, Amy; Duran, Eyup H; Shah, Divya K

    2015-03-01

    To compare rates of clinical pregnancy (CPR) and live birth (LBR) following embryo transfer (ET) performed by reproductive endocrinology and infertility (REI) fellows before and after a prolonged lapse in clinical training due to an 18-month research rotation. Retrospective cohort study. Not applicable. All women undergoing in vitro fertilization (IVF) and IVF-intracytoplasmic sperm injection (ICSI) cycles with ET performed by REI fellows from August 2003 to July 2012. Eighteen-month lapse in clinical training of REI fellows. CPR and LBR before and after the lapse in clinical training were calculated and compared per fellow and as a composite group. Alternating logistic regression models were used to calculate the odds of clinical pregnancy and live birth following transfers performed before and after the lapse in training. Unadjusted odds of clinical pregnancy and live birth were similar between the two time periods both for individual fellows and for the composite group. Alternate logistic regression analysis revealed no significant difference in CPR (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.83-1.07) or LBR (OR 1.05, 95% CI 0.94-1.18) after the lapse in training compared with before. A research rotation is common in REI fellowship training programs. This prolonged departure from clinical training does not appear to negatively affect pregnancy outcome following fellow ET. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Mental health, pregnancy and self-rated health in antenatal women attending primary health clinics.

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    Sonkusare, S; Adinegara; Hebbar, S

    2007-12-01

    The purpose of this study was to study the determinants of self rated health in the low-risk pregnant women of Melaka Tengah in Malaysia. A total of 387 subjects were analysed. The role of mental health, psychosocial stressors, support from husband, coping skills, socio-economic status and pregnancy characteristics in determining self- rated health were studied. Health items were taken from the Duke Health Profile. Bad obstetric history, poor mental health, stress from the family were found to be significantly associated with poor self - rated health whereas good support from the husband was related to good self - rated health.

  8. EFFECT OF ANTIBIOTIC TREATMENT ON PREGNANCY RATE OF REPEAT BREEDER DAIRY CROSS BRED COWS WITH SUB-CLINICAL UTERINE INFECTION

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    H. M. WARRIACH, N. AHMAD, G. AHMAD, M. S. KHAN1, M. RABBANI2 AND I. AHMAD3

    2008-01-01

    Full Text Available The objective of this study was to investigate the effect of antibiotic treatment on pregnancy rate in repeat breeder dairy crossbred cows. Based upon culture and sensitivity test, cows were assigned into two groups. Genta (n = 10 cows were treated with gentamycin (100 mg/ml and ENRO (n = 12 cows were treated with enrofloxacin (100 mg/ml intramuscularly 4 ml/100 kg body weight and intra-uterine 2-4 ml diluted with 16 ml of physiological salt solution with 24 hours interval for five days in both groups (five infusions per animal on every other day basis. Control (n = 14 cows were untreated control (non-repeat breeder. After treatment, cows were inseminated approximately 12 h after the standing heat. Pregnancy diagnosis was performed by ultrasonography between days 25 and 30 post insemination. The overall pregnancy rates after three services among three groups were significantly different (P0.05 from Control cows (93%. However, overall pregnancy rates of Enro cows (33% were lower (P<0.05 than Genta and Control cows. In conclusion, the pregnancy rates could be improved by treatment with gentamycin compared to enrofloxacin in repeat breeder dairy crossbred cows with sub-clinical uterine infection.

  9. Clinical Variables Affecting The Pregnancy Rate of Intracervical Insemination Using Cryopreserved Donor Spermatozoa:A Retrospective Study in China

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    Xiao-Jun Chen

    2012-01-01

    Full Text Available Background: The aim of this study was to investigate whether several clinical variables can affectthe pregnancy rate of intracervical insemination (ICI using cryopreserved donor spermatozoa.Materials and Methods: In this retrospective study, age, years of infertility, cervicitis, urinaryluteinizing hormone (LH surge, insemination number, uterus position, endometrial thickness andmorphology, maximal follicle diameter, and the number of dominant follicles on the day of humanchorionic gonadotropin (HCG administration were retrospectively analyzed in 501 women whounderwent their first ICI cycle using cryopreserved donor spermatozoa.Results: Increased age, length of infertility (>5 years, retroverted uterine position, and endometrialthickness (14 mm were associated with lower rates of pregnancy.Conclusion: In older women with infertile periods longer than five years, especially those with aretroverted uterus, intrauterine insemination (IUI combined with ovarian stimulation should berecommended. In vitro fertilization with donor spermatozoa (IVFD should be offered earlier toachieve a much higher success rate.

  10. Clinical variables affecting the pregnancy rate of intracervical insemination using cryopreserved donor spermatozoa: a retrospective study in china.

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    Chen, Xiao-Jun; Wu, Li-Ping; Lan, Hai-Lian; Zhang, Li; Zhu, Yi-Min

    2012-10-01

    The aim of this study was to investigate whether several clinical variables can affect the pregnancy rate of intracervical insemination (ICI) using cryopreserved donor spermatozoa. In this retrospective study, age, years of infertility, cervicitis, urinary luteinizing hormone (LH) surge, insemination number, uterus position, endometrial thickness and morphology, maximal follicle diameter, and the number of dominant follicles on the day of human chorionic gonadotropin (HCG) administration were retrospectively analyzed in 501 women who underwent their first ICI cycle using cryopreserved donor spermatozoa. Increased age, length of infertility (>5 years), retroverted uterine position, and endometrial thickness (14 mm) were associated with lower rates of pregnancy. In older women with infertile periods longer than five years, especially those with a retroverted uterus, intrauterine insemination (IUI) combined with ovarian stimulation should be recommended. in vitro fertilization with donor spermatozoa (IVFD) should be offered earlier to achieve a much higher success rate.

  11. Low-dose growth hormone supplementation increases clinical pregnancy rate in poor responders undergoing in vitro fertilisation.

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    Lattes, Karinna; Brassesco, Mario; Gomez, Manuel; Checa, Miguel A

    2015-07-01

    Poor ovarian response (POR) often means low success rates after in vitro fertilisation (IVF). We aim to study the impact of a low-dose growth hormone (GH) supplementation in pregnancy rates in poor responders in a prospective, self-controlled study of 64 poor responders to previous IVF cycles, who failed to achieve pregnancy and were supplemented with low-doses of GH in a subsequent cycle using the same gonadotropin dose and protocol. Our primary endpoint was the clinical pregnancy rate (CPR), considering secondary endpoints, the number of retrieved oocytes, embryos, embryo quality and the proportion of cycles with embryo transfer. CPR in the GH group was 34.4%. Significant differences were observed for the GH group both in the number of top quality embryos (0.64 ± 0.88 versus 1.03 ± 1.17, p < 0.05) and cryopreserved embryos (0.3 ± 0.81 versus 0.85 ± 1.49, p < 0.05). This is, to our knowledge, the first clinical trial to use a low dose of GH as a supplement for IVF in POR patients. Despite this low dose, we achieved excellent success rates in patients with a very poor prognosis, at a reasonable cost and without side effects, which makes this a safe and cost-effective alternative.

  12. Endometrial thickness significantly affects clinical pregnancy and live birth rates in frozen-thawed embryo transfer cycles.

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    Bu, Zhiqin; Wang, Keyan; Dai, Wei; Sun, Yingpu

    2016-07-01

    In order to explore the relationship between endometrial thickness on the day of embryo transfer and pregnancy outcomes in frozen-thawed embryo transfer (FET) cycles, we retrospectively analyzed data from 2997 patients undergoing their first FET cycles from January 2010 to December 2012. All patients were divided into three groups (Group A, ≤8 mm; Group B, 9-13 mm; Group C, ≥14 mm) according to the endometrial thickness on embryo transfer day. Compared with patients in the other two groups, patients with thin endometrial thickness in Group A had significantly lower clinical pregnancy rate (33.4%, 41.3% and 45.4%, p birth rate (23.8%, 32.2% and 34.0%, p confidence interval (CI): 1.10-1.77, p birth rate (aOR: 1.50; 95% CI: 1.16-1.95, p < 0.01) were significant. We conclude that for patients undergoing FET, endometrial thickness on the embryo transfer day significantly affects IVF outcomes in cleavage embryo transfer cycles independent of other factors.

  13. Endometrial local injury improves the pregnancy rate among recurrent implantation failure patients undergoing in vitro fertilisation/intra cytoplasmic sperm injection: a randomised clinical trial.

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    Karimzadeh, Mohammad Ali; Ayazi Rozbahani, Maryam; Tabibnejad, Nasim

    2009-12-01

    Implantation failure is the most important cause of recurrent in vitro fertilisation (IVF)/intra cytoplasmic sperm injection (ICSI) failure. It has been reported that endometrial injury using a biopsy catheter resulted in a higher pregnancy rate in following cycle of treatment. The local endometrial trauma increases the implantation rate through the release of chemical mediators such as histamine and growth factor. To evaluate the influence of endometrial biopsy on increasing implantation rate in patients with recurrent implantation failures. In a randomised control trial study, 115 women each with at least two implantation failures were randomly assigned to two groups. In the case group, endometrial biopsy was obtained from patients in the luteal phase of previous cycle, and implantation and clinical pregnancy rates were compared with those of patients in the control group. The implantation rate was determined as 10.9% in the biopsy group compared to 3.38% in the controls. The clinical pregnancy rate was significantly higher in the case group than in controls (27.1% and 8.9% respectively). The results suggest that pregnancy outcome increases through IVF or ICSI after endometrial biopsy.

  14. Clinical diagnosis and treatment of ectopic pregnancy.

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    Alkatout, Ibrahim; Honemeyer, Ulrich; Strauss, Alexander; Tinelli, Andrea; Malvasi, Antonio; Jonat, Walter; Mettler, Liselotte; Schollmeyer, Thoralf

    2013-08-01

    Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The product of conception can be removed safely by laparoscopic surgery and be submitted for histological examination. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The prevalence of ectopic pregnancy in all women presenting to an emergency department with first-trimester bleeding, lower abdominal pain, or a combination of the 2 is between 6% and 16%. DESIGNATION: Workup of all localizations of ectopic pregnancies at a university department of obstetrics and gynecology. Comparison of diagnostic and therapeutic modalities from the surgical laparoscopic approach to nonsurgical, medical options. Tubal pregnancies: (1) to preserve tubal function, salpingotomy, partial salpingectomy followed by laparoscopic anastomosis, or fimbrial milking is performed. (2) Tubectomy or salpingectomy is performed only in severely damaged or ruptured tubes or if the patient does not desire further pregnancies. Nontubal ectopic pregnancies (ovarian pregnancy, ectopic abdominal pregnancy, interstitial or cornual pregnancy/rudimentary horn, intraligamental and cervical pregnancies) all require their own specific treatment. The predominant drug is methotrexate, but other systemic drugs, such as actinomycin D, prostaglandins, and RU 486, can also be applied. Tubal rupture is a complication of late diagnosed tubal pregnancy that is more difficult to treat conservatively and often indicates tubectomy or segmental resection. In 5% to 15% of treated ectopic pregnancy cases, remnant conception product parts may require a final methotrexate injection. This article is a review to aid clinical diagnosis of ectopic pregnancies that now can be diagnosed earlier and treated effectively by laparoscopic surgery.

  15. The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis

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    Manheimer, Eric; van der Windt, Daniëlle; Cheng, Ke; Stafford, Kristen; Liu, Jianping; Tierney, Jayne; Lao, Lixing; Berman, Brian M.; Langenberg, Patricia; Bouter, Lex M.

    2013-01-01

    BACKGROUND Recent systematic reviews of adjuvant acupuncture for IVF have pooled heterogeneous trials, without examining variables that might explain the heterogeneity. The aims of our meta-analysis were to quantify the overall pooled effects of adjuvant acupuncture on IVF clinical pregnancy success rates, and evaluate whether study design-, treatment- and population-related factors influence effect estimates. METHODS We included randomized controlled trials that compared needle acupuncture administered within 1 day of embryo transfer, versus sham acupuncture or no adjuvant treatment. Our primary outcome was clinical pregnancy rates. We obtained from all investigators additional methodological details and outcome data not included in their original publications. We analysed sham-controlled and no adjuvant treatment-controlled trials separately, but since there were no large or significant differences between these two subsets, we pooled all trials for subgroup analyses. We prespecified 11 subgroup variables (5 clinical and 6 methodological) to investigate sources of heterogeneity, using single covariate meta-regressions. RESULTS Sixteen trials (4021 participants) were included in the meta-analyses. There was no statistically significant difference between acupuncture and controls when combining all trials [risk ratio (RR) 1.12, 95% confidence interval (CI), 0.96–1.31; I2 = 68%; 16 trials; 4021 participants], or when restricting to sham-controlled (RR 1.02, 0.83–1.26; I2 = 66%; 7 trials; 2044 participants) or no adjuvant treatment-controlled trials (RR 1.22, 0.97–1.52; I2 = 67%; 9 trials; 1977 participants). The type of control used did not significantly explain the statistical heterogeneity (interaction P = 0.27). Baseline pregnancy rate, measured as the observed rate of clinical pregnancy in the control group of each trial, was a statistically significant effect modifier (interaction P acupuncture across all trials (adjusted R2 = 93%; I2 residual = 9

  16. Acute Appendicitis in Pregnancy: Predictive Clinical Factors and Pregnancy Outcomes.

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    Theilen, Lauren H; Mellnick, Vincent M; Shanks, Anthony L; Tuuli, Methodius G; Odibo, Anthony O; Macones, George A; Cahill, Alison G

    2017-05-01

    Objective  The objective of this study was to identify clinical factors predictive of appendicitis in pregnant women and associated obstetric outcomes. Study Design  We performed a single-center, retrospective cohort study of pregnant women who underwent magnetic resonance imaging for suspected appendicitis from 2007 to 2012. Rates and odds of appendicitis based on presenting signs and symptoms were estimated. We also estimated rates and odds of adverse obstetric outcomes among women with a diagnosis of appendicitis. Results  Of 171 pregnant women evaluated, 14 (8.2%) had pathology-confirmed appendicitis. White blood cell (WBC) count on admission was moderately predictive of appendicitis (area under the receiver operating characteristic curve, 0.74). A WBC count > 18,000 made the diagnosis of appendicitis more than 10 times more likely (adjusted odds ratio, 10.51; 95% confidence interval, 1.67-43.1). Of 127 women with complete pregnancy follow-up, women with appendicitis had a higher rate of pregnancy loss appendicitis. Appendicitis diagnosed in the first trimester was associated with increased risk of pregnancy loss  18,000 on admission is significantly associated with appendicitis in pregnant women undergoing evaluation for appendicitis. Appendicitis during the first trimester of pregnancy is associated with previable pregnancy loss. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Ectopic Pregnancy Rates in the Medicaid Population

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    STULBERG, Debra B.; CAIN, Loretta R.; DAHLQUIST, Irma; LAUDERDALE, Diane S.

    2013-01-01

    Objective The Centers for Disease Control and Prevention last estimated a national ectopic pregnancy rate in 1992, when it was 1.97 percent of all reported pregnancies. Since then rates have been reported among privately insured women and regional healthcare provider populations, ranging from 1.6 to 2.45 percent. This study assessed the rate of ectopic pregnancy among Medicaid beneficiaries (New York, California, and Illinois, 2000–03), a previously unstudied population. Study Design We identified Medicaid administrative claims records for inpatient and outpatient encounters with a principal ICD9 diagnosis code for ectopic pregnancy. We calculated the ectopic pregnancy rate among female beneficiaries ages 15–44 as the number of ectopic pregnancies divided by the number of total pregnancies, which included spontaneous abortions, induced abortions, ectopic pregnancies, and all births. We used Poisson regression to assess the risk of ectopic pregnancy by age and race. Results Four-year Medicaid ectopic pregnancy rates were 2.38 percent of pregnancies in New York, 2.07 percent in California, and 2.43 percent in Illinois. Risk was higher among Black women compared to whites in all states (RR= 1.26, 95% CI 1.25 – 1.28, pectopic pregnancy than reported for privately insured women nationwide in the same years. Relying on private insurance databases may underestimate ectopic pregnancy’s burden in the United States population. Furthermore, within this low-income population racial disparities exist. PMID:23313717

  18. A Randomized Trial to Evaluate the Effect of Local Endometrial Injury on the Clinical Pregnancy Rate of Frozen Embryo Transfer Cycles in Patients With Repeated Implantation Failure

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    Ensieh Shahrokh-Tehraninejad

    2016-12-01

    Full Text Available Objective: Repeated implantation failure (RIF is a condition in which the embryos implantation decreases in the endometrium. So, our aim was to evaluate the effect of local endometrial injury on embryo transfer results.Materials and methods: In this simple randomized clinical trial (RCT, a total of 120 patients were selected. The participants were less than 40 years old, and they are in their minimum two cycles of vitro fertilization (IVF. Patients were divided randomly into two groups of LEI (Local endometrial injury and a control group (n = 60 in each group. The first group had four small endometrial injuries from anterior, posterior, and lateral uterus walls which were obtained from people who were in 21th day of their previous IVF cycle. The second group was the patients who have not received any intervention.Results: The experimental and control patients were matched in the following factors. Regarding the clinical pregnancy rate, there was no significant difference noted between the experimental and the control group.Conclusion: Local endometrial injury in a preceding cycle does not increase the clinical pregnancy rate in the subsequent FET cycle of patients with repeated implantation failure.

  19. Pregnancy rates in central Yellowstone bison

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    Gogan, Peter J.; Russell, Robin E.; Olexa, Edward M.; Podruzny, Kevin M.

    2013-01-01

    Plains bison (Bison b. bison) centered on Yellowstone National Park are chronically infected with brucellosis (Brucella abortus) and culled along the park boundaries to reduce the probability of disease transmission to domestic livestock. We evaluated the relationship between pregnancy rates and age, dressed carcass weight, and serological status for brucellosis among bison culled from the central Yellowstone subpopulation during the winters of 1996–1997, 2001–2002, and 2002–2003. A model with only dressed carcass weight was the best predictor of pregnancy status for all ages with the odds of pregnancy increasing by 1.03 (95% CI = 1.02–1.04) for every 1-kg increase in weight. We found no effect of age or the serological status for brucellosis on pregnancy rates across age classes; however, we did find a positive association between age and pregnancy rates for bison ≥2 years old. Bison ≥2 years old had an overall pregnancy rate of 65% with markedly different rates in alternate ages for animals between 3 and 7 years old. Pregnancy rates were 0.50 (95% CI = 0.31–0.69) for brucellosis positive and 0.57 (95% CI = 0.34–0.78) for brucellosis negative 2- and 3-year-olds and 0.74 (95% CI = 0.60–0.85) in brucellosis positive and 0.69 (95% CI = 0.49–0.85) in brucellosis negative bison ≥4 years old. Only 1 of 21 bison <2 years old was pregnant. Our findings are important to accurately predict the effects of brucellosis on Yellowstone bison population dynamics. We review our results relative to other studies of Yellowstone bison that concluded serological status for brucellosis influences pregnancy rates.

  20. Successful pregnancy rates achieved with day 4 embryo transfers.

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    Skorupski, Josh C; Stein, Daniel E; Acholonu, Uchenna; Field, Heather; Keltz, Martin

    2007-04-01

    To assess the success of day 4 embryo transfers (ETs) following IVF at one institution. Retrospective analysis. A university hospital IVF program. Two hundred nondonor, fresh IVF cycles. None. Outcomes of IVF. Outcome assessments after day 4 ETs included rates of implantation, clinical pregnancy, and singleton and multiple live births. The overall live-birth rate was 54.4%. Implantation rates were highest in younger age groups, and similar in patients 35-40 years of age. Pregnancy and live-birth rates were similar across all age groups up to age 40 years. Multiple gestations were highest in women < or =40 years of age. Acceptable pregnancy rates can be achieved with day 4 ETs.

  1. The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Manheimer, E.W.; van der Windt, D.; Cheng, K.; Stafford, K.; Liu, J.P.; Tierney, J.; Lao, L.X.; Berman, B.M.; Langenberg, P.; Bouter, L.M.

    2013-01-01

    Background: Recent systematic reviews of adjuvant acupuncture for IVF have pooled heterogeneous trials, without examining variables that might explain the heterogeneity. The aims of our meta-analysis were to quantify the overall pooled effects of adjuvant acupuncture on IVF clinical pregnancy

  2. Fertility Clinic Success Rates

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    ... Defects ART and Autism 2013 Assisted Reproductive Technology Fertility Clinic Success Rates Report Recommend on Facebook Tweet ... Additional Information About ART in the United States. Fertility Clinic Tables Introduction to Fertility Clinic Tables [PDF - ...

  3. Alcohol use and pregnancy consensus clinical guidelines.

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    Carson, George; Cox, Lori Vitale; Crane, Joan; Croteau, Pascal; Graves, Lisa; Kluka, Sandra; Koren, Gideon; Martel, Marie-Jocelyne; Midmer, Deana; Nulman, Irena; Poole, Nancy; Senikas, Vyta; Wood, Rebecca

    2010-08-01

    to establish national standards of care for the screening and recording of alcohol use and counselling on alcohol use of women of child-bearing age and pregnant women based on the most up-to-date evidence. published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library in May 2009 using appropriate controlled vocabulary (e.g., pregnancy complications, alcohol drinking, prenatal care) and key words (e.g., pregnancy, alcohol consumption, risk reduction). Results were restricted to literature published in the last five years with the following research designs: systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment (HTA) and HTA-related agencies, national and international medical specialty societies, clinical practice guideline collections, and clinical trial registries. Each article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by the Society of Obstetricians and Gynaecologists of Canada. The quality of evidence was evaluated and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care. the quality of evidence was rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table 1). the Public Health Agency of Canada and the Society of Obstetricians and Gynaecologists of Canada. these consensus guidelines have been endorsed by the Association of Obstetricians and Gynecologists of Quebec; the Canadian Association of Midwives; the Canadian Association of Perinatal, Women's Health and Neonatal Nurses (CAPWHN); the College of Family Physicians of

  4. Cholera in pregnancy: Clinical and immunological aspects

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    Ashraful I. Khan

    2015-10-01

    Conclusions: To our knowledge, this is the first report of immune responses in pregnant women with cholera. We found that pregnant woman early in pregnancy has comparable clinical illness and subsequent immune responses compared to non-pregnant women. These findings suggest that the evaluation of safety and immunogenicity of oral cholera vaccines in pregnancy should be an area of future investigations.

  5. Clinical follow-up of pregnancy in myasthenia gravis patients.

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    Ducci, Renata D; Lorenzoni, Paulo J; Kay, Claudia S K; Werneck, Lineu C; Scola, Rosana H

    2017-04-01

    This study aimed to analyze the outcome and impact of pregnancy in women with myasthenia gravis (MG). Obstetric and clinical data were retrospectively analyzed before, during and after pregnancy. Predictors of outcome were studied. We included 35 pregnancies from 21 MG patients. In the course of MG symptoms in 30 pregnancies with live births, 50% deteriorated (mainly during the second trimester, p = 0.028), 30% improved, and 20% remained unchanged. The deterioration group had more frequent abnormal repetitive nerve stimulation (RNS) (p = 0.028) and lower myasthenia gravis composite (MGC) scores (p = 0.045) before pregnancy. The improvement group was associated with higher MGC scores (p = 0.012) before pregnancy. The no-change group was associated with longer duration of MG (p = 0.026) and normal RNS (p = 0.008) before pregnancy. The course of MG in the second pregnancy was different from that in the previous pregnancy in 65.3% of cases. Obstetric complications were reported in 20 pregnancies; the most common was preterm premature rupture of membranes (PPROM) (25.8%), and the most severe were abortion (11.4%) and fetal death (2.9%). Most of the patients delivered via caesarean section (66.7%). Spinal anesthesia was performed in 73.3%. Transient neonatal myasthenia gravis occurred in 12.9% of live-born infants, and no predictors were found. In conclusion, severity and duration of MG, RNS and treatment influence MG and pregnancy. Pregnant MG patients have greater rates of PPROM and caesarean delivery. Our data suggest that duration of MG, MGC and RNS before pregnancy may be useful in helping to predict the course of MG during pregnancy. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Teenage pregnancy and exclusive breastfeeding rates.

    Science.gov (United States)

    Puapompong, Pawin; Raungrongmorakot, Kasem; Manolerdtewan, Wichian; Ketsuwan, Sukwadee; Wongin, Sinutchanan

    2014-09-01

    Teenage pregnancy is an important health issue globally and in Thailand Younger age mothers decide on the breastfeeding practices ofthe first 6-month. To find the rates of 6-month exclusive breastfeeding practices of teenage mothers and compare them with the rates of 6-month exclusive breastfeeding practices in mothers who are 20 years of age or more. Three thousand five hundred sixty three normal, postpartum women, who delivered without complications at the HRH Princess Maha Chakri Sirindhorn Medical Center in the Nakhon Nayok Province between 2010 and2013 were included in this study. At the second daypostpartum, the data of latch scores and the data of the practice of exclusive breastfeeding were collected Telephone follow-ups on the seventh, fourteenth, and forty-fifth postpartum days and at the second, fourth, and sixth month postpartum month were collected and used for exclusive breastfeeding data following discharge. Demographic data included the maternal age, parity, gestational age, marital status, occupation, religion, route ofdelivery, estimated blood loss, body mass index, nipple length, and the childs birth weight. The collected data was analyzed by the t-test, Chi-square, and odds ratio with 95% confidence interval. The percentage of teenage pregnancies was at 14.8% (527 cases). On postpartum day 2, the percentage of latch scores of 8 or less was 66.4%. At the seventh, fourteenth, and forty-fifth day and at the second, fourth, and sixth months postpartum, the exclusive breastfeeding rates were 88.5, 78.5, 57.6, 43.1, 32.9, and27.0%, respectively. Comparison of the 6-month exclusive breastfeeding rates between teenage mothers and mothers 20 years ofage or older were not statistically significant (pteenage mothers was at 27.0% and had no significant differences from the rates of mothers 20 years of age or more.

  7. Risk of inflammatory bowel disease according to self-rated health, pregnancy course, and pregnancy complications

    DEFF Research Database (Denmark)

    Harpsøe, Maria C; Jørgensen, Kristian Tore; Frisch, Morten

    2013-01-01

    Poor self-rated health (SRH) has been connected to immunological changes, and pregnancy complications have been suggested in the etiology of autoimmune diseases including inflammatory bowel disease (IBD). We evaluated the impact of self-rated pre-pregnancy health and pregnancy course, hyperemesis...

  8. The frequency of clinical pregnancy and implantation rate after cultivation of embryos in a medium with granulocyte macrophage colony-stimulating factor (GM-CSF) in patients with preceding failed attempts of ART.

    Science.gov (United States)

    Tevkin, S; Lokshin, V; Shishimorova, M; Polumiskov, V

    2014-10-01

    The application in IVF practice of modern techniques can improve positive outcome of each cycle in the assisted reproductive technology (ART) programs and the effectiveness of treatment as a whole. There are embryos in the female reproductive tract in physiological medium which contain various cytokines and growth factors. It plays an important role in the regulation of normal embryonic development, improve implantation and subsequently optimizing the development of the fetus and the placenta. Granulocyte macrophage colony-stimulating factor (GM-CSF is one of the cytokines playing an important role in reproductive function. Addition of recombinant GM-CSF to the culture medium can makes closer human embryos culture to in vivo conditions and improve the efficacy ART cycles. The analysis of culture embryos in EmbryoGen medium has shown that fertilization rate embryo culture and transfer to patients with previous unsuccessful attempts increases clinical pregnancy rate compared to the control group 39.1 versus 27.8%, respectively. It is noted that the implantation rate (on 7 weeks' gestation) and progressive clinical pregnancy rate (on 12 weeks' gestation) were significantly higher in group embryos culture in EmbryoGen medium compared to standard combination of medium (ISM1+VA), and were 20.4 and 17.4% versus 11.6 and 9.1%, respectively.

  9. Cholera in pregnancy: Clinical and immunological aspects.

    Science.gov (United States)

    Khan, Ashraful I; Chowdhury, Fahima; Leung, Daniel T; Larocque, Regina C; Harris, Jason B; Ryan, Edward T; Calderwood, Stephen B; Qadri, Firdausi

    2015-10-01

    The objective of this study was to examine the clinical and immunological features of cholera in pregnancy. Women of reproductive age presenting to the icddr,b Dhaka hospital with cholera, and enrolled as part of a larger cohort study, were tested for pregnancy on admission. We compared initial clinical features and immune responses of pregnant patients with non-pregnant female patients at days 2, 7 and 21 after infection. Among reproductive age women enrolled between January 2001 and May 2006, 9.7% (14/144) were pregnant. The duration of diarrhoea prior to admission tended to be higher in pregnant compared to non-pregnant patients (p=0.08), but other clinical characteristics did not differ. Antibody responses to cholera toxin B subunit (CtxB), toxin-coregulated pilus A (TcpA), Vibrio cholerae lipopolysaccharide (LPS), and serum vibriocidal antibody responses, were comparable between pregnant and non-pregnant patients. There were no deaths among the pregnant cases or non-pregnant controls, and no adverse foetal outcomes, including stillbirths, during 21 days of follow up of pregnant cases. To our knowledge, this is the first report of immune responses in pregnant women with cholera. We found that pregnant woman early in pregnancy has comparable clinical illness and subsequent immune responses compared to non-pregnant women. These findings suggest that the evaluation of safety and immunogenicity of oral cholera vaccines in pregnancy should be an area of future investigations. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  10. Insemination, pregnancy and abortion rates in a population of ...

    African Journals Online (AJOL)

    Insemination, pregnancy and abortion rates in a population of Glossina palpalis palpalis (robineau-desvoidy) at a relict forest in the Southern Guinea Savanna, Nigeria. ... The results indicate that nutritional and physical stress were the likely constraints to optimum productivity. Keywords: insemination, pregnancy ...

  11. High rate of teenage pregnancy and sexually transmitted infections ...

    African Journals Online (AJOL)

    There is increased in teenage pregnancy despite the presence of dual protection practice and health care awareness programmes related to health and sexuality education in South Africa. The present study explores the underlying causes of high teenage pregnancy and sexually transmitted diseases rates, including HIV ...

  12. Changes in heart rate variability and QT variability during the first trimester of pregnancy.

    Science.gov (United States)

    Carpenter, R E; D'Silva, L A; Emery, S J; Uzun, O; Rassi, D; Lewis, M J

    2015-03-01

    The risk of new-onset arrhythmia during pregnancy is high, presumably relating to changes in both haemodynamic and cardiac autonomic function. The ability to non-invasively assess an individual's risk of developing arrhythmia during pregnancy would therefore be clinically significant. We aimed to quantify electrocardiographic temporal characteristics during the first trimester of pregnancy and to compare these with non-pregnant controls. Ninety-nine pregnant women and sixty-three non-pregnant women underwent non-invasive cardiovascular and haemodynamic assessment during a protocol consisting of various physiological states (postural manoeurvres, light exercise and metronomic breathing). Variables measured included stroke volume, cardiac output, heart rate, heart rate variability, QT and QT variability and QTVI (a measure of the variability of QT relative to that of RR). Heart rate (p pregnancy only during the supine position (p pregnancy in all physiological states (p pregnancy in all states (p pregnancy is associated with substantial changes in heart rate variability, reflecting a reduction in parasympathetic tone and an increase in sympathetic activity. QTVI shifted to a less favourable value, reflecting a greater than normal amount of QT variability. QTVI appears to be a useful method for quantifying changes in QT variability relative to RR (or heart rate) variability, being sensitive not only to physiological state but also to gestational age. We support the use of non-invasive markers of cardiac electrical variability to evaluate the risk of arrhythmic events in pregnancy, and we recommend the use of multiple physiological states during the assessment protocol.

  13. Rate, correlates and outcomes of repeat pregnancy in HIV-infected women.

    Science.gov (United States)

    Floridia, M; Tamburrini, E; Masuelli, G; Martinelli, P; Spinillo, A; Liuzzi, G; Vimercati, A; Alberico, S; Maccabruni, A; Pinnetti, C; Frisina, V; Dalzero, S; Ravizza, M

    2017-07-01

    The aim of the study was to assess the rate, determinants, and outcomes of repeat pregnancies in women with HIV infection. Data from a national study of pregnant women with HIV infection were used. Main outcomes were preterm delivery, low birth weight, CD4 cell count and HIV plasma viral load. The rate of repeat pregnancy among 3007 women was 16.2%. Women with a repeat pregnancy were on average younger than those with a single pregnancy (median age 30 vs. 33 years, respectively), more recently diagnosed with HIV infection (median time since diagnosis 25 vs. 51 months, respectively), and more frequently of foreign origin [odds ratio (OR) 1.36; 95% confidence interval (CI) 1.10-1.68], diagnosed with HIV infection in the current pregnancy (OR: 1.69; 95% CI: 1.35-2.11), and at their first pregnancy (OR: 1.33; 95% CI: 1.06-1.66). In women with sequential pregnancies, compared with the first pregnancy, several outcomes showed a significant improvement in the second pregnancy, with a higher rate of antiretroviral treatment at conception (39.0 vs. 65.4%, respectively), better median maternal weight at the start of pregnancy (60 vs. 61 kg, respectively), a higher rate of end-of-pregnancy undetectable HIV RNA (60.7 vs. 71.6%, respectively), a higher median birth weight (2815 vs. 2885 g, respectively), lower rates of preterm delivery (23.0 vs. 17.7%, respectively) and of low birth weight (23.4 vs. 15.4%, respectively), and a higher median CD4 cell count (+47 cells/μL), with almost no clinical progression to Centers for Disease Control and Prevention stage C (CDC-C) HIV disease (0.3%). The second pregnancy was significantly more likely to end in voluntary termination than the first pregnancy (11.4 vs. 6.1%, respectively). Younger and foreign women were more likely to have a repeat pregnancy; in women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, suggesting that women with HIV infection who desire multiple

  14. [Clinical features and adverse pregnancy outcomes of new onset systemic lupus erythematosus during pregnancy].

    Science.gov (United States)

    Zhan, Z P; Yang, Y; Zhan, Y F; Chen, D Y; Liang, L Q; Yang, X Y

    2016-11-08

    Objective: To investigate the clinical characteristics and adverse pregnancy outcomes in pregnant women with new onset systemic lupus erythematosus (SLE) during pregnancy. Methods: The clinical data of 263 pregnancies with SLE in the First Affiliated Hospital of Zhongshan University from 2001 to 2015 were collected and analyzed retrospectively. Results: Of all the 263 pregnancies, 188 were diagnosed before pregnancy and 75 were newly diagnosed during pregnancy. Among the 75 new onset SLE, 27, 31, 14 and 3 cases were diagnosed during first trimester, second trimester, third trimester and puerperium, respectively. Active lupus was noted in 81.3% of the patients with new onset SLE. The main clinical manifestations of new onset SLE were lupus nephritis (57.3%) and thrombocytopenia (38.7%). SLEPDAI scores as well as the prevalence of lupus nephritis, and thrombocytopenia in patients with new onset SLE was higher than those in the previously diagnosed ones ( P pregnancies, adverse pregnancy outcomesoccurred in 53 patients, including 34 with pregnancy loss, 15with premature, 8with intrauterine growth restriction, 5with fetal distress and5 with neonatal lupus. Compared with patients withnon-newonset SLE, patients with newonset SLEhad a higher prevalence of adverse pregnancy outcomes (56.4% vs 70.7%, P pregnancy loss (21.8% vs 45.3%, P lupus nephritis and thrombocytopenia. Patients with new onset SLE were more prone to active lupus, lupus nephritis and thrombocytopenia, as well as more adverse pregnancy outcomes and pregnancy loss.

  15. Aneuploidy rates in failed pregnancies following assisted reproductive technology.

    Science.gov (United States)

    Nayak, Shweta; Pavone, Mary Ellen; Milad, Magdy; Kazer, Ralph

    2011-08-01

    Approximately 10%-15% of clinically recognized pregnancies end with a first trimester loss. Cytogenetic analysis of products of conception (POC) has revealed that a large proportion of these spontaneous miscarriages are a result of chromosomal abnormalities. However, relatively few studies have evaluated chromosomal abnormalities in pregnancies achieved using assisted reproductive technologies (ART). Here, we review the incidence and type of chromosomal abnormalities that occurred in our infertility patient population undergoing ART and provide a review of the literature pertaining to this subject. A retrospective chart review of all patients from our medical center who conceived using ART between January 2000 and January 2008, who experienced a subsequent early pregnancy loss, and whose POCs were successfully karyotyped were included. We also conducted a literature review in PubMed, searching for other articles on this subject. Two hundred fourteen patients conceived with ART, experienced an early loss, and subsequently underwent a dilation and curettage (D&C) between 2000 and 2008. A total of 59 (27%) patients chose to have cytogenetic testing, and their POCs were successfully karyotyped. The overall rate of aneuploidy in this group was 83%. Our PubMed search revealed a total of 12 studies that were identified and evaluated and deemed appropriate for review. Consistent with most of the literature, we found a high rate of aneuploidy present in infertile patients conceiving using ART. Because an abnormal karyotype provides an explanation for an early loss, this and other studies seem to suggest that routinely carrying out this assessment in such patients may be of value.

  16. Clinical pattern of gynaecological / early pregnancy complaints and ...

    African Journals Online (AJOL)

    complaints of vaginal bleeding with or without pains, history of amenorrhea or infertility ; clinical and ultrasound impressions of early pregnancy complaints including ectopic pregnancies and pelvic inflammatory diseases (PID) with exclusion of uro-genital and gastrointestinal complaints/ cases. Pregnancies greater than 12 ...

  17. Clinical pattern of gynecological/early pregnancy complaints and the ...

    African Journals Online (AJOL)

    ... complaints of vaginal bleeding, with or without pain, history of amenorrhea or infertility, clinical and ultrasound impression of early pregnancy complaints, including ectopic pregnancies and pelvic inflammatory diseases (PID), with exclusion of urogenital and gastrointestinal complaints/cases. Pregnancies greater than 12 ...

  18. Tubal patency following surgical and clinical treatment of ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Julio Elito Junior

    Full Text Available CONTEXT AND OBJECTIVE: As there is little information about fertility outcomes among women following clinical treatment (methotrexate and expectant management and surgery (salpingectomy consequent to ectopic pregnancy, we evaluate the results from hysterosalpingography subsequent to treatment. The objective was to evaluate contralateral tubal patency using hysterosalpingography following surgery and clinical treatment of tubal pregnancy. DESIGN AND SETTING: This was a prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center. METHOD: Among 115 patients who underwent hysterosalpingography following surgery and clinical treatment of tubal pregnancy between April 1994 and February 2002, 30 were treated with a single intramuscular dose of methotrexate (50 mg/m², 50 were followed up expectantly and 35 underwent salpingectomy. RESULTS: The patency of the ipsilateral tube was 84% after methotrexate treatment and 78% after expectant management. In addition, contralateral tubal patency was 97% after methotrexate treatment, 92% after expectant management and 83% after salpingectomy. There were no statistically significant differences between the clinical treatment and surgery groups. CONCLUSIONS: The findings from this study suggest similar contralateral tubal patency rates following salpingectomy, methotrexate treatment and expectant management.

  19. Psychotherapeutic counseling and pregnancy rates in in vitro fertilization.

    Science.gov (United States)

    Poehl, M; Bichler, K; Wicke, V; Dörner, V; Feichtinger, W

    1999-07-01

    Since the Austrian propagation bill of July 1, 1992, was passed into law, Austrian physicians are committed to offer psychological counseling to women before performing assisted reproductive techniques, unless refused by the patient. The acceptance of psychotherapeutic counseling (PSITCO) and its influence on pregnancy rate were carefully reviewed. The study comprised 1156 consecutive patients (mean age, 33.3 years) and 1736 in vitro fertilization (IVF) cycles. In a consent form for follicle puncture, the patients were interviewed about PSITCO as follows. Several methods of psychological support during IVF-embryo transfer treatment were offered to patients especially psychotherapy, hypnotherapy, and relaxation and physical perception exercises. Forty-two and three-tenths percent of patients rejected PSITCO, 17.8% had already received PSITCO, and 10.4% were willing to undergo PSITCO. The acceptance of PSITCO had no relevance on pregnancy rate. The cumulative calculation of pregnancy rates showed that up to 56.4% of women who had undergone PSITCO conceived. In patients who were planning to undergo PSITCO, the pregnancy rate was 41.9%. Concerning the cumulative pregnancy rate, this study showed that patients who accepted or underwent PSITCO had a higher pregnancy rate than those who did not avail themselves of this possibility. These results should encourage sterility specialists to consider psychological therapy as an essential aspect of IVF. Solely a written declaration of the patient stating his/her awareness of the possibility to undergo PSITCO is, in our opinion, insufficient.

  20. Appendicectomy is associated with increased pregnancy rate: a cohort study.

    Science.gov (United States)

    Wei, Li; Macdonald, Thomas M; Shimi, Sami M

    2012-12-01

    This study was carried out to determine whether pregnancy rate is reduced after appendicitis or appendicectomy. The association between appendicectomy, appendicitis, and subsequent fertility is controversial. A cohort study was carried out in the Medicines Monitoring database. The cohort of women who underwent appendicectomy and appropriate comparators were followed up until first pregnancy after appendicectomy date. Pathology of the appendix was verified manually. The association between appendicectomy, appendicitis, and pregnancy was determined by Cox regression models. The age and social deprivation score-matched analyses included 2935 patients who had appendicectomy with 5870 comparators. There were 1277 (43.5%) pregnancies in the appendicectomy cohort and 2319 (39.5%) in the comparator cohort during a mean follow-up of 12.4 (standard deviation: 7.3) years. The adjusted hazard ratios (HRs) for pregnancy rates were 1.20 (95% confidence interval [CI]: 1.10-1.31). In an unmatched cohort analysis (3009 in the appendicectomy cohort and 122,912 in the comparator cohort), the adjusted HRs for pregnancy rates were 1.65 (95% CI: 1.55-1.75). Within the histologically proven appendicitis subset, the adjusted HR was 1.21 (95% CI: 1.08-1.37) in comparison with the matched comparator cohort. In comparison with the group of participants who had appendicectomy for a normal appendix, the HRs were 0.98 (95% CI: 0.83-1.15) for mucosal and catarrhal appendicitis, 0.72 (95% CI: 0.64-0.82) for suppurative appendicitis, and 0.64 (95% CI: 0.50-0.80) for gangrenous appendicitis. Appendicectomy and early appendicitis were associated with increased pregnancy rates. Young women with early appendicitis had better pregnancy rates than those with advanced appendicitis. Early referral for laparoscopy and appendicectomy is advocated.

  1. Catastrophic antiphospholipid syndrome and pregnancy. Clinical report.

    Science.gov (United States)

    Khizroeva, J; Bitsadze, V; Makatsariya, A

    2018-01-08

    We have observed the development of a catastrophic antiphospholipid syndrome (CAPS) in a pregnant woman hospitalized at 28 weeks of gestation with a severe preeclampsia. On the same day, an eclampsia attack developed, and an emergency surgical delivery was performed. On the third day, multiorgan failure developed. Examination showed a persistent circulation of lupus anticoagulant, high level of antibodies to cardiolipin, b2-glycoprotein I, and prothrombin. The usual diagnosis of the severe preeclampsia masked a catastrophic antiphospholipid syndrome, exacerbated by the coincident presence of several types of antiphospholipid antibodies. The first pregnancy resulted in a premature birth at 25 weeks, possibly also due to the circulation of antiphospholipid antibodies. The trigger of the catastrophic form development was the pregnancy itself, surgical intervention, and hyperhomocysteinemia. CAPS is the most severe form of antiphospholipid syndrome, manifested in multiple microthrombosis of microcirculation of vital organs and in the development of multiorgan failure against the background of the high level of antiphospholipid antibodies. CAPS is characterized by renal, cerebral, gastrointestinal, adrenal, ovarian, skin, and other forms of microthrombosis. Thrombosis recurrence is typical. Thrombotic microvasculopathy lies at the heart of multiorgan failure and manifests clinically in central nervous system lesions, adrenal insufficiency, and ARDS development. CAPS is a life-threatening condition, therefore, requires an urgent treatment. Optimal treatment of CAPS is not developed. CAPS represent a general medical multidisciplinary problem.

  2. Effect of endometrial cavity fluid on pregnancy rate of fresh versus frozen In Vitro fertilization cycle

    Directory of Open Access Journals (Sweden)

    Nitika Gupta

    2017-01-01

    Full Text Available Objective: This study aims to study the difference in etiology and outcome in terms of implantation rate and abortion rate in fresh (self-stimulated versus frozen (oocyte donation cycle in vitro fertilization (IVF and in transient versus persistent fluid. Material and Methods: This retrospective study was conducted in the Department of Reproductive Medicine of tertiary care center from January 2012 to November 2015. Data were collected retrospectively from the departmental files. Twenty-four patients from fresh IVF-stimulated cycles and 24 from frozen oocyte donation cycle with their endometrium prepared by hormone replacement treatment were included in the study. All patients selected in the study had grade-A embryo transfer of day 3–4 with maximum three embryo transferred. Pregnancy was defined by rising serum beta-human chorionic gonadotrophin levels performed after 14 days of embryo transfer and further confirmed by ultrasonographic visualization of gestational sac at 6 weeks. All biochemical pregnancies were included in implantation failure. All pregnant patients were followed till the termination of pregnancy and further noted as live birth or abortion. Results: Clinical pregnancy rate was seen more in self-stimulated cycle (62.5% with live birth rate of 50% than hormone replacement treatment cycle, in which clinical pregnancy rate was 45.83% with live birth rate of 33.33%. Clinical pregnancy rate was highest in group with very less fluid in cavity (1–2 mm 63% and with live birth of 52.63%. Clinical pregnancy was seen only in two patients of group B with anterior and posterior (AP diameter of fluid in cavity of 2–3 mm with live birth of only one, whereas in group C, with AP diameter of 3–5 mm, none of the patient conceived. This difference was statistically significant. Clinical pregnancy rate was 65.62% in transient fluid accumulation with live birth rate of 53.25%, which was significantly higher than persistent fluid accumulation

  3. Multimodal intervention raises smoking cessation rate during pregnancy

    DEFF Research Database (Denmark)

    Hegaard, Hanne K; Kjaergaard, Hanne; Møller, Lars F

    2003-01-01

    rates during pregnancy were significantly higher in the intervention group (14%) than in the group receiving usual care (5.0%) (p test). Cotinine-validated cessation rates during pregnancy were significantly higher among the former (7%) than the latter (2%) (p = 0...... of the midwives' prenatal care. All pregnant smokers in the usual care group (n = 320) received standard counseling from a midwife. Outcome was self-reported smoking cessation in the 37th week of pregnancy and the reported cessation was validated by cotinine saliva concentration. RESULTS: Self-reported cessation.......003). The adjusted odds ratio (OR) for smoking cessation was 4.20 (95% CI 2.13-8.03). Logistic regression analysis showed a significant positive association of smoking cessation with low caffeine consumption in pregnancy, many years in school, no exposure to passive smoking outside the home, and previous attempts...

  4. Change of Diurnal Heart Rate Patterns During Pregnancy and Lactation in Dogs (Canis familiaris

    Directory of Open Access Journals (Sweden)

    Häggström J

    2003-09-01

    Full Text Available Pregnancy and lactation involve great demands on the cardiovascular system. The purpose of this study was to investigate how the heart rate and diurnal heart rate pattern change when dogs become pregnant or lactate. Five clinically healthy female beagle dogs were mated, and delivered three to seven healthy puppies. The heart rate was investigated with 24-h ECG (Holter once during anoestrus, at 3, 5, 7 and 9 weeks of pregnancy, and at week 4 postpartum (lactation. However, at 9 weeks, the ECG could not be recorded for the fully 24 h in 4 of 5 dogs, because labour started and the dogs then appeared disturbed by the recordings. The results at this date are not included in the statistical comparison. The heart rate increased progressively during pregnancy and was still elevated at 4 weeks of lactation. During late pregnancy the difference in heart rates between daytime and nighttime became smaller, but the heart rate was significantly higher in daytime in all periods. In conclusion, the increased heart rates during pregnancy and lactation reflect increased demands on the cardiovascular system and may be important to consider in clinical practice.

  5. The Clinical and Ultrasonic Study of Clinically Suspected Ectopic Pregnancy: Laying Emphasis on 15 proven Ectopic Pregnancies

    International Nuclear Information System (INIS)

    Byun, Myung Ho; Chung, Yung Sun

    2010-01-01

    Ectopic preganacies are unsuccessful pregnancies that result from implantation of fertilized ovum occurring in an aberrant area. Aside from an emergency case, the early diagnosis of ectopic pregnancy is very difficult particularly in a case with insidious onset and mild clinical manifestations. Early diagnosis not only reduces the danger, but also simplifies the management of ectopic pregnancy. Ultrasonography has been an indispensable diagnostic tool in Obstetrics and Gynecology. In the authors' experience, clinical suspected ectopic pregnancy was one of the common indications for performing ultrasonography. Since Kobayashi at al. reported the appearances of ectopic pregnancy utilizing bistable B-scan ultrasonography, the ultrasonic findings of ectopic pregnancy have been reported by many authors. But, its accuracy and reliability in the diagnosis of ectopic pregnancy are still open to controversy. The authors studied 65 cases of clinically suspected ectopic pregnancy with Picker 80 L gray scale ultrasonography from Aug. 1982 to June. 1983. There were 29 confirmed cases, of which 15 were proved to have ectopic pregnancy and 14 were proved to have diseases other than ectopic pregnancy by surgical and histopathological study or by laparoscopy and follow up study. 29 confirmed cases were reviewed. The results were as follows: 1. Among 15 ectopic pregnancies, there were 12 ampullary pregnancies, 2 isthmic pregnancies and 1 interstitial pregnancy. Among 14 cases of no ectopic pregnancy, there were 5 intrauterine pregnancies, 3 myoma uteri, 2 P.I.D., and 1 case of dermoid cyst, cystic teratoma, H-mole and tubal hematoma due to previous tuball ligation, respectively. 2. The age distribution of ectopic pregnancy was from 22 to 41 years. The common clinical manifestations of ectopic pregnancy were lower abdominal pain (73.3%), vaginal spotting or bleeding (73.3%) and amenorrhea (66.7%). 3. Positive result of urine immunologic pregnancy test was 28.6% in ectopic pregnancy

  6. The Clinical and Ultrasonic Study of Clinically Suspected Ectopic Pregnancy: Laying Emphasis on 15 proven Ectopic Pregnancies

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Myung Ho; Chung, Yung Sun [Chonnam National University College of Medicine, Gwangju (Korea, Republic of)

    2010-05-15

    Ectopic preganacies are unsuccessful pregnancies that result from implantation of fertilized ovum occurring in an aberrant area. Aside from an emergency case, the early diagnosis of ectopic pregnancy is very difficult particularly in a case with insidious onset and mild clinical manifestations. Early diagnosis not only reduces the danger, but also simplifies the management of ectopic pregnancy. Ultrasonography has been an indispensable diagnostic tool in Obstetrics and Gynecology. In the authors' experience, clinical suspected ectopic pregnancy was one of the common indications for performing ultrasonography. Since Kobayashi at al. reported the appearances of ectopic pregnancy utilizing bistable B-scan ultrasonography, the ultrasonic findings of ectopic pregnancy have been reported by many authors. But, its accuracy and reliability in the diagnosis of ectopic pregnancy are still open to controversy. The authors studied 65 cases of clinically suspected ectopic pregnancy with Picker 80 L gray scale ultrasonography from Aug. 1982 to June. 1983. There were 29 confirmed cases, of which 15 were proved to have ectopic pregnancy and 14 were proved to have diseases other than ectopic pregnancy by surgical and histopathological study or by laparoscopy and follow up study. 29 confirmed cases were reviewed. The results were as follows: 1. Among 15 ectopic pregnancies, there were 12 ampullary pregnancies, 2 isthmic pregnancies and 1 interstitial pregnancy. Among 14 cases of no ectopic pregnancy, there were 5 intrauterine pregnancies, 3 myoma uteri, 2 P.I.D., and 1 case of dermoid cyst, cystic teratoma, H-mole and tubal hematoma due to previous tuball ligation, respectively. 2. The age distribution of ectopic pregnancy was from 22 to 41 years. The common clinical manifestations of ectopic pregnancy were lower abdominal pain (73.3%), vaginal spotting or bleeding (73.3%) and amenorrhea (66.7%). 3. Positive result of urine immunologic pregnancy test was 28.6% in ectopic

  7. Early Gestational Weight Gain Rate and Adverse Pregnancy Outcomes in Korean Women.

    Directory of Open Access Journals (Sweden)

    Eun-Hee Cho

    Full Text Available During pregnancy, many women gain excessive weight, which is related to adverse maternal and neonatal outcomes. In this study, we evaluated whether rate of gestational weight gain (RGWG in early, mid, and late pregnancy is strongly associated with adverse pregnancy outcomes. A retrospective chart review of 2,789 pregnant Korean women was performed. Weights were recorded at the first clinic visit, during the screening test for fetal anomaly, and during the 50g oral glucose challenge test and delivery, to represent early, mid, and late pregnancy, respectively. A multivariate logistic regression analysis was performed to examine the relationship between RGWG and adverse pregnancy outcomes. At early pregnancy, the RGWG was significantly associated with high risk of developing gestational diabetes mellitus (GDM, pregnancy-induced hypertension (PIH, large for gestational age (LGA infants, macrosomia, and primary cesarean section (P-CS. The RGWG of mid pregnancy was not significantly associated with any adverse pregnancy outcomes. The RGWG at late pregnancy was significantly associated with a lower risk of developing GDM, preterm birth and P-CS, but with a higher risk of developing LGA infants and macrosomia. When the subjects were divided into three groups (Underweight, Normal, and Obese, based on pre-pregnancy body mass index (BMI, the relationship between early RGWG and adverse pregnancy outcomes was significantly different across the three BMI groups. At early pregnancy, RGWG was not significantly associated to adverse pregnancy outcomes for subjects in the Underweight group. In the Normal group, however, early RGWG was significantly associated with GDM, PIH, LGA infants, macrosomia, P-CS, and small for gestational weight (SGA infants, whereas early RGWG was significantly associated with only a high risk of PIH in the Obese group. The results of our study suggest that early RGWG is significantly associated with various adverse pregnancy outcomes

  8. Use of long-acting reversible contraceptives to reduce the rate of teen pregnancy.

    Science.gov (United States)

    Rome, Ellen

    2015-11-01

    Long-acting reversible contraceptives (LARCs) are safe for use in adolescents and do not rely on compliance or adherence for effectiveness. Continuation rates are higher and pregnancy rates are lower for adolescent users of LARCs compared with short-acting methods such as oral contraceptives. Similarly, repeat pregnancy rates are lower when LARCs are used compared with other forms of contraception. Myths and misconceptions about LARCs and other contraceptives remain a barrier to their use. Health care providers are in a unique position to provide confidential care to adolescents, and should provide education to them about the various contraceptive options, especially LARCs. Copyright © 2015 Cleveland Clinic.

  9. Rating Pregnancy Wheel Applications Using the APPLICATIONS Scoring System.

    Science.gov (United States)

    Chyjek, Kathy; Farag, Sara; Chen, Katherine T

    2015-06-01

    To identify the top-rated pregnancy wheel applications (apps) using a newly developed APPLICATIONS scoring system. A list of pregnancy wheel apps was identified. Consumer-based and inaccurate apps were excluded. The APPLICATIONS scoring system was developed to rate the remaining apps. Application comprehensiveness was evaluated. Objective rating components included price, paid subscription, literature used, in-app purchases, connectivity to the Internet, advertisements, text search field, interdevice compatibility, and other components such as images or figures, videos, and special features. Subjective rating components were ease of navigation and subjective presentation. A complete list of 55 pregnancy wheel apps was created from three sources. Thirty-nine (71%) were consumer-based, inaccurate, or both, leaving 16 (29%) for analysis using the APPLICATIONS scoring system. More than two thirds of pregnancy wheel apps were excluded from our study secondary to being consumer-based, inaccurate, or both. This highlights the importance of identifying systematically, reviewing critically, and rating the thousands of available apps to health care providers to ensure accuracy and applicability. We propose that our APPLICATIONS scoring system be used to rate apps in all specialties with the goal of improving health care provider performance and thereby patient outcomes. III.

  10. Clinical Study on Acute Pancreatitis in Pregnancy in 26 Cases

    OpenAIRE

    Qihui, Cheng; Xiping, Zhang; Xianfeng, Ding

    2012-01-01

    Aim. This paper investigated the pathogenesis and treatment strategies of acute pancreatitis (AP) in pregnancy. Methods. We analyzed retrospectively the characteristics, auxiliary diagnosis, treatment strategies, and clinical outcomes of 26 cases of patients with AP in pregnancy. Results. All patients were cured finally. (1) Nine cases of 22 mild acute pancreatitis (MAP) patients selected automatic termination of pregnancy because of the unsatisfied therapeutic efficacy or those patients’ req...

  11. Dose dependent effect of GnRH analogue on pregnancy rate of repeat breeder crossbred cows.

    Science.gov (United States)

    Kharche, S D; Srivastava, S K

    2007-05-01

    The aim of this study was to investigate the effect of treating repeat breeder dairy crossbred cows with different doses of GnRH analogue through i.m. at the time of artificial insemination, on pregnancy rates from their first service after treatment and overall pregnancy rates. One hundred and thirty seven crossbred dairy cows with a history of repeat breeding and eligible after 6-8 infertile services but clinically free of diseases were selected for the study. The animals were randomly divided into three groups. Group 1 (n = 55) cows were treated intramuscularly with each 20 microg Buserelin-acetate (Receptal, Hoechst Roussel Vet GmbH) at the time of artificial insemination. Group 2 (n = 40) cows were treated intramuscularly with each 10 microg Buserelin-acetate at the time of artificial insemination. Group 3 (n = 42) cows were treated intramuscularly with saline as control at the time of artificial insemination. The first service pregnancy rates in Groups 1-3 were 45, 25 and 17%, respectively. Similarly, the overall conception rates in Groups 1-3 were 87, 58 and 48%, respectively. The results indicated that the pregnancy rate in crossbred cows could be improved by the GnRH treatment. The higher dose of GnRH significantly increased (P < 0.05) the first service as well as overall pregnancy rate in a dose dependent manner in repeat breeder crossbred cow bred previously 6-8 times unsuccessfully. (c)2006 Elsevier B.V. All rights reserved.

  12. Geographic and racial variation in teen pregnancy rates in Wisconsin.

    Science.gov (United States)

    Layde, Molly M; Remington, Patrick L

    2013-08-01

    Despite recent declines in teen birth rates, teenage pregnancy remains an important public health problem in Wisconsin with significant social, economic, and health-related effects. Compare and contrast teen birth rate trends by race, ethnicity, and county in Wisconsin. Teen (ages 15-19 years) birth rates (per 1000 teenage females) in Wisconsin from 2001-2010 were compared by racelethnicity and county of residence using data from the Wisconsin Interactive Statistics on Health. Teen birth rates in Wisconsin have declined by 20% over the past decade, from 35.5/1000 teens in 2001 to 28.3/1000 teens in 2010-a relative decline of 20.3%. However, trends vary by race, with declines among blacks (-33%) and whites (-26%) and increases among American Indians (+21%) and Hispanics (+30%). Minority teen birth rates continue to be 3 to 5 times greater than birth rates among whites. Rates varied even more by county, with an over 14-fold difference between Ozaukee County (7.8/1000) and Menominee County (114.2). Despite recent declines, teen pregnancy continues to be an important public health problem in Wisconsin. Pregnancy prevention programs should be targeted toward the populations and counties with the highest rates.

  13. Preovulatory progesterone concentration associates significantly to follicle number and LH concentration but not to pregnancy rate

    DEFF Research Database (Denmark)

    Yding Andersen, Claus; Bungum, Leif; Andersen, Anders Nyboe

    2011-01-01

    of HCG administration and the probability of clinical pregnancy in women undergoing ovarian stimulation with GnRH agonists and gonadotrophins for assisted reproduction treatment.Instead, late-follicular-phase progesterone concentration appears to be governed by the number of preovulatory follicles and LH...... with or without rLH administration from day 6 of stimulation. There was no significant association between the late-follicular-phase progesterone concentration and the clinical pregnancy rate. However, progesterone concentration was strongly associated with the number of follicles and retrieved oocytes. Late...

  14. Psychotherapeutic Counseling and Pregnancy Rates in In Vitro Fertilization

    OpenAIRE

    Poehl, Michaela; Bichler, Katherina; Wicke, Veronika; Dörner, Veronika; Feichtinger, Wilfried

    1999-01-01

    Purpose:Since the Austrian propagation bill of July 1, 1992, was passed into law, Austrian physicians are committed to offer psychological counseling to women before performing assisted reproductive techniques, unless refused by the patient. The acceptance of psychotherapeutic counseling (PSITCO) and its influence on pregnancy rate were carefully reviewed.

  15. Are obstetric intervention rates and pregnancy outcome worsened ...

    African Journals Online (AJOL)

    Background: Pregnancy induced hypertension and it sequelae eclampsia are major causes of maternal and perinatal morbidity and mortality in developing countries. The aim of this study was to compare the obstetric intervention rates and maternal and fetal outcome in cases of gestational hypertension to that of ...

  16. Preovulatory progesterone concentration associates significantly to follicle number and LH concentration but not to pregnancy rate

    DEFF Research Database (Denmark)

    Yding Andersen, Claus; Bungum, Leif; Nyboe Andersen, Anders

    2011-01-01

    with or without rLH administration from day 6 of stimulation. There was no significant association between the late-follicular-phase progesterone concentration and the clinical pregnancy rate. However, progesterone concentration was strongly associated with the number of follicles and retrieved oocytes. Late...

  17. Cesarean section in twin pregnancies in two Danish counties with different cesarean section rates

    DEFF Research Database (Denmark)

    Henriksen, T B; Sperling, Lene; Hedegaard, M

    1994-01-01

    OBJECTIVE: Based on a comparison of the clinical indications for cesarean section (CS) in two Danish counties and a review of the literature regarding this issue the aim of this study was to discuss possible explanations for variations in CS rates in twin pregnancies. The comparison of indications...

  18. Effects of piroxicam administration on pregnancy outcome in intrauterine insemination (IUI) cycles: a randomized clinical trial.

    Science.gov (United States)

    Zarei, A; Mahboubi, M; Parsanezhad, M E; Alborzi, S; Younesi, M; Madadi, G

    2016-01-01

    Uterus contractibility is considered a powerful prognostic factor in predicting the embryo transfer outcome. Moreover, uterine contractions are known to be stimulated by prostaglandins which are produced by cyclooxygenase from arachidonic acid. As such, suppressing the inflammatory response and contractions using anti-inflammatory and relaxant agents is expected to result in increased success rate of embryo transfer and artificial insemination. To investigate the effect of piroxicam administration on the success rate in intrauterine insemination (IU) cycles in patients presenting with unexplained infertility. This randomized, placebo-controlled clinical trial included 260 women with unexplained infertility undergoing IUI cycles. Patients were randomly assigned to receive either piroxicam ten mg/day on days 4-6 after IUI or placebo (control group). The main outcome measures were number of IUI cycles, pregnancy, abortion, and multiple pregnancy rates. The pregnancy rate was found to be 25 (19.2%) and 16 (12.3%) in piroxicam and control groups, respectively (p = 0.039). Five patients (3.8%) in piroxicam group experienced twin pregnancy whereas only three patients (2.3%) in control group had twin pregnancy (p = 0.361). The pregnancy rate per cycle was also significantly higher in those who received piroxicam as compared to controls (11.16 vs. 6.66; p = 0.021). Administration of piroxicam after IUI is associated with decreased number of cycles, as well as increased pregnancy rate and pregnancy rate per cycle in IUI cycles. However, piroxicam did not have any effect on abortion, multiple pregnancy, and ongoing pregnancy rates.

  19. Durable effects of implementation intentions: reduced rates of confirmed pregnancy at 2 years.

    Science.gov (United States)

    Martin, Jilly; Sheeran, Paschal; Slade, Pauline; Wright, Alison; Dibble, Tracey

    2011-05-01

    To assess the long-term impact of implementation intention formation in reducing consultations for emergency contraception and pregnancy testing among teenage women. Teenage women visiting a family planning clinic were randomly assigned to implementation intention versus control conditions. Objective measures of consultation outcomes were obtained from clinic records at 2-year follow-up (N = 227). Rates of consultation for emergency contraception and pregnancy testing in the implementation intentions condition were 19% and 33% lower, respectively, compared to the rates observed in the control condition. Pregnancy rates were 43% lower. Intervention participants who consulted for emergency contraception and pregnancy testing at baseline were more than twice as likely to change to consulting for contraceptive supplies over the follow-up period compared to equivalent control participants (19% vs. 9%). The impact of implementation intention formation on reducing pregnancy risk among teenagers is durable over 2 years. Implementation intentions were successful in changing behavior among precisely those participants who were at greatest risk of becoming pregnant. (c) 2011 APA, all rights reserved.

  20. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

    Directory of Open Access Journals (Sweden)

    O. V. Gaisenok

    2014-01-01

    Full Text Available Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  1. Evaluation of the effect of indomethacin and piroxicam administration before embryo transfer on pregnancy rate.

    Science.gov (United States)

    Kumbasar, Serkan; Gül, Özer; Şık, Aytek

    2017-03-01

    The aim of this study was to evaluate the effect of non-steroidal anti-inflammatory drug (NSAID) administration before embryo transfer (ET) on pregnancy rates in women undergoing in vitro fertilization/intracytoplasmic sperm injection ET. Our study included 255 patients diagnosed with primary or secondary infertility caused by a male or tubal-related factor, endometriosis or unexplained factors. The patients were divided randomly into three groups. Two groups were administered oral piroxicam (10 mg capsules) or 100 mg indomethacin (rectal suppository), respectively, 1-2 h before ET. As a control, the third group did not receive any form of treatment before ET. Basal levels of follicle-stimulating hormone, luteinizing hormone, and level 17β-estradiol on the day of human chorionic gonadotropin administration, the collected and transferred number of embryos, and the number of grade A embryos obtained were determined in all patients. The implantation, clinical pregnancy, and miscarriage rates of the groups were compared. The clinical pregnancy rate per ET and the implantation rate were 35.2% and 12.15% in the piroxicam group, 31.7% and 10.9% in the indomethacin group, and 32.9% and 12.5% in the control, respectively. The miscarriage rates of groups 1, 2 and 3 were 12%, 11.7% and 11.7%, respectively (P = 0.964). The differences in clinical pregnancy rates among the groups were not statistically significant (P = 0.887). There were also no significant differences in the implantation rates (P = 0.842). These results suggest that NSAID administration before ET has no additional effect on pregnancy outcome in patients undergoing in vitro fertilization. © 2017 Japan Society of Obstetrics and Gynecology.

  2. Clinical implications of methicillin-resistant Staphylococcus aureus in pregnancy.

    Science.gov (United States)

    Beigi, Richard H

    2011-04-01

    Methicillin-resistant Staphylococcus aureus (MRSA) has become an increasingly aggressive and prevalent pathogen in medicine. This pattern has also been noted in obstetrics. This review will delineate the epidemiology and clinical implications of MRSA during pregnancy. Investigations have focused on prevalence of MRSA colonization in obstetrics and the associated morbidity. In addition, some attention has been focused on the neonatal implications of maternal colonization. Overall, the rates of maternal MRSA colonization noted in the United States have been low, in the range of 0.5-4%. The clinical impact of MRSA colonization among pregnant women has also been estimated to be modest. Roughly 357 invasive MRSA infections per 100,000 live births in the United States occur on an annual basis. It is however important to note that published estimates likely underestimate the full scope of MRSA in pregnancy given the lack of formal reporting, importance of related neonatal colonization and morbidity, the complicated treatment implications in pregnant women, the recognized high pathogenicity of MRSA infections, and propensity for recurrent infections among community-acquired MRSA strains. MRSA is an increasingly important pathogen in modern healthcare and in the obstetric population. Continued surveillance and research remains a top priority.

  3. Medical treatment of ectopic pregnancy and clinical score

    OpenAIRE

    Glišić Andreja

    2007-01-01

    Introduction: Ectopic pregnancy is an important cause of morbidity and mortality worldwide. Furthermore, with earlier diagnosis, medical therapy with methotrexate can be offered and surgery avoided in some women, though the best regimen remains unclear. Although there have been advances in the management of ectopic pregnancy, there are still questions to be answered. Objective. The use of clinical score was evaluated after the clinical treatment for selection of patients for medical treatment...

  4. The clinical significance of pregnancy in Brugada syndrome.

    Science.gov (United States)

    Rodríguez-Mañero, Moisés; Casado-Arroyo, Rubén; Sarkozy, Andrea; Leysen, Eva; Sieira, Juan Antonio; Namdar, Mehdi; Conte, Gulio; Levinstein, Moisés; Chierchia, Gian-Battista; de Asmundis, Carlo; Brugada, Pedro

    2014-03-01

    Little is known about the risks and outcomes of pregnancy in women with Brugada syndrome. We therefore evaluated pregnancy outcomes and the influence of pregnancy in patients with Brugada syndrome. A retrospective analysis was performed in all pregnant women with Brugada syndrome. We included 104 women with a total of 219 deliveries. There were 15 spontaneous abortions. One infant died suddenly during the night 3 months after birth. Six pregnant women reported they had experienced at least 1 syncope during the pregnancy. Of the 3 women who received an implantable cardioverter-defibrillator before the pregnancy, none received arrhythmia episodes. There were no events during the pregnancy in 4 patients with a previously aborted sudden cardiac death. Of 24 patients with syncope when not pregnant, 18 were asymptomatic and 6 experienced a recurrent syncope during the pregnancy. During the follow-up (mean follow-up 298.9 days; 95% confidence interval, 289.6-308.2), 2 women received appropriate shocks. In this retrospective, single-center study, serious events were not more frequent during pregnancy and the peripartum period in women with Brugada syndrome. The occurrence of syncope during pregnancy was not associated with a worst outcome in the peri- and postpartum periods or during follow-up. The reported rate of miscarriage and sudden infant death will require further studies to confirm or rule out its association with Brugada syndrome. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  5. Heart rate variability in neonates of type 1 diabetic pregnancy.

    Science.gov (United States)

    Russell, Noirin E; Higgins, Mary F; Kinsley, Brendan F; Foley, Michael E; McAuliffe, Fionnuala M

    2016-01-01

    Cardiomyopathy is a common finding in offspring of pre-gestational type 1 diabetic pregnancy. Echocardiographic and biochemical evidence of fetal cardiac dysfunction have also been reported. Studies suggest that offspring of diabetic mothers (ODM) undergo a fetal programming effect due to the hyperglycaemic intrauterine milieu which increases their risk of cardiovascular morbidity in adult life. Decreased neonatal heart rate variability (HRV) has been described in association with in-utero growth restriction, prematurity, sudden infant death syndrome and congenital heart disease. The effect of in-utero exposure to hyperglycaemia in diabetic pregnancy on neonatal HRV is unknown. Our aim was to determine if neonatal HRV differs between normal and diabetic pregnancy. This was a prospective observational study of 38 patients with pregestational type 1 diabetes and 26 controls. HRV assessment was performed using Powerlab (ADI Instruments Ltd). Heart rate variability assessment and cord blood sampling for pH and glucose were performed for all neonates. Maternal glycaemic control was assessed via measurement of glycosylated haemoglobin in each trimester in the diabetic cohort. Neonates of diabetic mothers had evidence of altered heart rate variability, with increased low frequency to high frequency ratio (LF: HF), suggestive of a shift towards sympathetic predominance (pheart to fluctuations in maternal glycaemia with subsequent alterations in HRV may explain why infants of diabetic mothers are at greater risk of cardiovascular disease in later life. Copyright © 2015. Published by Elsevier Ireland Ltd.

  6. Transfer of spontaneously hatching or hatched blastocyst yields better pregnancy rates than expanded blastocyst transfer

    Directory of Open Access Journals (Sweden)

    Natachandra M Chimote

    2013-01-01

    Full Text Available Context: Blastocyst stage embryo transfer (ET has become routine practice in recent years. However, probably due to limitations of assisted hatching techniques, expanded blastocyst transfer (EBT is still the preferred mode. Inexplicably, not much consideration has been given to spontaneously hatching/hatched blastocyst transfer (SHBT. Aim: This study aimed to investigate developmental potential of spontaneously hatching/hatched blastocyst against EBT in in vitro fertilization (IVF cycles. Settings and Design: Prospective study of 146 women undergoing their first IVF- ET cycle. SUBJECTS AND Methods: On the basis of blastocyst status, women were classified into SHBT and EBT groups. Intracytoplasmic sperm injection cycles were excluded to remove male factor bias. Implantation rate (IR, clinical pregnancy rate, and live birth rate were the main outcome measures. Statistical Analysis: Graph-pad Prism 5 statistical package. Results: SHBT group showed significantly higher blastocyst formation rate (53.3 ± 17.5 vs. 43.1 ± 14.5%, P = 0.0098, top-quality blastocysts (71.8 vs. 53.7%, P = 0.0436, IR (43.6 vs. 27.9%, P = 0.0408, pregnancy rate (59.4 vs. 45.1%, P = 0.0173, and live birth rate (36.8 vs. 22.8%, P = 0.003 compared to EBT group. Multiple pregnancy rates remained comparable between the two groups. Implantation correlated strongly with top-quality blastocysts (Pearson, r = 0.4441 in SHBT group, while the correlation was nonsignificant in EBT group. Conclusion: Extending culture of expanded blastocysts by a few hours to allow transfer of spontaneously hatching/hatched blastocysts gives higher implantation and pregnancy rates with no added risk of multiple gestations. Spontaneously hatching/hatched blastocysts have a better potential to implant and develop into a positive pregnancy.

  7. No. 245-Alcohol Use and Pregnancy Consensus Clinical Guidelines.

    Science.gov (United States)

    Carson, George; Cox, Lori Vitale; Crane, Joan; Croteau, Pascal; Graves, Lisa; Kluka, Sandra; Koren, Gideon; Martel, Marie-Jocelyne; Midmer, Deana; Nulman, Irena; Poole, Nancy; Senikas, Vyta; Wood, Rebecca

    2017-09-01

    To establish national standards of care for the screening and recording of alcohol use and counselling on alcohol use of women of child-bearing age and pregnant women based on the most up-to-date evidence. Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library in May 2009 using appropriate controlled vocabulary (e.g., pregnancy complications, alcohol drinking, prenatal care) and key words (e.g., pregnancy, alcohol consumption, risk reduction). Results were restricted to literature published in the last five years with the following research designs: systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment (HTA) and HTA-related agencies, national and international medical specialty societies, clinical practice guideline collections, and clinical trial registries. Each article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by the Society of Obstetricians and Gynaecologists of Canada. The quality of evidence was evaluated and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care. The quality of evidence was rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table 1). The Public Health Agency of Canada and the Society of Obstetricians and Gynaecologists of Canada. These consensus guidelines have been endorsed by the Association of Obstetricians and Gynecologists of Quebec; the Canadian Association of Midwives; the Canadian Association of Perinatal, Women's Health and Neonatal Nurses (CAPWHN); the College of Family Physicians

  8. Effect of Helicobacter pylori infection on pregnancy rates and early pregnancy loss after intracytoplasmic sperm injection.

    Science.gov (United States)

    Hajishafiha, Masomeh; Ghasemi-Rad, Mohammad; Memari, Aishe; Naji, Siamak; Mladkova, Nikol; Saeedi, Vida

    2011-01-01

    There is a need to elucidate what affects the implantation and early pregnancy course in pregnancies conceived with assisted reproductive technology (ART) so that pregnancy rates and outcomes can be improved. Our aim was to determine the role of maternal Helicobacter pylori infection. We did a prospective study of 187 infertile couples undergoing intracytoplasmic sperm injection (ICSI) and segregated those according to underlying infertility etiology. We assessed the status of H. pylori IgG antibodies and anti-CagA IgG antibodies by ELISA assay. All pregnancies were followed for early pregnancy loss (EPL, first 12 weeks). The likelihood of H. pylori infection increased with age (1.01, 95% confidence interval [CI]: 1.0-1.13; P = 0.040) but there was no association with EPL. Women infected with CagA-positive strains were more likely to have EPL (19.39, 95% CI: 1.8-208.4; P = 0.014). Women with tubal factor or ovulatory disorder infertility were more likely to abort early (12.95, 95% CI: 1.28-131.11; P = 0.030, 10.84, 95% CI: 1.47-80.03; P = 0.020, respectively). There was no association between EPL and age, number of embryos formed or transferred, or number of oocytes retrieved. Our findings suggest that infection with CagA-positive H. pylori strains is linked to an increase in women's potential to abort early (possibly through increased release of inflammatory cytokines). In addition, tubal factor and ovulatory disorder infertility are linked to EPL after ICSI due to unknown mechanisms. Proposals to eradicate H. pylori infection prior to ICSI could lead to a decrease in EPL after ART.

  9. Diabetes and pregnancy: an endocrine society clinical practice guideline.

    Science.gov (United States)

    Blumer, Ian; Hadar, Eran; Hadden, David R; Jovanovič, Lois; Mestman, Jorge H; Murad, M Hassan; Yogev, Yariv

    2013-11-01

    Our objective was to formulate a clinical practice guideline for the management of the pregnant woman with diabetes. The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, 5 additional experts, a methodologist, and a medical writer. This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. One group meeting, several conference calls, and innumerable e-mail communications enabled consensus for all recommendations save one with a majority decision being employed for this single exception. Using an evidence-based approach, this Diabetes and Pregnancy Clinical Practice Guideline addresses important clinical issues in the contemporary management of women with type 1 or type 2 diabetes preconceptionally, during pregnancy, and in the postpartum setting and in the diagnosis and management of women with gestational diabetes during and after pregnancy.

  10. Clinical significance of pregnancy in adolescence in Japan.

    Science.gov (United States)

    Suzuki, Shunji

    2018-01-07

    We examined the clinical characteristics and obstetric outcomes in adolescent pregnancies in Japanese women. The present study was a retrospective investigation of all primiparous Japanese women with singleton pregnancies who gave birth at ≥22 weeks' gestation aged ≤18 years old (adolescent pregnancy, n = 325) and aged 28-30 years old (n = 2029) at Japanese Red Cross, Katsushika Maternity Hospital between 2002 and 2016. The frequencies of smoking, economic problems, an unmarried single status at delivery and the start of prenatal care in the first trimester in the adolescent pregnancy group were significantly higher than in the control group (p < .01). The incidences of Chlamydia trachomatis, Condyloma acuminatum, and mental disorders in the adolescent pregnancy group were significantly higher than in the control group (p < .01). Pregnancy in adolescence was not related to adverse obstetric outcomes except preterm delivery (p = .02). Adolescent pregnancy was not associated with adverse obstetric outcomes; however, adequate social, economic, and mental support is needed for adolescent pregnant women.

  11. Unintended Pregnancy and Its Correlates among Female Attendees of Sexually Transmitted Disease Clinics in Eastern China

    Directory of Open Access Journals (Sweden)

    Qiaoqin Ma

    2013-01-01

    Full Text Available This study is to determine the prevalence of unintended pregnancy and its risk factors among the female attendees of sexually transmitted disease (STD clinics in Zhejiang Province, China. A self-administered questionnaire survey of a cross-sectional design was administered to attendees at four STD clinics in 2007. Of the 313 female STD clinic attendees, 42.5% reported that they had at least one unintended pregnancy; the induced abortion rate was 39.0%. Over their lifetime, 12.1% responded “use condoms always/often” and 5.4% “always/often used oral contraceptives.” The risk factors for the unintended pregnancy identified by the multivariate analysis were as follows: being married, experience of nonconsensual sex, and a history of STD, having two and over two sexual partners. Unintended pregnancies and induced abortion by female STD clinic attendees have reached an alarming prevalence. Doctors at STD clinics should attach importance not only to the STD problem of the female attendees, but also to the unintended pregnancy and the associated factors. Targeted contraceptive counseling and intervention should be promoted at STD clinics as a strategy to improve the efficiency and effectiveness of the reproductive health services in China.

  12. Acute Fatty Liver of Pregnancy: A Clinical-Paraclinical Survey

    Directory of Open Access Journals (Sweden)

    Mohammad Jafari

    2015-02-01

    Full Text Available Background Acute Fatty Liver of Pregnancy (AFLP is one of the serious complications of the pregnancy period. Surveying the laboratory and clinical signs is effective in timely prognosis and fast treatment of this illness. Objectives The current study aimed to evaluate AFLP among the hospitalized subjects. Patients and Methods This retrospective study was conducted on clinical and preclinical records of 25 females with AFLP for maternal and perinatal prognosis from 2000 to 2009. The data was analyzed using SPSS ver. 19. Results The patients aged 16 - 45 years old with one to four pregnancies (pregnancy; they were 24 to 39 weeks pregnant with the mean of 33.56 weeks, and 56% were multifarious. The most prevalent clinical symptoms were nausea, vomiting, abdominal pain, headache, pruritus, and icterus. The laboratory signs included disorders of liver, coagulation, kidney, and hypoglycemia. Nausea and vomiting in the first and second age groups (Group 1, patients were 35 years. were the most prevalent symptoms. No patient had fever, ascites, and polydipsia. There was one case of mother and fetal death. Conclusions In the current study, the clinical and paraclinical signs of AFLP were mostly - liver, coagulation, kidney, and hypoglycemia disorders. Considering that patients mostly refer in three phases of clinical, laboratory, and complications, it is essential to evaluate the suspected ones who present clinical symptoms especially nausea, vomiting and abdominal pain.

  13. The effects of cervical mucus removal before Intrauterine Insemination (IUI in improving pregnancy rates infertile women

    Directory of Open Access Journals (Sweden)

    Ghasemi A

    2011-07-01

    Full Text Available "n 800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} Background: Intrauterine insemination (IUI is a less expensive and less invasive treatment in comparison with other assisted reproductive techniques, and it has been widely used for a variety of indications as well as in the treatment of couples with infertility. The outcome of IUI may be affected by numerous factors but in this study, we evaluated the effects of cervical mucus removal undertaken before IUI on clinical pregnancy rates."n"nMethods : In this randomized clinical trial study, all infertile women who were candidates for IUI and attended Shahid Akbar Abadi Hospital during 2009 and 2010 were recruited. The participants were randomly assigned into two groups. Cervical mucus was removed prior to IUI in patients in group A but in group B, a classic IUI was done without removing the cervical mucus. Pregnancy rates were assessed in the two groups by serum levels of β-HCG and detection of fetus in the uterus.  "n"nResults : 291 women including 143 in the classic IUI group and 148 in cervical mucus removal group completed the study. The pregnancy rates were 14.2% (21 pregnancies upon 148 cycles in the cervical mucus removal group and 7% (10 pregnancies upon 143 cycles in the control group (P=0.04, OR: 2.199; CI 95%: 0.997-4.85."n"nConclusion: The findings showed that cervical mucus removal could result in a two-fold increase in pregnancy rate in comparison with classic IUI. Thus, we suggest this practical and noninvasive method to improve pregnancy rate in these patients.

  14. [Risk factors and clinical features of ectopic pregnancy].

    Science.gov (United States)

    Escobar-Padilla, Beatriz; Perez-López, Carlos A; Martínez-Puon, Horacio

    2017-01-01

    Ectopic pregnancy (EP) is the most frequent cause of maternal death in the first trimester of pregnancy. The objective was to establish the clinical features and risk factors associated with EP. Observational, retrospective, transversal and analytic case-control study. Two groups were included: the cases group (28 patients) and the control group (56 postpartum patients). Univariate and bivariate descriptive statistical analysis were carried out using the Pearson chi-square test, p pregnancy 82.1% (23), unruptured EP 60.7% (17), hemoperitoneum 60.7% (17). Gestational age for EP was of 4-8 weeks (75%) and surgical treatment 96.4%. The frequency of EP found in our population was 1 in every 122 live births. Risk factors associated with ectopic pregnancy with statistically higher values were: smoking, being multigravid, having a clinical record of EP, IUD use before conception, abdominal surgery. The more frequent clinical characteristics were pelvic pain, right EP, tubal pregnancy, EP with no ruptures, hemoperitoneum < 750 ml, a gestational age between four and eight weeks.

  15. Myasthenia gravis and pregnancy: clinical implications and neonatal outcome

    Directory of Open Access Journals (Sweden)

    Estanol Bruno

    2004-11-01

    Full Text Available Abstract Background The myasthenia gravis is twice as common in women as in men and frequently affects young women in the second and third decades of life, overlapping with the childbearing years. Generally, during pregnancy in one third of patients the disease exacerbates, whereas in two thirds it remains clinically unchanged. Complete remission can occur in some patients. Methods To describe the clinical course, delivery and neonatal outcome of 18 pregnant women with the diagnosis of myasthenia gravis. Retrospective chart review of pregnant patients with myasthenia gravis, followed at the National Institute of Perinatology in Mexico City over an 8-year period. Data was abstracted from the medical records on the clinical course during pregnancy, delivery and neonatal outcome. Results From January 1, 1996 to December 31, 2003 18 patients with myasthenia gravis were identified and included in the study. The mean ± SD maternal age was 27.4 ± 4.0 years. During pregnancy 2 women (11% had an improvement in the clinical symptoms of myasthenia gravis, 7 women (39% had clinical worsening of the condition of 9 other patients (50% remained clinically unchanged. Nine patients delivered vaginally, 8 delivered by cesarean section and 1 pregnancy ended in fetal loss. Seventeen infants were born at mean ± SD gestational age of 37.5 ± 3.0 weeks and a mean birth weight of 2710 ± 73 g. Only one infant presented with transient neonatal myasthenia gravis. No congenital anomalies were identified in any of the newborns. Conclusions The clinical course of myasthenia gravis during pregnancy is variable, with a significant proportion of patients experiencing worsening of the clinical symptoms. However, neonatal transient myasthenia was uncommon in our patient population.

  16. Prenatal Pregnancy Complications and Psychiatric Symptoms: Children with ASD versus Clinic Controls

    Science.gov (United States)

    Tudor, Megan E.; DeVincent, Carla J.; Gadow, Kenneth D.

    2012-01-01

    The current study examined the association between prenatal pregnancy complications (PPC) and childhood psychiatric symptoms in children with an autism spectrum disorder (ASD) and non-ASD children who were referred to a psychiatric clinic (Controls). Parents completed a "DSM-IV"-referenced rating scale and developmental history questionnaire.…

  17. Effect of embryo age and recipient asynchrony on pregnancy rates in a commercial equine embryo transfer program.

    Science.gov (United States)

    Jacob, J C F; Haag, K T; Santos, G O; Oliveira, J P; Gastal, M O; Gastal, E L

    2012-04-01

    In the present study, 809 uterine flushes and 454 embryo transfers performed in mares over a 4-yr interval were examined to evaluate the effects of: (1) the day of embryo collection on recovery rates; (2) the degree of synchrony between donor and recipient mares on pregnancy rates; (3) the recipient day post ovulation on pregnancy rates; and (4) the age of the embryo at recovery on pregnancy rates at 60 days. Uterine flushes were performed on Days 6, 7, 8, 9, and 10 (Day 0 = ovulation) and embryos were transferred to recipients with degrees of synchrony varying between +1 to -6 (recipient ovulated 1 day before through 6 days after the donor). Recipient mares ranged from 2 to 8 days post ovulation. Embryo recovery rates were similar for flushes performed on Day 7 (61%), Day 8 (66%), Day 9 (59%), and Day 10 (56%), but the embryo recovery rate was lower (P recipient mares on Day 2 (33%) compared with mares on Day 3 (66%), Day 4 (66%), Day 5 (62%), Day 6 (55%), Day 7 (58%), and Day 8 (56%). Pregnancy rate was higher (P recipient mares does not need to be as restricted as previously reported in horses. Acceptable pregnancy rates (e.g., 70%, 99/142) were obtained even when recipient mares ovulated 4 to 5 days after the donors; (3) similar pregnancy rates were obtained when recipient mares received embryos within a large range of days post ovulation (Days 3 to 8); and (4) Day 7 embryos produced higher pregnancy rates when compared with Days 8 and 9 embryos. In clinical terms, the application of these new findings will be beneficial to large equine embryo transfer operations in producing more pregnancies per season. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Appendicitis during Pregnancy: The Clinical Experience of a Secondary Hospital

    Science.gov (United States)

    Jung, Soo Jung; Kim, Jun Hyun; Kong, Pil Sung; Kim, Kyung Ha; Bae, Sung Woo

    2012-01-01

    Purpose Appendicitis is the most common condition leading to an intra-abdominal operation for a non-obstetric problem in pregnancy. The aim of this study was to examine our experience and to analyze the clinical characteristics and the pregnancy outcomes for appendicitis during pregnancy that was reported in Korea. Methods We reported 25 cases of appendicitis during pregnancy that were treated at Good Moonhwa Hospital from January 2004 to March 2010. We also analyzed appendicitis during pregnancy reported in Korea between 1970 and 2008 by a review of journals. Results The incidence of acute appendicitis during pregnancy was one per 568 deliveries. The mean age was 27.92 years old, the gestational stage at the onset of symptoms was the first trimester in 10 patients (40%), the second trimester in 14 patients (56%), and the third trimester in 1 patient (4%). Among the 25 cases, 21 were treated with an open appendectomy and 4 with laparoscopic appendectomies. The postoperative complications were 2 wound infections and 1 spontaneous abortion. Conclusion Our experience demonstrated that appendectomies on pregnant patients can be successfully performed at secondary hospitals. PMID:22816059

  19. Thyroid-Stimulating Hormone Receptor Antibodies in Pregnancy: Clinical Relevance

    Science.gov (United States)

    Bucci, Ines; Giuliani, Cesidio; Napolitano, Giorgio

    2017-01-01

    Graves’ disease is the most common cause of thyrotoxicosis in women of childbearing age. Approximately 1% of pregnant women been treated before, or are being treated during pregnancy for Graves’ hyperthyroidism. In pregnancy, as in not pregnant state, thyroid-stimulating hormone (TSH) receptor (TSHR) antibodies (TRAbs) are the pathogenetic hallmark of Graves’ disease. TRAbs are heterogeneous for molecular and functional properties and are subdivided into activating (TSAbs), blocking (TBAbs), or neutral (N-TRAbs) depending on their effect on TSHR. The typical clinical features of Graves’ disease (goiter, hyperthyroidism, ophthalmopathy, dermopathy) occur when TSAbs predominate. Graves’ disease shows some peculiarities in pregnancy. The TRAbs disturb the maternal as well as the fetal thyroid function given their ability to cross the placental barrier. The pregnancy-related immunosuppression reduces the levels of TRAbs in most cases although they persist in women with active disease as well as in women who received definitive therapy (radioiodine or surgery) before pregnancy. Changes of functional properties from stimulating to blocking the TSHR could occur during gestation. Drug therapy is the treatment of choice for hyperthyroidism during gestation. Antithyroid drugs also cross the placenta and therefore decrease both the maternal and the fetal thyroid hormone production. The management of Graves’ disease in pregnancy should be aimed at maintaining euthyroidism in the mother as well as in the fetus. Maternal and fetal thyroid dysfunction (hyperthyroidism as well as hypothyroidism) are in fact associated with several morbidities. Monitoring of the maternal thyroid function, TRAbs measurement, and fetal surveillance are the mainstay for the management of Graves’ disease in pregnancy. This review summarizes the biochemical, immunological, and therapeutic aspects of Graves’ disease in pregnancy focusing on the role of the TRAbs in maternal and fetal

  20. Sibling teenage pregnancy and clinic-referred girls’ condom use: The protective role of maternal monitoring

    Science.gov (United States)

    Nichols, Sara; Javdani, Shabnam; Rodriguez, Erin; Emerson, Erin; Donenberg, Geri

    2016-01-01

    Younger sisters of teenage parents have elevated rates of engaging in unprotected sex. This may result from changes in parenting behavior after a sibling becomes pregnant or impregnates a partner, and be particularly pronounced for girls seeking mental health treatment. The current study examines condom use over time in 211 African-American girls recruited from outpatient psychiatric clinics. Findings indicate that having a sibling with a teenage pregnancy history predicts less consistent condom use two years later. After accounting for earlier condom use and mental health problems, maternal monitoring moderates condom use such that for girls with a sibling with a pregnancy history, more vigilant maternal monitoring is associated with increased condom use, while for girls with no sibling pregnancy history, maternal monitoring is unrelated to adolescents’ condom use two years later. Findings suggest that targeted interventions to increase maternal monitoring of high-risk teens may be beneficial for girls with a sibling history of teenage pregnancy. PMID:27172111

  1. [Clinical evaluation of patients with breast cancer and pregnancy].

    Science.gov (United States)

    Rojo-Contreras, Wendoline; Balderrama-Ibarra, Ricardo; Salas-González, Efrain; Salazar-Páramo, Mario

    2015-04-01

    Breast cancer is the second most common malignancy diagnosed in pregnancy. Breast cancer in pregnancy represents a challenge in diagnosis as well as in treatment. To evaluate clinically patients with breast cancer in pregnancy. METERIAL AND METHODS: Retrospective, transversal, descriptive study was done in which we enrolled women with breast cancer and pregnancy from the outpatient clinic of medical oncology of a tertiary care center hospital. Statistical analysis: descriptive statistics. The variables of 15 clinical records were examined, median age 33.3 ± 5.5 years, tobacco use 3/15, oral contraceptives use 2/15, age at first birth 25.8 ± 7 years, breastfed 4/15. The initial medical evaluation was done 7.5 ± 7.7 months after the onset of symptoms, the diagnosis was made with trucut biopsy in 9/15 of patients, excisional biopsy 4/15 and fine needle aspiration biopsy 2/15. Clinical stage was IIA 3/15, IIIA 8/15, IIIB 3/15 and IV 1/15. Six patients were treated with chemotherapy during pregnancy in the second and third trimester and three with surgical treatment. There were no fetal deaths related to treatment. Response to treatment: 8/15 are disease-free, 5/15 progressed to death and 2/15 had bone metastasis. Even major cancer centers have limited experience with breast cancer in pregnancy. Medical and surgical treatment should not be differed. More prospective studies are needed to assess factors related to treatment and prognosis.

  2. Preovulatory progesterone concentration associates significantly to follicle number and LH concentration but not to pregnancy rate

    DEFF Research Database (Denmark)

    Yding Andersen, Claus; Bungum, Leif; Nyboe Andersen, Anders

    2011-01-01

    Using data from a large prospective randomized controlled trial that evaluated the effect of recombinant LH (rLH)co-administration for ovarian stimulation, the present study assessed whether progesterone concentration on the day of human chorionic gonadotrophin (HCG) administration was associated...... with or without rLH administration from day 6 of stimulation. There was no significant association between the late-follicular-phase progesterone concentration and the clinical pregnancy rate. However, progesterone concentration was strongly associated with the number of follicles and retrieved oocytes. Late...... of HCG administration and the probability of clinical pregnancy in women undergoing ovarian stimulation with GnRH agonists and gonadotrophins for assisted reproduction treatment.Instead, late-follicular-phase progesterone concentration appears to be governed by the number of preovulatory follicles and LH...

  3. Pelvic endometriosis with peritoneal fluid reduces pregnancy rates in women undergoing intrauterine insemination.

    Science.gov (United States)

    Wu, Hong-Ming; Tzeng, Chii-Ruey; Chen, Chi-Hung; Chen, Pi-Hua

    2013-12-01

    This study investigated the occurrence of peritoneal fluid in women undergoing intrauterine insemination (IUI) and its correlation with the stage of pelvic endometriosis and its influence on pregnancy outcomes. A retrospective case-control design was used to recruit 272 infertile women with pelvic endometriosis. The treatment protocol consisted of controlled ovarian hyperstimulation with downregulation and gonadotropin for IUI treatment following ultrasound and laparoscopic intervention. The amount and color of the peritoneal fluid were determined during laparoscopy. The mean amount of peritoneal fluid with pelvic endometriosis that was detected using transvaginal ultrasound was ~ 15.1 mL. Women whose cycles contained more peritoneal fluid had significantly lower pregnancy rates (17.2% and 31.3%, respectively). The total clinical pregnancy rate was not significantly different between the two groups with reddish and yellowish peritoneal fluid who had pelvic endometriosis. Pelvic endometriosis and peritoneal fluid, detected through vaginal ultrasound, have negative effects on the pregnancy outcome of IUI treatment. Copyright © 2013. Published by Elsevier B.V.

  4. Clinical pattern of gynecological/early pregnancy complaints and the ...

    African Journals Online (AJOL)

    Background: Gynecological and early pregnancy complaints (GEPC)/lower abdominal complaints (LAC) are common in female patients seeking medical advice or treatments. Clinical limitations of GEPC or LAC are better resolved through appropriate laboratory and imaging investigation, among which the ultrasound ...

  5. The impact of a pregnancy confirmation clinic on the ...

    African Journals Online (AJOL)

    If this test was positive, on-site testing for syphilis, anaemia and rhesus status, dipstick testing of the urine, clinical examination and ultrasound examination were performed. Women with abnormal test results ... the pregnancy. Conclusion. It is possible to shift the commencement of antenatal care to an earlier gestational age.

  6. Triploid pregnancies: genetic and clinical features of 158 cases

    DEFF Research Database (Denmark)

    Jørgensen, Mette Warming; Niemann, I.; Rasmussen, AA

    2014-01-01

    OBJECTIVE: The purpose of this study was to analyze the correlation between the genetic constitution and the phenotype in triploid pregnancies. STUDY DESIGN: One hundred fifty-eight triploid pregnancies were identified in hospitals in Western Denmark from April 1986 to April 2010. Clinical data...... at ultrasound scanning, by macroscopic inspection of the evacuated tissue, at histology, or because of a high human chorionic gonadotropin in maternal serum level each predict the parental type PPM with a very high specificity. In contrast, the sensitivity of these observations was

  7. Pregnancy in HIV clinical trials in Sub Saharan Africa: failure of consent or contraception?

    Directory of Open Access Journals (Sweden)

    Agnes Ssali

    Full Text Available OBJECTIVE: Higher than expected pregnancy rates have been observed in HIV related clinical trials in Sub-Saharan Africa. We designed a qualitative study to explore the factors contributing to high pregnancy rates among participants in two HIV clinical trials in Sub-Saharan Africa. METHODS: Female and male participants enrolled in one of two clinical HIV trials in south-west Uganda were approached. The trials were a phase III microbicide efficacy trial among HIV negative women using vaginal gel (MDP; and a trial of primary prevention prophylaxis for invasive cryptococcal disease using fluconazole among HIV infected men and women in Uganda (CRYPTOPRO. 14 focus group discussions and 8 in-depth interviews were conducted with HIV positive and negative women and their male partners over a six month period. Areas explored were their experiences about why and when one should get pregnant, factors affecting use of contraceptives, HIV status disclosure and trial product use. RESULTS: All respondents acknowledged being advised of the importance of avoiding pregnancy during the trial. Factors reported to contribute to pregnancy included; trust that the investigational product (oral capsules/vaginal gel would not harm the baby, need for children, side effects that led to inconsistent contraceptive use, low acceptance of condom use among male partners. Attitudes towards getting pregnant are fluid within couples over time and the trials often last for more than a year. Researchers need to account for high pregnancy rates in their sample size calculations, and consider lesser used female initiated contraceptive options e.g. diaphragm or female condoms. In long clinical trials where there is a high fetal or maternal risk due to investigational product, researchers and ethics committees should consider a review of participants contraceptive needs/pregnancy desire review after a fixed period, as need for children, partners and health status of participants may

  8. Lithium exposure during pregnancy: outcomes for women who attended a specialist antenatal clinic.

    Science.gov (United States)

    Frayne, Jacqueline; Nguyen, Thinh; Mok, Tabitha; Hauck, Yvonne; Liira, Helena

    2017-06-15

    Lithium treatment in pregnancy represents a significant dilemma for women and treating health professionals alike. The complexity of risk-benefit analysis is impacted by limited information. A cohort study of 33 women with severe mental illness, who were prescribed lithium at any time during the pregnancy, and gave birth between December 2007 and January 2015 at a specialist antenatal clinic in Western Australia. A descriptive comparison for women who continued lithium throughout pregnancy, and those who ceased on discovery of pregnancy was undertaken examining demographic, obstetric, neonatal and psychiatric variables. Women who were prescribed lithium, irrespective of whether they continued or discontinued the medication represented a high risk group obstetrically, with high rates of smoking overall (33%) medical comorbidities (54%) and antenatal complications (88%). Preconception counseling occurred in 33% of the cohort but increased the likelihood of continuing lithium in pregnancy (p = .007). Compared to those who ceased lithium, women who remained on lithium through the pregnancy had increased rates of fetal ultrasound abnormalities such as abdominal circumference >90th % (p = .005). Psychiatric relapses through the antenatal and immediate postpartum period appeared to be due to a combination of factors. Pregnant women with severe mood disorders treated with lithium are a vulnerable, high-risk obstetric population who would benefit from preconception counseling, regular antenatal care in a tertiary center, delivery with neonatal pediatric support and experienced psychiatric management.

  9. Management of HIV in pregnancy: a clinical review | Agboghoroma ...

    African Journals Online (AJOL)

    Context: The prevalence rate of HIV infection in pregnant women in some African countries is over 30 percent. HIV may adversely affect pregnancy outcome leading to spontaneous abortion, premature delivery, intrauterine growth restriction and low birth weight infants. The natural perinatal transmission risk varies from ...

  10. MRI for clinically suspected appendicitis during pregnancy.

    NARCIS (Netherlands)

    Cobben, L.P.; Groot, I.; Haans, L.; Blickman, J.G.; Puylaert, J.

    2004-01-01

    OBJECTIVE: The purpose of this study was to evaluate whether MRI can be used to accurately diagnose or exclude appendicitis in pregnant patients with clinically suspected appendicitis. CONCLUSION: Our results suggest that MRI is helpful in the examination and diagnosis of acute appendicitis in

  11. High ovarian response does not jeopardize ongoing pregnancy rates and increases cumulative pregnancy rates in a GnRH-antagonist protocol.

    Science.gov (United States)

    Fatemi, Human M; Doody, Kevin; Griesinger, Georg; Witjes, Han; Mannaerts, Bernadette

    2013-02-01

    Is the ovarian response to controlled ovarian stimulation (COS) related to the ongoing pregnancy rate when taking into account the main covariates affecting the probabilities of pregnancy following fresh embryo transfer? In patients treated with corifollitropin alfa or daily recombinant FSH (rFSH) in a GnRH-antagonist protocol, a high ovarian response did not compromise ongoing pregnancy rates and increased cumulative pregnancy rates following fresh and frozen-thawed embryo transfer. A strong association between the number of oocytes and pregnancy rates has been described but this is the first comprehensive analysis assessing important confounders that might affect pregnancy rates. In a large, prospective, double-blind, randomized trial (Engage; n = 1506), patients were treated with either a single dose of 150 μg corifollitropin alfa or daily 200 IU rFSH for the first 7 days of COS in a GnRH-antagonist (ganirelix) protocol. In this retrospective analysis, patients were categorized into five groups according to the number of oocytes retrieved (0-5, 6-9, 10-13, 14-18 and >18 oocytes). The number of good-quality embryos obtained and transferred, as well as the ongoing pregnancy rates, live birth rates and cumulative ongoing pregnancy rates per started cycle by group were evaluated. Univariate analysis was performed to identify factors that predict the chance of ongoing pregnancy. Logistic regression analysis on the dependent variables ongoing pregnancy and cumulative ongoing pregnancy, respectively, including oocyte category as an independent factor in the model, was performed by treatment group (corifollitropin alfa and rFSH) and overall. The likelihood of ongoing pregnancy and cumulative ongoing pregnancy was then evaluated taking into account ovarian response as well as other identified significant predictors of success. In total, 1506 patients had been randomized in a ratio of 1:1 to either of the treatment groups. Patients were aged ≤ 36 years and had a body

  12. Clinical features and pregnancy outcome in antiphospholipid syndrome patients with history of severe pregnancy complications.

    Science.gov (United States)

    Matsuki, Yuko; Atsumi, Tatsuya; Yamaguchi, Koushi; Hisano, Michi; Arata, Naoko; Oku, Kenji; Watanabe, Noriyoshi; Sago, Haruhiko; Takasaki, Yoshinari; Murashima, Atsuko

    2015-03-01

    Abstract Objective. To clarify the clinical significance of antiphospholipid antibody (aPL) profile in patients with obstetric antiphospholipid syndrome (APS). Methods. Clinical records of 13 pregnant patients (15 pregnancies) with obstetrical APS were reviewed over 10 years. Patients who met the Sapporo Criteria fully were studied, whereas those with only early pregnancy loss were excluded. In addition to classical aPL: lupus anticoagulant (LA), anticardiolipin antibody (aCL), and anti-β2-glycoprotein I (aβ2GPI); phosphatidylserine-dependent anti-prothrombin antibody (aPS/PT) and kininogen-dependent anti-phosphatidylethanolamine antibody (aPE) were also examined in each case. Results. Cases were divided into two groups according to patient response to standard treatment: good and poor outcome groups. All cases with poor outcome presented LA, with IgG aβ2GPI and IgG aPS/PT were also frequently observed. IgG aPE did not correlate with pregnancy outcome. Conclusion. aPL profile may predict pregnancy outcome in patients with this subset of obstetric APS.

  13. Reducing twin pregnancy rates after IVF--elective single embryo transfer (eSET).

    LENUS (Irish Health Repository)

    Milne, P

    2010-01-01

    Multiple pregnancy is a major complication of IVF and is associated with increased maternal, fetal and neonatal morbidity. Elective single embryo transfer (eSET) during IVF, rather than the more standard transfer of two embryos (double embryo transfer or DET), has been shown to significantly reduce the multiple pregnancy rate associated with IVF, while maintaining acceptable pregnancy rates. Couples undergoing IVF in 2008 who met good prognostic criteria had eSET performed. Pregnancy and twinning rates were compared with those for similar couples in 2007 who had DET. Couples unsuccessful with a fresh cycle of treatment had subsequent frozen embryo transfer cycles with DET. The cumulative pregnancy rate was similar for each group. However there were no multiple pregnancies in the eSET group, compared to 4 twins of 5 pregnancies in the DET group. 96% of eligible couples agreed to eSET. ESET is successful in and acceptable to good prognosis Irish couples undergoing IVF.

  14. Clinical Study on Acute Pancreatitis in Pregnancy in 26 Cases

    Directory of Open Access Journals (Sweden)

    Cheng Qihui

    2012-01-01

    Full Text Available Aim. This paper investigated the pathogenesis and treatment strategies of acute pancreatitis (AP in pregnancy. Methods. We analyzed retrospectively the characteristics, auxiliary diagnosis, treatment strategies, and clinical outcomes of 26 cases of patients with AP in pregnancy. Results. All patients were cured finally. (1 Nine cases of 22 mild acute pancreatitis (MAP patients selected automatic termination of pregnancy because of the unsatisfied therapeutic efficacy or those patients’ requirements. (2 Four cases of all patients were complicated with severe acute pancreatitis (SAP; 2 cases underwent uterine incision delivery while one of them also received cholecystectomy, debridement and drainage of pancreatic necrosis, and percutaneous jejunostomy. One case had a fetal death when complicated with SAP; she had to receive extraction of bile duct stones and drainage of abdominal cavity after induced abortion. The other one case with hyperlipidemic pancreatitis was given induced abortion and hemofiltration. Conclusions. The first choice of MAP in pregnancy is the conventional therapy. Apart from the conventional therapy, we need to terminate pregnancy as early as possible for patients with SAP. Removing biliary calculi and drainage is supposed to be considered for acute biliary pancreatitis. Lowering blood lipids treatment should be applied to hyperlipidemic pancreatitis or given to hemofiltration when necessary.

  15. Does adding metformin to clomifene citrate lead to higher pregnancy rates in a subset of women with polycystic ovary syndrome?

    Science.gov (United States)

    Moll, E; Korevaar, J C; Bossuyt, P M M; van der Veen, F

    2008-08-01

    An RCT among newly diagnosed, therapy naive women with polycystic ovary syndrome (PCOS) showed no significant differences in ovulation rate, ongoing pregnancy rate or spontaneous abortion rate in favour of clomifene citrate plus metformin compared with clomifene citrate. We wanted to assess whether there are specific subgroups of women with PCOS in whom clomifene citrate plus metformin leads to higher pregnancy rates. Subgroup analysis based on clinical and biochemical parameters of 111 women randomized to clomifene citrate plus metformin compared with 114 women randomized to clomifene citrate plus placebo. The data for age, BMI, waist-hip ratio (WHR) and plasma testosterone were available in all women, 2 h glucose in 80% of women and homeostatic model assessment for assessing insulin sensitivity (HOMA) in 50% of women. Of the women who were allocated to the metformin group, 44 women (40%) reached an ongoing pregnancy. In the placebo group, 52 women (46%) reached an ongoing pregnancy. There was a significantly different chance of an ongoing pregnancy for metformin versus placebo between subgroups based on age and WHR (P = 0.014). There was a positive effect of metformin versus placebo on pregnancy rate in older women (>or=28 years) with a high WHR, a negative effect of metformin versus placebo in young women (Metformin may be an effective addition to clomifene citrate in infertile women with PCOS, especially in older and viscerally obese patients.

  16. The effect of progesterone supplementation on pregnancy rates in controlled ovarian stimulation and intrauterine insemination cycles: a randomized prospective trial.

    Science.gov (United States)

    Agha-Hosseini, Marzieh; Rahmani, Mahboobeh; Alleyassin, Ashraf; Safdarian, Leila; Sarvi, Fatemeh

    2012-12-01

    To evaluate the effect of vaginal progesterone as luteal phase support on pregnancy rates in controlled ovarian stimulation and intrauterine insemination cycles in couples with unexplained or mild male factor infertility. 290 Patients who met the inclusion criteria were included in a prospective randomized controlled trial. All patients underwent controlled ovarian stimulation and intrauterine insemination: 148 patients were randomized to start with a supported cycle and 142 patients with an unsupported cycle. In supported cycles, patients received vaginal progesterone once daily from the day after insemination until 12 weeks of pregnancy or, in non-pregnant women, for 14 days. No progesterone was given during unsupported cycles. The main outcome measures were clinical pregnancy rates per cycle. In total, 148 cycles with luteal phase support and 142 cycles without luteal phase support were performed. The clinical pregnancy rates per cycle were higher for cycles with luteal phase support than for the unsupported cycles (24.3% vs. 14.1% respectively, p=0.027). The use of vaginal suppositories as luteal phase support significantly improved clinical pregnancy rates in controlled ovarian stimulation and intrauterine insemination in patients with unexplained or mild male factor infertility. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  17. Syphilis Infection during Pregnancy: Fetal Risks and Clinical Management

    Directory of Open Access Journals (Sweden)

    Marco De Santis

    2012-01-01

    Full Text Available Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early congenital syphilis and late congenital syphilis. Diagnosis of maternal infection is based on clinical findings, serological tests, and direct identification of treponemes in clinical specimens. Adequate treatment of maternal infection is effective for preventing maternal transmission to the fetus and for treating fetal infection. Prenatal diagnosis of congenital syphilis includes noninvasive and invasive diagnosis. Serological screening during pregnancy and during preconception period should be performed to reduce the incidence of congenital syphilis.

  18. Syphilis Infection during pregnancy: fetal risks and clinical management.

    Science.gov (United States)

    De Santis, Marco; De Luca, Carmen; Mappa, Ilenia; Spagnuolo, Terryann; Licameli, Angelo; Straface, Gianluca; Scambia, Giovanni

    2012-01-01

    Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early congenital syphilis and late congenital syphilis. Diagnosis of maternal infection is based on clinical findings, serological tests, and direct identification of treponemes in clinical specimens. Adequate treatment of maternal infection is effective for preventing maternal transmission to the fetus and for treating fetal infection. Prenatal diagnosis of congenital syphilis includes noninvasive and invasive diagnosis. Serological screening during pregnancy and during preconception period should be performed to reduce the incidence of congenital syphilis.

  19. Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial

    DEFF Research Database (Denmark)

    Krag Moeller, Lars Bo; Moeller, Charlotte; Thomsen, Sten Grove

    2009-01-01

    . A total of 106 women diagnosed with ectopic pregnancy (EP). Methods. Between March 1997 and September 2000, 1,265 women were diagnosed with EP, 395 (31%) were eligible, 109 (9%) were randomized of whom 106 had an EP. The study was originally powered to a sample size of 422 patients. The women were......, subsequent intrauterine, and recurrent ectopic pregnancies. Results. The success rates were 74% following MTX treatment and 87% after surgery (n.s.); the subsequent spontaneous intrauterine pregnancy rate was 73% after MTX and 62% after surgery; and the EP rate was 9.6% after MTX and 17.3% following surgery......Objective. To determine which treatment should be offered to women with a non-ruptured tubal pregnancy: a single dose of methotrexate (MTX) or laparoscopic surgery. Design. Prospective, randomized, open multicenter study. Setting. Seven Danish departments of obstetrics and gynecology. Sample...

  20. Effects of Stretching Exercise on Heart Rate Variability During Pregnancy.

    Science.gov (United States)

    Logan, Jeongok G; Yeo, SeonAe

    Little evidence exists for effects of low-intensity exercises such as stretching on cardiovascular health in pregnant women. Our aim was to evaluate the effect of a 20-minute stretching exercise on heart rate variability (HRV), blood pressure (BP), and heart rate (HR) in healthy pregnant women. In 15 pregnant women with a mean (SD) age of 29.47 (4.07) years and mean (SD) gestational weeks of 26.53 (8.35), HRV, and BP were measured before and after the 20-minute stretching exercise. Compared with before the stretching exercise, standard deviation of the normal-to-normal intervals, total variability of heart rate, increased by 7.40 milliseconds (t = -2.31, P = .04) and root mean square of successive differences, a surrogate measure of parasympathetic outflow, also increased by 11.68 milliseconds (Z = -2.04, P = .04) after the stretching exercise. Diastolic BP and HR decreased by 2.13 mm Hg (t = 1.93, P = .07) and 3.31 bpm (t = 2.17, P = .05), respectively, but they did not reach statistical significance. These preliminary data suggest that 20 minutes of stretching exercise may promote cardiovascular health by attenuating the loss of parasympathetic tone associated with pregnancy.

  1. Pregnancies in women with hyperprolactinaemia: clinical course and obstetric complications of 41 pregnancies in 27 women. [Yttrium 90

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, W.F.; Doyle, F.H.; Mashiter, K.; Banks, L.M.; Gordon, H.; Joplin, G.F.

    1979-09-01

    Observations are reported on 41 pregnancies in 27 patients who initially had infertility and raised serum prolactin concentrations. Associated symptoms were secondary amenorrhoea and galactorrhoea. All patients were at risk of pituitary expansion during pregnancy, especially these 19 (70 per cent) with radiological evidence of pituitary tumors. Fifteen patients had 21 pregnancies after pituitary implantation with 90 yttrium; 14 patients had 20 pegnancies without prior pituitary implantation or any other attempt to prevent tumor expansion. The induction and Cesarean section rates were about 30 per cent in 32 term pregnancies in 25 patients. Details of how pregnancy was achieved and the associated obstetric problems are given.

  2. Long-term ongoing pregnancy rate and mode of conception after a positive and negative post-coital test.

    Science.gov (United States)

    Hessel, Marloes; Brandes, Monique; de Bruin, Jan Peter; Bots, Rob S G M; Kremer, Jan A M; Nelen, Willianne L D M; Hamilton, Carl J C M

    2014-09-01

    Many fertility clinics have decided to abolish the post-coital test. Yet, it is a significant factor in prognostic models that predict the spontaneous pregnancy rate within one year. The aim of this study was to evaluate (1) the long-term outcome of infertile couples with a positive or a negative post-coital test during their fertility work-up and (2) the contribution of the different modes of conception. Retrospective cohort study. Three fertility clinics in the Netherlands, of which two are secondary care training hospitals and is a one tertiary care academic training hospital. 2476 newly referred infertile couples, where a post-coital test was performed in 1624 couples. After basic fertility work-up, couples were treated according to the national treatment protocols. Spontaneous and overall ongoing pregnancy rate. The spontaneous and overall ongoing pregnancy rates after three years were 37.7 and 77.5% after a positive post-coital test compared with 26.9 and 68.8% after a negative test (p pregnancy rate, justifying expectant management. After a follow-up of three years a positive post-coital test is still associated with a higher spontaneous and a higher overall ongoing pregnancy rate, even in couples with severe male factor infertility. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. Randomized controlled trial: effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization.

    Science.gov (United States)

    Moy, Irene; Milad, Magdy P; Barnes, Randall; Confino, Edmond; Kazer, Ralph R; Zhang, Xingqi

    2011-02-01

    To evaluate the influence of "true" versus "sham" acupuncture on pregnancy rates (PRs) in women undergoing IVF. Randomized controlled trial, double-blinded with independent observer. Academic infertility clinic. One hundred sixty patients acupuncture 25 minutes before and after ET. Subjects completed a McGill Pain Questionnaire regarding their clinical symptoms during ET. Clinical PR and clinical symptoms during ET. While the overall clinical PR was 51.25%, there was no significant difference between the arms of the study (true = 45.3% vs. sham = 52.7%); 33.1% of the patients had ultrasound-documented singleton pregnancy, and 15% of patients had twin gestations, while one patient in the true arm had a triplet gestation. There were significant differences in the subjective, affective, and total pain experience between both arms. The subjects in the true arm described their acupuncture session as being more "tiring" and "fearful" and experienced more "achiness" compared with their sham counterparts. There was no statistically significant difference in the clinical or chemical PRs between both groups. Patients undergoing true acupuncture had differing sensory experiences compared with patients in the sham arm. There were no significant adverse effects observed during the study, suggesting that acupuncture is safe for women undergoing ET. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Early Embryonic Heart Rate in Normal Pregnancies In Memory of ...

    African Journals Online (AJOL)

    At 33 days one of 31 (3.2%) pregnancies showed cardiac activity and by 36days 18 out of 21 (85.8) pregnancies had cardiac activity. By day 37 all pregnancies showed embryonic cardiac activity using the LMP. From days 33 to 56, mean embryonic cardiac activity rose from 84 at day 33 to 173.9 bear per minutes. This study ...

  5. Antiretroviral therapy initiation before, during, or after pregnancy in HIV-1-infected women: maternal virologic, immunologic, and clinical response.

    Directory of Open Access Journals (Sweden)

    Vlada V Melekhin

    2009-09-01

    Full Text Available Pregnancy has been associated with a decreased risk of HIV disease progression in the highly active antiretroviral therapy (HAART era. The effect of timing of HAART initiation relative to pregnancy on maternal virologic, immunologic and clinical outcomes has not been assessed.We conducted a retrospective cohort study from 1997-2005 among 112 pregnant HIV-infected women who started HAART before (N = 12, during (N = 70 or after pregnancy (N = 30.Women initiating HAART before pregnancy had lower CD4+ nadir and higher baseline HIV-1 RNA. Women initiating HAART after pregnancy were more likely to receive triple-nucleoside reverse transcriptase inhibitors. Multivariable analyses adjusted for baseline CD4+ lymphocytes, baseline HIV-1 RNA, age, race, CD4+ lymphocyte count nadir, history of ADE, prior use of non-HAART ART, type of HAART regimen, prior pregnancies, and date of HAART start. In these models, women initiating HAART during pregnancy had better 6-month HIV-1 RNA and CD4+ changes than those initiating HAART after pregnancy (-0.35 vs. 0.10 log(10 copies/mL, P = 0.03 and 183.8 vs. -70.8 cells/mm(3, P = 0.03, respectively but similar to those initiating HAART before pregnancy (-0.32 log(10 copies/mL, P = 0.96 and 155.8 cells/mm(3, P = 0.81, respectively. There were 3 (25% AIDS-defining events or deaths in women initiating HAART before pregnancy, 3 (4% in those initiating HAART during pregnancy, and 5 (17% in those initiating after pregnancy (P = 0.01. There were no statistical differences in rates of HIV disease progression between groups.HAART initiation during pregnancy was associated with better immunologic and virologic responses than initiation after pregnancy.

  6. Clinical Features of Miller-Fisher Syndrome in Pregnancy

    Directory of Open Access Journals (Sweden)

    Masanori Ono

    2015-01-01

    Full Text Available Miller-Fisher syndrome (MFS is recognized as a variant of Guillain-Barré syndrome (GBS. MFS is a rare disorder that is characterized by the acute onset of ophthalmoplegia, ataxia, and areflexia/hyporeflexia. MFS has a higher incidence in Asia, where the incidence is estimated to be 18%–26% of GBS compared with 3%–5% in the West. The differential diagnosis of MFS includes Wernicke’s encephalopathy (WE which is characterized by a clinical triad (nystagmus and ophthalmoplegia, mental status changes, and ataxia, myasthenia gravis, and brainstem stroke. The association between MFS and pregnancy has not been reported previously. Here, we describe the clinical features of a pregnant woman in early pregnancy with MFS. This case highlights the fact that it is necessary to establish an accurate diagnosis based on the details from the patient’s history on appropriate complementary testing in a pregnant patient with MFS.

  7. The effect of metformin use on pregnancy rates among polycystic ovary syndrome patients undergoing in vitro fertilization: A retrospective-cohort study

    Directory of Open Access Journals (Sweden)

    Yazed Sulaiman Al-Ruthia

    2017-09-01

    Conclusions: Metformin co-treatment during IVF may negatively affect pregnancy rates. Further well-designed, randomized, double-blind placebo-control clinical trials are needed to confirm the findings of this study.

  8. Syphilis Infection during Pregnancy: Fetal Risks and Clinical Management

    OpenAIRE

    De Santis, Marco; De Luca, Carmen; Mappa, Ilenia; Spagnuolo, Terryann; Licameli, Angelo; Straface, Gianluca; Scambia, Giovanni

    2012-01-01

    Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early co...

  9. Long-term ongoing pregnancy rate and mode of conception after a positive and negative post-coital test

    NARCIS (Netherlands)

    Hessel, M.; Brandes, M.; Bruin, J.P.; Bots, R.S.; Kremer, J.A.; Nelen, W.L.; Hamilton, C.J.

    2014-01-01

    OBJECTIVE: Many fertility clinics have decided to abolish the post-coital test. Yet, it is a significant factor in prognostic models that predict the spontaneous pregnancy rate within one year. The aim of this study was to evaluate (1) the long-term outcome of infertile couples with a positive or a

  10. Pregnancy rate and birth outcomes among women receiving ...

    African Journals Online (AJOL)

    Introduction: In Sub-Saharan Africa, few studies reported pregnancy incidence and outcomes in women taking antiretroviral therapy (ART). This survey aims to estimate the incidence and outcomes of pregnancy in a cohort of HIV positive women initiating ART in Bobo-Dioulasso, Burkina Faso. Methods: We carried out a ...

  11. The Impact of State Abortion Policies on Teen Pregnancy Rates

    Science.gov (United States)

    Medoff, Marshall

    2010-01-01

    The availability of abortion provides insurance against unwanted pregnancies since abortion is the only birth control method which allows women to avoid an unwanted birth once they are pregnant. Restrictive state abortion policies, which increase the cost of obtaining an abortion, may increase women's incentive to alter their pregnancy avoidance…

  12. Ovarian Drilling Efficacy, Estradiol Levels and Pregnancy Rate in Females With Polycystic Ovary Syndrome

    Directory of Open Access Journals (Sweden)

    Moramezi

    2015-02-01

    Full Text Available Background Polycystic ovary syndrome (PCOS is the most common cause of oligoovulation and anovulation in general population and in females with infertility. Objectives The purpose of this study was to compare the efficacy of ovarian laparoscopic drilling procedure (LOD in females with PCOS, resistant to treatment with estradiol (E2 level less than 40 pg/mL versus more than 40 pg/mL. Materials and Methods Females with PCOS, resistant to drug for ovary stimulation, were grouped based on the Estradiol levels of ≤ 40 pg/mL (n = 13 and > 40 pg/mL (n = 15. To survey the ovulation, continuing spontaneous ovulation and cumulative pregnancy rate, ovarian laparoscopic drilling was carried out after the analysis of serum E2. Results There was significant difference in the average starting time of ovulation and continuing spontaneous ovulation of cases with PCOS with E2 levels > 40 pg/mL, compared with ones with E2 ≤ 40 pg/mL (P = 0.029, P = 0.05, respectively. Significant differences were also found in pregnancy rates of cases with PCOS with E2 levels > 40 pg/mL compared with ones with E2 ≤ 40 pg/mL (P = 0.05. Conclusions This study revealed that LOD in females with PCOS with a serum E2 > 40 pg/mL was sufficient and safe to trigger development of ovarian follicles followed by clinical pregnancy.

  13. Effect of mastitis on luteal function and pregnancy rates in buffaloes.

    Science.gov (United States)

    Mansour, Mohamed Mohsen; Hendawy, Amin O; Zeitoun, Moustafa M

    2016-09-15

    The aim of this study was to investigate the effects of mastitis on CL development and function and pregnancy rate in buffaloes. Sixty-six buffaloes (Bubalus bubalus) reared in a commercial farm at El-Beheira governorate, north of Egypt were used in this study. According to the visual observation of milk, physical examination of the udder and actual somatic cell count in milk, buffalo cows were divided into three groups: without mastitis (W), n = 23; subclinical mastitis (SC), n = 18; and clinical mastitis (C), n = 25. All buffalo cows were synchronized by double dose of PGF2α (11-day interval) and inseminated by frozen-thawed semen of fertile bull. Mean CL diameter was ultrasonically examined on Days 5, 9, 12, 16, 21, and 25 after artificial insemination (AI). Blood samples were taken on the days of ultrasonography for progesterone (P4) assay. Results indicated that pregnancy rates were lower (P mastitis occurred during Day -15 before to Day +30 after AI, compared with 59.22% in the uninfected cows. The diameter of CL was greater (P mastitis revealed suppression to both CL diameter and function leading to significant reduction in pregnancy outcome of buffalo cows. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Clinical characteristics of persistent ectopic pregnancy after salpingostomy and influence on ongoing pregnancy.

    Science.gov (United States)

    Zhang, Yongli; Chen, Jinhong; Lu, Wen; Li, Bilan; Du, Guiqiang; Wan, Xiaoping

    2017-03-01

    The aim of this study was to assay the clinical characteristics of persistent ectopic pregnancy (PEP) and its influence on ongoing pregnancy. We retrospectively reviewed 2498 patients who received salpingostomies as primary management for ectopic pregnancies from January 2004 to December 2009, using medical records and telephone inquiries. Clinical characteristics of the 52 patients (2.08%) who were diagnosed with PEP after salpingostomy were compared with those who received satisfactory treatment. The odds ratios and 95% confidential intervals were calculated for each variable by univariate and (for significantly different factors) multivariate analysis. Preoperatively, patients with PEP after salpingostomy significantly differed from the non-PEP patients in gestational age, mass size and pelvic adhesiolysis. Serum β-human chorionic gonadotropin levels in PEP patients were monitored after surgery, which had declined by 28.31% on postoperative day (POD) 4, 40.22% on POD 7, 51.46% on POD 10 and 53.43% on POD 21. Repeat ectopic pregnancy (REP) tended to occur more frequently in PEP patients (PEP: 5 cases, 10.20%; non-PEP: 4 cases, 2.80%; P = 0.034). Multivariate analysis showed that pelvic adhesions and PEP were the strongest independent predictors of REP. Gestational age, mass size and pelvic adhesions were significantly correlated with PEP. PEP was an independent prognostic factor for REP. However, a multicenter study is needed to support and extend our findings. © 2017 The Authors Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.

  15. Treating Female Infertility and Improving IVF Pregnancy Rates With a Manual Physical Therapy Technique*

    Science.gov (United States)

    Wurn, Belinda F; Wurn, Lawrence J; Roscow, Amanda S; King, C. Richard; Heuer, Marvin A; Scharf, Eugenia S; Shuster, Jonathan J

    2004-01-01

    Context Infertility and pregnancy. Objective To assess the effectiveness of site-specific manual soft tissue therapy in (1) facilitating natural fertility and (2) improving in vitro fertilization (IVF) pregnancy rates in women with histories indicating abdominopelvic adhesion formation. Design and Intervention Pursuant to 2 promising pilot studies, 53 infertile, premenopausal patients received a 10- to 20-hour series of site-specific manual physical therapy treatments. Seventeen patients hoped to achieve a natural pregnancy; 36 planned to undergo IVF within 15 months. The primary criteria for inclusion in the studies were the inability to conceive following a minimum of 12 months of unprotected intercourse and suspected or confirmed pelvic adhesions due to abdominal and/or pelvic surgery, infectious or inflammatory disease (eg, endometriosis, PID), or trauma. Treatments were specifically designed to address biomechanical dysfunctions of the pelvis, sacrum, and coccyx and restricted soft tissue and visceral mobility due to adhesions or microadhesions affecting the reproductive organs and adjacent structures. Main Outcome Measures (1) Natural fertility group: pregnancy within 1 year of therapy and subsequent full-term delivery; (2) Pre-IVF group: pregnancy (via transfer of fresh embryos from nondonor eggs) within 15 months of the last manual treatment date. Results Natural Fertility Group Of the 14 patients available for follow-up (ages 25 to 44; mean, 33.5 years), 10 (71.4%) became pregnant within 1 year, and 9 (64.3%) reported full-term deliveries. Three of the 9 women who delivered reported a subsequent pregnancy, suggesting that the treatment protocol might have lasting effects. Two women have had a second live birth delivery; and the third is still pregnant. Pre-IVF group Of the 25 patients available for follow-up (ages 28 to 44; mean, 36 years), clinical pregnancies were documented in 22 of 33 embryo transfers vs the US Centers for Disease Control and

  16. Treating female infertility and improving IVF pregnancy rates with a manual physical therapy technique.

    Science.gov (United States)

    Wurn, Belinda F; Wurn, Lawrence J; King, C Richard; Heuer, Marvin A; Roscow, Amanda S; Scharf, Eugenia S; Shuster, Jonathan J

    2004-06-18

    Infertility and pregnancy. To assess the effectiveness of site-specific manual soft tissue therapy in (1) facilitating natural fertility and (2) improving in vitro fertilization (IVF) pregnancy rates in women with histories indicating abdominopelvic adhesion formation. Pursuant to 2 promising pilot studies, 53 infertile, premenopausal patients received a 10- to 20-hour series of site-specific manual physical therapy treatments. Seventeen patients hoped to achieve a natural pregnancy; 36 planned to undergo IVF within 15 months. The primary criteria for inclusion in the studies were the inability to conceive following a minimum of 12 months of unprotected intercourse and suspected or confirmed pelvic adhesions due to abdominal and/or pelvic surgery, infectious or inflammatory disease (eg, endometriosis, PID), or trauma. Treatments were specifically designed to address biomechanical dysfunctions of the pelvis, sacrum, and coccyx and restricted soft tissue and visceral mobility due to adhesions or microadhesions affecting the reproductive organs and adjacent structures. (1) Natural fertility group: pregnancy within 1 year of therapy and subsequent full-term delivery; (2) Pre-IVF group: pregnancy (via transfer of fresh embryos from nondonor eggs) within 15 months of the last manual treatment date. Natural fertility group: Of the 14 patients available for follow-up (ages 25 to 44; mean, 33.5 years), 10 (71.4%) became pregnant within 1 year, and 9 (64.3%) reported full-term deliveries. Three of the 9 women who delivered reported a subsequent pregnancy, suggesting that the treatment protocol might have lasting effects. Two women have had a second live birth delivery; and the third is still pregnant. Pre-IVF group: Of the 25 patients available for follow-up (ages 28 to 44; mean, 36 years), clinical pregnancies were documented in 22 of 33 embryo transfers vs the US Centers for Disease Control and Prevention (CDC) 2001 age-adjusted expected number of 12.7 (P mobility, is a

  17. What's behind the Good News: The Decline in Teen Pregnancy Rates during the 1990s.

    Science.gov (United States)

    Flanigan, Christine

    Noting that rates of teen pregnancies and births have declined over the past decade, this analysis examined how much of the progress is due to fewer teens having sex and how much to lower rates of pregnancy among sexually active teens. The analysis drew on data from the federal government's National Survey of Family Growth (NSFG), a large,…

  18. Semen levels of spermatid-specific thioredoxin-3 correlate with pregnancy rates in ART couples.

    Directory of Open Access Journals (Sweden)

    Clayton Buckman

    Full Text Available Spermatid specific thioredoxin-3 (SPTRX3 or TXNDC8 is a testis/male germ line specific member of thioredoxin family that accumulates in the superfluous cytoplasm of defective human spermatozoa. We hypothesized that semen levels of SPTRX3 are reflective of treatment outcome in assisted reproductive therapy (ART couples treated by in vitro fertilization (IVF or intracytoplasmic sperm injection (ICSI. Relationship between SPTRX3 and treatment outcome was investigated in 239 couples undergoing ART at an infertility clinic. Sperm content of SPTRX3 was evaluated by flow cytometry and epifluorescence microscopy, and correlated with clinical semen analysis parameters, and data on embryo development and pregnancy establishment. High SPTRX3 levels (>15% SPTRX3-positive spermatozoa were found in 51% of male infertility patients (n = 72, in 20% of men from couples with unexplained, idiopathic infertility (n = 61 and in 14% of men from couples previously diagnosed with female-only infertility (n = 85. Couples with high SPTRX3 produced fewer two-pronuclear zygotes and had a reduced pregnancy rate (19.2% pregnant with >15% SPTRX3-positive spermatozoa vs. 41.2% pregnant with 15% of SPTRX3-positive spermatozoa, a cutoff value established by ROC analysis, had their chance of fathering children by IVF or ICSI reduced by nearly two-thirds. The percentage of SPTRX3-positive spermatozoa had predictive value for pregnancy after ART. Gradient purification and sperm swim-up failed to remove all SPTRX3-positive spermatozoa from semen prepared for ART. In summary, the elevated semen content of SPTRX3 in men from ART couples coincided with reduced incidence of pregnancy by IVF or ICSI, identifying SPTRX3 as a candidate biomarker reflective of ART outcome.

  19. Short-term copper intrauterine device placement improves the implantation and pregnancy rates in women with repeated implantation failure.

    Science.gov (United States)

    Mao, Xiaoyan; Zhang, Jie; Chen, Qiuju; Kuang, Yanping; Zhang, Shaozhen

    2017-07-01

    To study if hysteroscopy and short-term copper intrauterine device placement (Cu-IUD) improves the pregnancy rates of women with repeated implantation failure (RIF) undergoing frozen-thawed embryo transfer (FET). Retrospective study. Medical university hospital. Infertile women with at least two implantation failures with the use of at least one good-quality embryo. All patients received operative hysteroscopy in the follicular cycle, and if endometrial polyps, polypoid endometrium, or intrauterine adhesions were found they were removed. In some patients, a Cu-IUD was inserted immediately after hysteroscopy and removed after two menstrual periods before embryo implantation. All patients underwent in vitro fertilization or intracytoplasmic sperm injection and FET. Clinical pregnancy and implantation rates. A total of 440 women with a mean age of 33.42 ± 4.45 years (range 23-47 y) were included. There were 382 patients (554 cycles) in the IUD group and 58 patients (87 cycles) in the non-IUD group. The two groups were similar regarding age, body mass index, and infertility factors. The IUD group had a significantly higher implantation rate (29.29% vs. 16.56%), chemical pregnancy rate (53.25 vs. 41.38%), and clinical pregnancy rate (45.13% vs. 26.44%) than the non-IUD group. Multivariable regression analysis indicated that the odds of a chemical pregnancy was significantly increased with IUD usage. Cu-IUD placement for two menstrual cycles at the time of hysteroscopy can improve the implantation and pregnancy rates in women with RIF. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  20. Ectopic Pregnancy Rates and Racial Disparities in the Medicaid Population, 2004–08

    Science.gov (United States)

    STULBERG, Debra B.; CAIN, Loretta R.; DAHLQUIST, Irma; LAUDERDALE, Diane S.

    2014-01-01

    Objective To assess 2004–08 ectopic pregnancy rates among Medicaid recipients in 14 states and 2000–08 time trends in 3 states, and to identify differences in rate by race/ethnicity. Design Secondary analysis of Medicaid administrative claims data. Setting United States. Subjects Women ages 15–44 enrolled in Medicaid in Arizona, California, Colorado, Florida, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, New York, or Texas in 2004–08 (n=19,135,106), and in California, Illinois and New York in 2000–03. Interventions None. Main Outcome Measure Number of ectopic pregnancies divided by the number of total pregnancies (spontaneous abortions, induced abortions, ectopic pregnancies, and all births). Results The 2004–08 Medicaid ectopic pregnancy rate for all 14 states combined was 1.40% of all reported pregnancies. Adjusted for age, the rate was 1.47%. Ectopic pregnancy incidence was 2.3 per 1,000 woman-years. In states for which longer-term data were available (California, Illinois and New York), the rate declined significantly 2000–08. In all 14 states, Black women were more likely to experience an ectopic pregnancy compared to whites (Relative Risk 1.46, 95% Confidence Interval 1.45–1.47). Conclusions Ectopic pregnancy remains an important health risk for women enrolled in Medicaid. Black women are at consistently higher risk than whites. PMID:25439806

  1. Ectopic pregnancy rates and racial disparities in the Medicaid population, 2004-2008.

    Science.gov (United States)

    Stulberg, Debra B; Cain, Loretta R; Dahlquist, Irma; Lauderdale, Diane S

    2014-12-01

    To assess 2004-2008 ectopic pregnancy rates among Medicaid recipients in 14 states and 2000-2008 time trends in three states and to identify differences in rate by race/ethnicity. Secondary analysis of Medicaid administrative claims data. Not applicable. Women ages 15-44 enrolled in Medicaid in Arizona, California, Colorado, Florida, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, New York, or Texas in 2004-2008 (n = 19,135,106) and in California, Illinois, and New York in 2000-2003. None. Number of ectopic pregnancies divided by the number of total pregnancies (spontaneous abortions, induced abortions, ectopic pregnancies, and all births). The 2004-2008 Medicaid ectopic pregnancy rate for all 14 states combined was 1.40% of all reported pregnancies. Adjusted for age, the rate was 1.47%. Ectopic pregnancy incidence was 2.3 per 1,000 woman-years. In states for which longer term data were available (California, Illinois, and New York), the rate declined significantly in 2000-2008. In all 14 states, black women were more likely to experience an ectopic pregnancy compared with whites (relative risk, 1.46; 95% confidence interval, 1.45-1.47). Ectopic pregnancy remains an important health risk for women enrolled in Medicaid. Black women are at consistently higher risk than whites. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  2. Clinical presentation and management of diabetes mellitus in pregnancy

    Directory of Open Access Journals (Sweden)

    Al-Azemi N

    2013-12-01

    Full Text Available Nasser Al-Azemi,1 Michael F Diejomaoh,1,2 Elisavet Angelaki,1 Asiya T Mohammed2 1Maternity Hospital, Shuwaikh, Kuwait; 2Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Safat, Kuwait Objective: To evaluate the clinical presentation, management, and the outcome of diabetes mellitus in pregnancy. Methods: One hundred seventy-one patients with diabetes mellitus admitted between September 1, 2006, and June 30, 2008, to the labor room at Maternity Hospital in Kuwait for induction of labor made up the study population; while an equivalent number of patients without medical complications who also were admitted for induction of labor made up the control group. The patients were assessed at admission, and their medical data were extracted. The study and control patients were monitored through labor/puerperium, and the outcome was documented. Results: Gestational diabetes mellitus was diagnosed in 71.9% of the study patients, a past history of diabetes mellitus was recorded in 81.34% of the study patients, and 49.2% of the patients were admitted at 8–12 weeks of gestation for diabetic control. The mean weight gained in pregnancy was significantly higher for control patients (11.52±5.643 versus [vs] 9.90±5.757 kg/m2; P<0.009, and the body mass index of study patients was higher (32.00±6.160 vs 28.20±5.885 kg/m2; P<0.0001. Of the study population, 64.3% of the patients were managed with diet and increased physical activity and 35.7% with insulin, diet, and increased physical activity. The incidences of maternal morbidity in both study and control groups were comparable, and the incidence of preeclampsia was low, at 2.3%. The gestational age at delivery was higher in the control group (39.02±1.834 weeks vs 38.62±1.773 weeks; P<0.0001, and the percentage of cesarean deliveries was higher in the study population (44.4% vs 33.3%; P=0.046. The Apgar scores of the both groups were comparable and in the normal range, and the

  3. Clinical and scientific results in perinatal care of pregnancy complicated by insulin dependent diabetes mellitus in Croatia.

    Science.gov (United States)

    Djelmis, J

    1998-01-01

    At the Department of Obstetrics and Gynecology, Perinatal Unit for Diabetes and Fetal Growth, School of Medicine, Zagreb, perinatal care of pregnancies complicated with insulin dependent diabetes melitus (IDDM), has been performed for more than 36 years. The intention of this review is to show our own results in the management of IDDM pregnancies and the latest clinical advances in perinatal care of such pregnancies. Pregnancy complicated with IDDM is at risk because of numerous maternal, fetal and neonatal complications. Recent advances in medicine, especially in diabetology and perinatology, helps clinician avoid or lessen antenatal or perinatal complications in IDDM pregnancies. The main result of improved perinatal care is that today fetal and neonatal mortality in IDDM pregnancy is almost equal to that of healthy pregnant population. Intensive preconceptual care and optimal regulation of IDDM have resulted not only in decreased perinatal mortality but also in a decreased rate of congenital malformation. Tight glycemia control during pregnancy has a beneficial effect on fetal growth. Intensive control of fetal growth, verification of lung maturation at term by amniocenthesis, and control of fetal oxygenation will result in delivery of a mature eutrophic newborn with the lowest rate of neonatal complications possible. Perinatal mortality of less than 2% in IDDM pregnancy can be obtained by planned delivery between 38 and 39 weeks of gestation by either vaginal route or cesarean section, depending on indications. After delivery, intensive care of the newborn is necessary.

  4. Pregnancy Rates among Juvenile Justice Girls in Two Randomized Controlled Trials of Multidimensional Treatment Foster Care

    Science.gov (United States)

    Kerr, David C. R.; Leve, Leslie D.; Chamberlain, Patricia

    2009-01-01

    Preventing adolescent pregnancy is a national research priority that has had limited success. In the present study, the authors examined whether Multidimensional Treatment Foster Care (MTFC) relative to intervention services as usual (group care [GC]) decreased pregnancy rates among juvenile justice girls mandated to out-of-home care. Girls (13-17…

  5. High rates of unintended pregnancies among young women sex ...

    African Journals Online (AJOL)

    This study aimed to examine the correlates of unintended pregnancies among young women sex workers in conflict-affected northern Uganda. Data were drawn from the Gulu Sexual Health Study, a cross-sectional study of young women engaged in sex work. Bivariable and multivariable logistic regression was used to ...

  6. Increasing The Number of Embryos Transferred from Two to Three, Does not Increase Pregnancy Rates in Good Prognosis Patients

    Directory of Open Access Journals (Sweden)

    Mahnaz Ashrafi

    2015-10-01

    Full Text Available Background: To compare the pregnancy outcomes after two embryos versus three embryos transfers (ETs in women undergoing in vitro fertilization (IVF/intracytoplasmic sperm injection (ICSI cycles. Materials and Methods: This retrospective study was performed on three hundred eighty seven women with primary infertility and with at least one fresh embryo in good quality in order to transfer at each IVF/ICSI cycle, from September 2006 to June 2010. Patients were categorized into two groups according to the number of ET as follows: ET2 and ET3 groups, indicating two and three embryos were respectively transferred. Pregnancy outcomes were compared between ET2 and ET3 groups. Chi square and student t tests were used for data analysis. Results: Clinical pregnancy and live birth rates were similar between two groups. The rates of multiple pregnancies were 27 and 45.2% in ET2 and ET3 groups, respectively. The rate of multiple pregnancies in young women was significantly increased when triple instead of double embryos were transferred. Logistic regression analysis indicated two significant prognostic variables for live birth that included number and quality of transferred embryos; it means that the chance of live birth following ICSI treatment increased 3.2-fold when the embryo with top quality (grade A was transferred, but the number of ET had an inverse relationship with live birth rate; it means that probability of live birth in women with transfer of two embryos was three times greater than those who had three ET. Conclusion: Due to the difficulty of implementation of the elective single-ET technique in some infertility centers in the world, we suggest transfer of double instead of triple embryos when at least one good quality embryo is available for transfer in women aged 39 years or younger. However, to reduce the rate of multiple pregnancies, it is recommended to consider the elective single ET strategy.

  7. The Effects of Parental Involvement Laws and the AIDS Epidemic on the Pregnancy and Abortion Rates of Minors.

    Science.gov (United States)

    Altman-Palm, Nancy; Tremblay, Carol Horton

    1998-01-01

    Explores the effects of legislation requiring parental consent for a minor's abortion and the risk of acquiring AIDS on adolescent pregnancy and abortion rates. Finds lower pregnancy and abortion rates for women 15-17 in states with parental involvement legislation, while abortion doubles and pregnancy rates decline with the incidence of AIDS.…

  8. Clinical course of ectopic pregnancy: A single-center experience

    Directory of Open Access Journals (Sweden)

    Aqueela Ayaz

    2013-01-01

    Full Text Available Objectives: The objective was to highlight the frequency, clinical profile, and predisposing factors of ectopic pregnancy (EP in a general hospital. Materials and Methods: This descriptive study was conducted at the Obstetrics and Gynaecology department of Hera General hospital, Makkah, Saudi Arabia, from July 1, 2009 to December 29, 2010. Data were collected on chief medical complaints, sociodemographic characteristics, past obstetrics and gynecological history, management done, and outcome of management. Data were analyzed using Microsoft Office Excel (version 2007. Results: Out of total 7564 pregnancies, 44 (0.58% patients were diagnosed as EP. Out of 44, 22 (50% patients presented within 24 h of onset of symptoms. Mean age was 28 ± 7 years. Multigravida were predominant in 25 (57%, and 21 (48% had gestational age of 6-8 weeks at the time of presentation; the common presenting features were amenorrhea (41, 93.2%, abdominal pain (39, 88.6%, and tenderness (38, 86%. Previous pelvic surgery (13, 29.5%, infertility treatment (11, 25%, and pelvic inflammatory disease (10, 22.7% were the common predisposing factors. Twenty-five (57% presented with ruptured EP and were operated within 24 h, and the remaining were kept under observation till further diagnosis. After confirming the diagnosis, 12/19 underwent laparoscopy, whereas 7/19 received medical treatment. Surgery confirmed fallopian tube pregnancies in 35 (94.5%. No mortality was observed. Conclusion: Previous pelvic surgeries were the major etiological factor for EP. Other factors were infertility treatment and pelvic inflammatory disease. The most common site of EP was fallopian tubes.

  9. High pregnancy rate after microsurgical tubal reanastomosis by temporary loose parallel 4-quadrant sutures technique: a long long-term follow-up report on 961 cases.

    Science.gov (United States)

    Moon, Hwa Sook; Joo, Bo Sun; Park, Gun Sik; Moon, Sung Eun; Kim, Sang Gap; Koo, Ja Seong

    2012-06-01

    Only a limited portion of sterilized women undergo tubal reanastomosis due to high costs, limited availability of qualified practitioners willing to perform the procedure and increasing success rates with IVF. However, IVF has complications and an increased risk of ectopic pregnancy and multiple pregnancies. Recently, the importance of specialized training for tubal anastomosis has been re-emphasized. This study aimed to report the procedure of our microsurgical tubal reanastomosis by a temporary loose parallel 4-quadrant suture technique and its high pregnancy outcome over the last 20 years. This clinical study retrospectively analyzed data on 961 consecutive patients who underwent tubal reversal between March 1988 and August 2007 in a large urban medical center. All surgical operations were performed by microsurgical tubal reanastomosis using a temporary loose parallel 4-quadrant suture technique by a single surgeon. Subsequent pregnancy outcomes were evaluated. The overall pregnancy rate was 85.1, 82.6 being intrauterine and 2.5% ectopic. The pregnancy rate was significantly reduced in patients over 40 years old (53.9%) compared with patients aged 40 years or less (90.3%) (P technique resulted in a high pregnancy rate comparable with the level of natural fertility. The study also reveals that ectopic pregnancy frequently occurs in tubal reanastomosis of the interstitial-ampulla site compared with other sites.

  10. Review of Research Shows, Overall, Acupuncture Did Not Increase Pregnancy Rates with IVF

    Science.gov (United States)

    ... X Y Z Review of Research Shows, Overall, Acupuncture Did Not Increase Pregnancy Rates With IVF Share: An analysis of research conducted on acupuncture as an adjuvant (booster) treatment to in vitro ...

  11. Effect of meloxicam on pregnancy rate of recipient heifers following transfer of in vitro produced embryos.

    Science.gov (United States)

    Aguiar, T S; Araújo, C V; Tirloni, R R; Martins, L R

    2013-12-01

    The main objective of this study was to determine if administration of meloxicam, a cyclooxygenase (COX) two inhibitor, to heifers in which embryo transfer (ET) is more difficult and requires a greater manipulation of the tract, would be beneficial. Nulliparous recipient heifers were divided in two groups: CON (n = 102), in which animals received 10 ml of saline IM (the same volume of meloxicam) and MEL (n = 105) animals that were treated with meloxicam. According to the degree in passing the catheter, recipients from both groups were classified as Grade I, easy (meloxicam (10 ml).There was no difference in the pregnancy rates on Day 35 considering animals which presented Grade I cervix independently whether the treatment was performed or not (p = 0.22). There was a statistical difference in the pregnancy rates (p animals that presented Grade II cervix, the pregnancy rate was higher for MEL (21.15% and 78.84%, respectively) in both examinations (p meloxicam had a positive influence on general pregnancy rate of treated heifers in comparison to non-treated heifers. It was also observed that pregnancy rate was not influenced by meloxicam administration in Grade I heifers. Treatment increased the pregnancy rate of Grade II heifers. © 2013 Blackwell Verlag GmbH.

  12. Brucellosis in pregnancy: clinical aspects and obstetric outcomes.

    Science.gov (United States)

    Vilchez, Gustavo; Espinoza, Miguel; D'Onadio, Guery; Saona, Pedro; Gotuzzo, Eduardo

    2015-09-01

    Brucellosis is a zoonosis with high morbidity in humans. This disease has gained interest recently due to its re-emergence and potential for weaponization. Pregnant women with this disease can develop severe complications. Its association with adverse obstetric outcomes is not clearly understood. The objective of this study was to describe the obstetric outcomes of brucellosis in pregnancy. Cases of pregnant women with active brucellosis seen at the Hospital Nacional Cayetano Heredia from 1970 to 2012 were reviewed. Diagnostic criteria were a positive agglutination test and/or positive blood/bone marrow culture. Presentation and outcomes data were collected. The Chi-square test was used for nominal variables. A p-value of brucellosis in 6.4%. The most common treatment was aminoglycosides plus rifampicin (42.2% of cases). Complication rates decreased if treatment was started within 2 weeks of presentation (p brucellosis in pregnancy reported in the literature. Brucella presents adverse obstetric outcomes including fetal and maternal/neonatal death. Cases with unexplained spontaneous abortion should be investigated for brucellosis. Prompt treatment is paramount to decrease the devastating outcomes. Copyright © 2015. Published by Elsevier Ltd.

  13. Pregnancy Rates Among Juvenile Justice Girls in Two RCTs of Multidimensional Treatment Foster Care

    Science.gov (United States)

    Kerr, David C. R.; Leve, Leslie D.; Chamberlain, Patricia

    2009-01-01

    Preventing adolescent pregnancy is a national research priority that has had limited success. The present study examined whether Multidimensional Treatment Foster Care (MTFC) relative to intervention services as usual (group care [GC]) decreased pregnancy rates among juvenile justice girls mandated to out-of-home care. Girls (ages 13–17) with histories of criminal referrals (Mdn = 10) were randomly assigned to MTFC (n = 81) or GC (n = 85) as part of two randomized controlled trials. Pregnancy histories were assessed from baseline through 24 months. Fewer postbaseline pregnancies were reported for MTFC girls (26.9%) than for GC girls (46.9%), an effect that remained significant after controlling for baseline criminal referrals, pregnancy history, and sexual activity. MTFC has previously been shown to decrease arrest and lock-up rates. The present findings support the long-term preventive effects of MTFC on adolescent girls’ pregnancy rates. Findings are consistent with the notion that programs that target delinquency by impacting general risk behavior pathways and contexts may more successfully prevent teen pregnancy than those that directly target sexual behaviors. PMID:19485598

  14. Multimodal intervention raises smoking cessation rate during pregnancy

    DEFF Research Database (Denmark)

    Hegaard, Hanne K; Kjaergaard, Hanne; Møller, Lars F

    2003-01-01

    BACKGROUND: The aim was to study the effect of a multimodal smoking cessation intervention regimen on a number of pregnant smokers. METHODS: A prospective intervention study was designed where participants were allocated to intervention or control based on their birth date. The study included 647.......003). The adjusted odds ratio (OR) for smoking cessation was 4.20 (95% CI 2.13-8.03). Logistic regression analysis showed a significant positive association of smoking cessation with low caffeine consumption in pregnancy, many years in school, no exposure to passive smoking outside the home, and previous attempts...

  15. Correlation of Cystatin-C with Glomerular Filtration Rate by Inulin Clearance in Pregnancy

    Science.gov (United States)

    Saxena, Aditi R.; Karumanchi, S. Ananth; Fan, Shu-Ling; Horowitz, Gary L.; Seely, Ellen W.

    2012-01-01

    Objective To test utility of cystatin-C as a marker of glomerular filtration rate during pregnancy, we performed serial correlations with inulin clearance during pregnancy and postpartum. Methods Twelve subjects received inulin infusions and serum cystatin-C at three time points. Pearson's correlation coefficient was calculated. Results Cystatin-C levels ranged 0.66 to 1.48 mg/L during pregnancy, and 0.72 to 1.26 mg/L postpartum. Inulin clearance ranged 130 to 188 ml/min during pregnancy, and 110 to 167 ml/min postpartum. Cystatin-C did not correlate with inulin clearance at any time point. Conclusion Serum cystatin-C did not correlate with inulin clearance during pregnancy or postpartum. PMID:22008011

  16. Stillbirth rates in singleton pregnancies in a stable population at Karl ...

    African Journals Online (AJOL)

    To determine the changes in stillbirth rates in singleton pregnancies in a stable population over a period of 50 years. Methods. Stillbirth rates for ... stillbirths, neonatal deaths and deliveries, from which the stillbirth rates for fetuses ≥500 g ... from black residential areas have recently increased rapidly, the study was limited to ...

  17. Pregnancy rates and predictors in women with HIV/AIDS in Rio de Janeiro, Southeastern Brazil

    Directory of Open Access Journals (Sweden)

    Ruth Khalili Friedman

    2011-04-01

    Full Text Available OBJECTIVE: To assess incidence and predictors of first pregnancy among women with HIV/AIDS. METHODS: Prospective cohort study was conducted in Rio de Janeiro, southeastern Brazil, between 1996 and 2003. This study comprised 225 women with HIV/AIDS followed up until their first pregnancy or first censored event (hysterectomy, tubal ligation, menopause, 50 years of age, loss to follow-up, death or the end of December 2003. Pregnancy and abortion rates were estimated, and Cox proportional hazards models were used to identify baseline characteristics associated with pregnancy risk. RESULTS: The women were followed up for 565 person/years with a median follow-up of 3 years per women. The mean age was 32 years (SD: 7, and 54.7% were white. There were 60 pregnancies in 39 women, and 18 were terminated (induced abortions, accounting for a rate of 6.9% and 2.1% women/year, respectively. Repeated pregnancies occurred in 33.3% of the women (13/39. Higher pregnancy risk was seen among younger women (HR=3.42; 95%CI: 1.69;6.95 and those living with their partners (HR=1.89; 95%CI: 1.00;3.57. Lower pregnancy risk was associated with higher education level (HR=0.43; 95%CI: 0.19;0.99 and use of antiretroviral therapy (HR=061; 95%CI: 0.31;1.17. CONCLUSIONS: Lower pregnancy rates were found in our cohort than in the general population. Sociodemographic characteristics should be taken into consideration in the management of reproductive health in HIV-positive childbearing age women. Reproductive and family planning counseling must be incorporated into HIV/AIDS programs for women to help preventing HIV transmission to their partners and offspring.

  18. Clinical significance of DVM and its prevalence in pre-gestational diabetes cases versus normal pregnancies

    Directory of Open Access Journals (Sweden)

    Farideh Akhlaghi

    2015-06-01

    Full Text Available Pre-gestational diabetes mellitus affects less than 1% of all pregnancies and is a significant cause of fetal morbidity and mortality. It is hypothesized that impaired placental function, in the form of abnormal placental weight and/or abnormal placental histology, may be responsible for this event in such pregnancies. Delayed villous maturation of placental villi, which is one of the findings associated with pre-gestational diabetes increases the rate of perinatal mortality. There is limited literature regarding the delayed maturation of placental villous. This review included trials (randomized and non-randomized, cohort and case-control studies registered in Medline/PubMed database, from January 2001 to September 2012 that evaluated the clinical significance of delayed villous maturation and its prevalence in pre-gestational diabetic cases compared to normal pregnancies.It emphasizes that further studies with focus on possible clinical or ultrasound markers of placental delayed villous maturation, especially in a high risk-group such as women with pre-gestational diabetes mellitus are highly recommended.

  19. Effect of Pertubation on Pregnancy Rates before Intrauterine Insemination Treatment in Patients with Unexplained Infertility

    Directory of Open Access Journals (Sweden)

    Funda Yildiz

    2014-03-01

    Full Text Available Background: The aim of this study was to determine the relationship between marital violence and distress level among women with a diagnosis of infertility. Materials and Methods: In this prospective randomized study, a total of 180 patients were included in the study. Amongst these, pertubation of the uterine cavity was carried out in 79 patients prior to insemination. One patient in the pertubation group was later excluded because insemination could not be performed due to cycle cancellation. Results: There were no significant differences in demographic characteristics between the study and control groups. When the pregnancy rates of both groups were evaluated, 14(17.8% patients in the study group achieved pregancy. Three (3.8% had a biochemical pregnancy, 1(1.3% miscarried and 10(12.7% had live births. In the control group, a total of 24(23.8% pregnancies were achieved, amongst which one (1% had a biochemical pregnancy, 3(3% miscarried and 20(19.8% resulted in live births. There was no significant difference between groups in terms of total pregnancy and live birth rates (p>0.05. There was a 21% total pregnancy loss rate. There was no significant difference between the control and study groups in terms of pregnancy loss rates (p>0.05. Conclusion: This study on a homogenous group of unexplained infertile patients determined that the addition of pertubation to a controlled ovarian hyperstimulation plus intrauterine insemination (COH+IUI treatment protocol did not affect pregnancy rates (Registration Number: NCT01999959.

  20. Pregnancy

    DEFF Research Database (Denmark)

    Palmer, Keith T; Bonzini, Matteo; Bonde, Jens Peter Ellekilde

    2013-01-01

    Most pregnant women are exposed to some physical activity at work. This Concise Guidance is aimed at doctors advising healthy women with uncomplicated singleton pregnancies about the risks arising from five common workplace exposures (prolonged working hours, shift work, lifting, standing and heavy...... on pregnancy. Moreover, moderate physical exercise is thought to be healthy in pregnancy and most pregnant women undertake some physical work at home. The guidelines provide risk estimates and advice on counselling....

  1. Multimodal intervention raises smoking cessation rate during pregnancy

    DEFF Research Database (Denmark)

    Hegaard, Hanne K; Kjaergaard, Hanne; Møller, Lars F

    2003-01-01

    BACKGROUND: The aim was to study the effect of a multimodal smoking cessation intervention regimen on a number of pregnant smokers. METHODS: A prospective intervention study was designed where participants were allocated to intervention or control based on their birth date. The study included 647...... pregnant smokers. The intervention group (n = 327) received initial individual smoking cessation counseling supplemented by an invitation to join, individually or in a group, a smoking cessation program with nicotine replacement therapy as a voluntary option. Intervention was designed as an integral part...... of the midwives' prenatal care. All pregnant smokers in the usual care group (n = 320) received standard counseling from a midwife. Outcome was self-reported smoking cessation in the 37th week of pregnancy and the reported cessation was validated by cotinine saliva concentration. RESULTS: Self-reported cessation...

  2. The value of HCG serum concentrations after trigger in predicting pregnancy and live birth rates in IVF-ICSI.

    Science.gov (United States)

    Zhou, Jianjun; Wang, Shanshan; Wang, Bin; Wang, Junxia; Chen, Hua; Zhang, Ningyuan; Hu, Yali; Sun, Haixiang

    2015-06-01

    The aim of this study was to determine if an association existed between serum human chorionic gonadotrophin (HCG) level at 12 h after trigger and IVF and intracytoplasmic sperm (ICSI) treatment outcomes. Women undergoing initial IVF-ICSI and embryo transfer treatment using the long luteal phase gonadotrophin-releasing hormone agonist protocol between April 2012 and March 2013 for tubal factor were included (n = 699). In the clinical pregnancy group, HCG after trigger was significantly elevated (276.0 ± 5.1 versus 198.5 ± 6.1 mIU/mL; P HCG was 201.2 mIU/ml. Compared with the lower HCG group, the clinical pregnancy rate in the higher HCG group was increased in obese and non-obese patients (77.8% versus 57.3%, P HCG was associated with a better IVF-ICSI treatment outcome (OR 4.39, 95% CI 2.99 to 6.45). Clinical pregnancy rate was significantly higher across increasing quartiles of HCG. An elevated level of serum HCG at 12 h after trigger was associated with a better IVF-ICSI outcome. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  3. Weight gain potential affects pregnancy rates in bovine embryo recipients raised under pasture conditions.

    Science.gov (United States)

    Fernandes, Carlos Antonio de Carvalho; Palhao, Miller Pereira; Figueiredo, Ana Cristina Silva; Ribeiro, Josiane Rossi; Fonseca e Silva, Fabyano; Viana, Joao Henrique Moreira

    2016-01-01

    The aim of the present study was to evaluate the effect of differences in body weight gain after embryo transfer on the pregnancy rates of crossbred heifers used as recipients and raised under a grazing system. The study was performed during the dry (April to September) and the rainy (October to March) seasons. The embryos transferred were produced by in vitro fertilization. The body weight of each recipient was measured immediately before the embryo transfer and 23 to 25 days later, when the diagnosis of pregnancy was performed by ultrasonography. The associations among initial body weight (IBW), daily body weight gain (DWG), season, and pregnancy rate were evaluated using a logistic procedure that included the effect of the IBW, season, and linear and quadratic effects of the DWG. Altogether, there was no effect of season and pregnancy rates did not change between the dry and rainy seasons (42.3 vs. 45.8%, respectively; P > 0.05). However, the pregnancy rate was greater in the recipients with daily body weight gains over 250 g/day, regardless of the season. In addition, the pregnancy rate of the recipients was better (P heifer to become pregnant according to DWG is explained by the follow equation: P(y = 1) = (Exp((-1.06703 + 0.0108 * DWG - 0.00002 * DWG ^ 2)))/(1 + Exp((-1.6703 + 0.0108 * DWG - 0.00002 * DWG ^ 2))). In conclusion, body weight gain potential is a critical factor for the pregnancy rates of in vitro embryo recipients managed under grazing systems.

  4. Prediction of pregnancy success rate through in vitro fertilization based on maternal age

    Directory of Open Access Journals (Sweden)

    Soegiharto Soebijanto

    2009-12-01

    Full Text Available Aim To evaluate the correlation between the success of pregnancy through in vitro fertilization and maternal age. Methods Assessment of pregnancy was performed in eight in vitro fertilization centers in Indonesia: Harapan Kita Pediatric and Obstetric Hospital from 1997 to 2001, and seven in vitro fertilization centers in Indonesia. Follicular induction was performed through the long protocol, short protocol and natural cycle. Insemination was performed through ICSI (intra cytoplasmic sperm injection on petri dish. Spermatozoa were obtained through masturbation, testicular biopsy and epididimical biopsy. A successful pregnancy was indicated chemically, with the presence of fetal heart beat and the birth of a baby (take home baby. Results There was a 34% pregnancy rate for the age group below 30 years, 33.75% for those between 31 and 35 years olds, and 26% for the age group 36 to 40 years old, and 8% for the age group above 40 years. Conclusion The higher the maternal age, the lower pregnancy rate. In other words, the higher the maternal age, the higher the rate of miscarriage. (Med J Indones 2009; 18: 244-8Keywords: pregnancy, in vitro fertilization

  5. The association between homocysteine in the follicular fluid with embryo quality and pregnancy rate in assisted reproductive techniques.

    Science.gov (United States)

    Ocal, Pelin; Ersoylu, Bilge; Cepni, Ismail; Guralp, Onur; Atakul, Nil; Irez, Tulay; Idil, Mehmet

    2012-04-01

    To investigate the association between follicular fluid homocysteine levels and embryo quality and pregnancy rates in patients undergoing assisted reproduction. Fifty infertile women who were admitted to our clinic were enrolled in the study. Ovulation induction was performed by using GnRH agonist and gonadotropins. For each patient, homocysteine level in the follicular fluid was measured by using nephelometric method after the oocyte pick-up. The association between the homocysteine concentration in the follicular fluid and the oocyte-embryo quality, pregnancy rates and hormone levels were investigated. Mean ± SD Hcy was 9.6 ± 2.02 μmol/L and 14.9 ± 2.93 μmol/L in pregnant and non-pregnant women, respectively (p Homocystein did not have any correlation with M2, late M2, and total number of oocytes, number of fertilized oocytes and transferred embryos, and embryo quality grade. Area under curve (AUC) of hcy for prediction of pregnancy failure was 0.922 (p = 0.0001, 95% Confidence interval 0.85-0.99). A threshold of 11.9 μmol/L of hcy had a sensitivity of 82%, specificity of 100%, positive predictive value of 100% and negative predictive value of 91.6% for prediction of pregnancy failure. The subgroup analysis in male factor infertility group (n = 28), showed that mean homocystein was 9.9 ± 2.44 μmol/L and 14.1 ± 2.72 μmol/L in pregnant and non-pregnant women, respectively (p = 0.002). Low follicular fluid homocysteine level is associated with a better chance of clinical pregnancy.

  6. Background rates of adverse pregnancy outcomes for assessing the safety of maternal vaccine trials in sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Lauren A V Orenstein

    Full Text Available Maternal immunization has gained traction as a strategy to diminish maternal and young infant mortality attributable to infectious diseases. Background rates of adverse pregnancy outcomes are crucial to interpret results of clinical trials in Sub-Saharan Africa.We developed a mathematical model that calculates a clinical trial's expected number of neonatal and maternal deaths at an interim safety assessment based on the person-time observed during different risk windows. This model was compared to crude multiplication of the maternal mortality ratio and neonatal mortality rate by the number of live births. Systematic reviews of severe acute maternal morbidity (SAMM, low birth weight (LBW, prematurity, and major congenital malformations (MCM in Sub-Saharan African countries were also performed.Accounting for the person-time observed during different risk periods yields lower, more conservative estimates of expected maternal and neonatal deaths, particularly at an interim safety evaluation soon after a large number of deliveries. Median incidence of SAMM in 16 reports was 40.7 (IQR: 10.6-73.3 per 1,000 total births, and the most common causes were hemorrhage (34%, dystocia (22%, and severe hypertensive disorders of pregnancy (22%. Proportions of liveborn infants who were LBW (median 13.3%, IQR: 9.9-16.4 or premature (median 15.4%, IQR: 10.6-19.1 were similar across geographic region, study design, and institutional setting. The median incidence of MCM per 1,000 live births was 14.4 (IQR: 5.5-17.6, with the musculoskeletal system comprising 30%.Some clinical trials assessing whether maternal immunization can improve pregnancy and young infant outcomes in the developing world have made ethics-based decisions not to use a pure placebo control. Consequently, reliable background rates of adverse pregnancy outcomes are necessary to distinguish between vaccine benefits and safety concerns. Local studies that quantify population-based background rates of

  7. The role of MRI for clinically suspected appendicitis during pregnancy

    Directory of Open Access Journals (Sweden)

    André Luis Bergamaschi Zilio

    2016-01-01

    Full Text Available A 31 years female with approximately 20 weeks of gestation attends the emergency department of the Hospital de Clínicas de Porto Alegre (HCPA reporting pain in the lower abdomen radiating to the right iliac fossa. After clinical and laboratory examination, the clinical diagnosis of appendicitis was suspected, and then performed magnetic resonance imaging (MRI of the abdomen for diagnostic reasons. The MRI of the abdomen was performed and revealed signs of appendicitis. The intraoperative findings were purulent fluid in the right iliac fossa and appendix with necrotic appearance without signs of perforation. The pathological diagnosis was acute suppurative appendicitis, with periviscerite signals. In pregnant women the enlarged uterus can alter the position of the abdominal contentes and thus make sonography and clinical diagnosis more difficult. CT can be performed in such cases, but it involves a considerable amount of radiation. A typical dose for an abdominal CT examination is on the order of 10 mSv. The routine use of diagnostic CT for benign diseases, as in appendicitis, raises the question whether the diagnosis can be obtained by other radiologic means, especially in pregnant women and even more when the fetus is in the direct beam. The International Commission on Radiological Protection recently published a report on radiation and pregnancy. They recommended that if the expected dose for the fetus is high, one should question whether the diagnosis could be obtained without using ionizing radiation. MRI has been described as a valuable technique for the evaluation of patients with suspected acute appendicitis.

  8. [Dairy cattle pregnancy rate in fixed time artificial insemination program with and without ultrasonic gynecologic screening.

    Directory of Open Access Journals (Sweden)

    Gustavo Fernandes Grillo

    2016-06-01

    Full Text Available To evaluate the pregnancy rate and the importance of ultrasound gynecological screening (US performed prior to fixed time artificial insemination programs (TAI, 120 Girolando cows, over two breeding seasons (2013 and 2014, were divided into two groups: (C / T; n = 58 and without (S / T; n = 62 gynecological screening by ultrasound, using three protocols, and the same for the groups with and without screening. Protocol I - “OvSynch” (OV in which received 0.025 mg of buserelin acetate in D0; 0.15 mg d-cloprostenol on D7; 0.025 mg buserelin acetate D9; It is inseminated at fixed time in D10. Protocol II - “OvSynch” + progesterone (OP4 and III Protocol - “OvSynch” + LH + P4 (OP4LH. Protocols II and III followed the same dosages of “OvSynch” associated with the introduction of intravaginal device containing 1g first use of progesterone in D0 and D7 in withdrawal. In Protocol III, LH replaced buserelin acetate in ovulation induction (D9; 25mg. Gestation diagnosis was made by US 45 days after TAI, and the animals not pregnant were reinseminated as presented heat. Parameters pregnancy rate at TAI (TP, total pregnancy rate (TPT = TAI + Return heat were analyzed by Chi-square or Fisher’s exact with 5% significance level. The use of progesterone favored the pregnancy rate of cyclic and acyclic animals, this has not occurred with LH job as ovulation inductor, providing no increase in pregnancy rates and overall pregnancy rate of dairy cows referred to the rated protocol. The gynecological screening by ultrasonography allowed evaluating the cyclicity of the studied females, indicating that its previous execution to the TAI, can provide good results with the use of better efficiency protocols for TAI programs.

  9. Hispanic Teen Pregnancy and Birth Rates: Looking Behind the Numbers. Child Trends Research Brief. Publication #2005-01

    Science.gov (United States)

    Ryan, Suzanne; Franzetta, Kerry; Manlove, Jennifer

    2005-01-01

    This research brief focuses on the birth, pregnancy, contraceptive, and relationship behaviors of Hispanic teens because they represent an important risk group. Teen pregnancy and birth rates for U.S. teens have declined dramatically in recent years. Yet for Hispanic teens, reductions in teen pregnancy and childbearing have lagged behind that of…

  10. Incidence rate and prevalence of major risk factors for ectopic pregnancy in the Pakistani population: mini-review

    Directory of Open Access Journals (Sweden)

    Sabira Sultana

    2015-05-01

    Full Text Available Ectopic pregnancy is the complication of pregnancy in which the product of conception implants outside the uterine cavity i.e. in the uterine tubes, cervix, ovaries and abdomen. It is lifethreatening emergency and a major cause of maternal morbidity and mortality. The incidence rate is 0.5%-1.5% of all pregnancies. Even though its incidence rate is drop off when compared with earlier decades, it is still the foremost causes of maternal morbidity and mortality in the first trimester of pregnancy, especially in developing countries. In Pakistan, it varies from 1:1 124 to 1:130 pregnancies. Risk factors associated to ectopic pregnancy are pelvic inflammatory disease, past history of miscarriages, age, parity, infertility, previous ectopic pregnancy, induction of ovulation and intrauterine device usage. The aim of this study is to review the published literature concerning the disease knowledge and major risk factors associated to ectopic pregnancy in Pakistan.

  11. Pregnancy

    Science.gov (United States)

    ... Research Information Find a Study Resources and Publications Reading and Reading Disorders Condition Information NICHD Research Information Find a ... Medicine. (2013; Reaffirmed 2015). Committee Opinion No. 579. Definition of term pregnancy. Retrieved May 20, 2016, from ...

  12. Clinical Aspects of Pregnancy-induced Amelioration of Rheumatoid Arthritis: PARA-study

    NARCIS (Netherlands)

    Y.A. de Man (Yael)

    2009-01-01

    textabstractIn this PhD thesis, embedded in the PARA (Pregnancy-induced Amelioration of Rheumatoid Arthritis) study, several clinical aspects of the spontaneously occurring pregnancy-induced improvement of rheumatoid arthritis (RA) are addressed. An overview is given of inflammatory rheumatic

  13. Does an increased cesarean section rate improve neonatal outcome in term pregnancies?

    Science.gov (United States)

    Kupari, Marja; Talola, Nina; Luukkaala, Tiina; Tihtonen, Kati

    2016-07-01

    To clarify whether an increased cesarean section rate improves the short-term neonatal outcome in singleton term pregnancies with cephalic presentation. A retrospective study of institutional data on the mode of delivery and neonatal outcome. The study included two cohorts: 1998-1999 (n = 7437) and 2004-2005 (n = 8505), since the institutional cesarean section rate increased sharply between these cohorts and has remained stable after the latter study period. The caesarean section rate almost doubled from 6.8 to 11.3 % (p cesarean section rate from a low to a moderate does not improve the short-term neonatal outcome in term singleton pregnancies. On the contrary neonatal intensive care unit admissions increased with increasing caesarean section rate. Furthermore it is possible to achieve good neonatal outcome with a low cesarean section rate.

  14. Management approach for recurrent spontaneous pneumothorax in consecutive pregnancies based on clinical and radiographic findings

    Directory of Open Access Journals (Sweden)

    Dixson George R

    2006-10-01

    Full Text Available Abstract Objective To describe management and clinical features observed in a patient's seven spontaneous pneumothoraces that developed during two consecutive pregnancies involving both hemithoraces. Materials and methods A 21 year old former smoker developed three spontaneous left pneumothoraces in the index pregnancy, having already experienced four right pneumothorax events in a prior pregnancy at age 19. Results Chest tubes were required in several (but not all hospitalizations during these two pregnancies. Following her fourth right pneumothorax, thoracoscopic excision of right apical lung blebs and mechanical pleurodesis was performed. The series of left pneumothoraces culminated in mini-thoracotomy and thoracoscopically directed mechanical pleurodesis. For both pregnancies unassisted vaginal delivery was performed with no adverse perinatal sequelae. With the exception of multiple pneumothoraces, there were no additional pregnancy complications. Conclusion Spontaneous pneumothorax in pregnancy is believed to be a rare phenomenon, yet the exact incidence is unknown. Here we present the first known case of multiple spontaneous pneumothoraces in two consecutive pregnancies involving both hemithoraces. Clinical management coordinated with obstetrics and surgical teams facilitated a satisfactory outcome for both pregnancies. The diagnosis of pneumothorax should be contemplated in any pregnant patient with dyspnea and chest pain, followed by radiographic confirmation.

  15. Ectopic Pregnancy: Reasons for the High Tubal Rupture Rates in a ...

    African Journals Online (AJOL)

    Tropical Journal of Obstetrics and Gynaecology ... The case notes were reviewed to obtain information on the socio demographic characteristics of the patients, clinical history and operative findings. Results: Of the ... Besides, majority of our women present late making them more vulnerable to ruptured ectopic pregnancy.

  16. Breast cancer in pregnancy: A brief clinical review.

    Science.gov (United States)

    Becker, Sven

    2016-05-01

    As global wealth increases and demographic changes similar to Europe and North America start affecting other societies, the global breast cancer epidemic will coincide with a delayed maternal age during first and subsequent pregnancies. Breast cancer in pregnancy will continue to increase, and standardized treatment strategies are required to be developed. This study will review current diagnostic and treatment approaches. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Disparate rates of persistent smoking and drug use during pregnancy of women of Hawaiian ancestry.

    Science.gov (United States)

    Wright, Tricia E; Tam, Elizabeth

    2010-01-01

    Significant disparity in smoking rates has been previously reported in pregnant and non-pregnant women of Native Hawaiian ancestry. Disparities in drug use rates have also been reported in non-pregnant women of Native Hawaiian ancestry. We undertook this study to compare rates of smoking and drug use during pregnancy among women in Hawaii to see if these differences are associated with disparities in pregnancy complications among Native Hawaiian women. Women were enrolled in the Pacific Research Center on Early Human Development study from July 2007 to January 2008, according to approved protocols. Persistent smoking was defined as self-reported smoking within 1 week of admission for labor. Drug use data was assessed by self-report, or if available, toxicology tests at the time of labor. There were 868 women enrolled in the study during this period. Women of Hawaiian/part-Hawaiian ancestry comprised 22% of the study population. Rates of persistent smoking and drug use among Hawaiian women were significantly higher than the remainder of the study population (21% and 8.3% vs. 7.8% and 2.1%, respectively, P Women of Hawaiian ancestry continue to smoke and use illicit drugs during pregnancy at significantly higher rates than women of other ethnic groups in Hawaii. In addition to the immediate effects on pregnancy, long-term adverse outcomes of in utero exposures of the offspring remain an important health disparity.

  18. Blood pressure and heart rate variability analysis of orthostatic challenge in normal human pregnancies.

    Science.gov (United States)

    Heiskanen, Nonna; Saarelainen, Heli; Valtonen, Pirjo; Lyyra-Laitinen, Tiina; Laitinen, Tomi; Vanninen, Esko; Heinonen, Seppo

    2008-11-01

    The aim of the present study was to evaluate pregnancy-related changes in autonomic regulatory functions in healthy subjects. We studied cardiovascular autonomic responses to head-up tilt (HUT) in 28 pregnant women during the third trimester of pregnancy and 3 months after parturition. The maternal ECG and non-invasive beat-to-beat blood pressure were recorded in the horizontal position (left-lateral position) and during HUT in the upright position. Stroke volume was assessed from blood pressure signal by using the arterial pulse contour method. Heart rate variability (HRV) was analysed in frequency domain, and baroreflex sensitivity by the cross-spectral and the sequence methods. In the horizontal position, all frequency components of HRV were lower during pregnancy than 3 months after parturition (P pregnancy had no influence on normalized low frequency and high frequency powers. During pregnancy haemodynamics was well balanced with only minor changes in response to postural change while haemodynamic responses to HUT were more remarkable after parturition. In pregnant women HRV and especially its very low frequency component increased in response to HUT, whereas at 3 months after parturition the direction of these changes was opposite. Parasympathetic deactivation towards term is likely to contribute to increased heart rate and cardiac output at rest, whereas restored sympathetic modulation with modest responses may contribute stable peripheral resistance and sufficient placental blood supply under stimulated conditions. It is important to understand cardiovascular autonomic nervous system and haemodynamic control in normal pregnancy before being able to judge whether they are dysregulated in complicated pregnancies.

  19. Association between long-acting reversible contraceptive use, teenage pregnancy, and abortion rates in England.

    Science.gov (United States)

    Connolly, Anne; Pietri, Guilhem; Yu, Jingbo; Humphreys, Samantha

    2014-01-01

    Since the late 1990s, the British government has launched major strategies to address high teenage pregnancy and abortion rates in England. These have focused in part on improving access to contraception through national campaigns. This study assessed teenage pregnancy and abortion rate trends since 1998 and possible associations with usage of long-acting reversible contraceptives (LARCs). Teenage conception rates and age-specific abortion rates were obtained from the Office for National Statistics and the Department of Health. LARC usage data was obtained for Depo-Provera, Implanon/Nexplanon, intrauterine devices, Mirena, and Noristerat from the IMS British Pharmaceutical Index, IMS Hospital Pharmacy Audit, IMS Disease Analyzer, and KT-31 reports. Through linear regression methods, changes in conception and abortion-related outcomes during 1998-2011 and the associations with LARC usage were assessed. Conception rates for girls younger than 18 years of age decreased significantly between 1998-2011, from 46.6 to 30.7 per 1,000 girls. A statistically significant association was observed between this decrease and increased LARC usage (P=0.0024) in this population. Abortion rates among females aged teenage pregnancy rates and abortion rates in females aged Government strategies appears to have a positive impact on these outcomes; however, abortion rates among women over 20 years of age remain an issue.

  20. Determination of salivary flow rate, pH, and dental caries during pregnancy: A study

    Directory of Open Access Journals (Sweden)

    Amruta A Karnik

    2015-01-01

    Full Text Available Introduction: Saliva is an important diagnostic biofluid and the salivary composition is affected by various systemic conditions including pregnancy. Aims: The study was conducted to evaluate the salivary flow rate and pH in pregnant and non-pregnant Indian women and, consequently, to compare and correlate the salivary flow rate, pH, and prevalence of dental caries in both groups. Settings and Design: A cross-sectional study was conducted in our institute on a sample of 30 pregnant and 30 non-pregnant women. Materials and Methods: The clinical findings for Decayed-Missing-Filled Teeth (DMFT index were recorded. Unstimulated whole saliva was collected to determine the salivary flow rate and pH. Statistical Analysis Used: Data were statistically analyzed using Student′s t-test. Results: Salivary flow rate was lower in pregnant women (0.63 ml/min as compared to that in non-pregnant women (0.81 ml/min (P < 0.05 and the pH was also lesser in pregnant women (6.56 than in non-pregnant women (6.86 (P < 0.05. DMFT index showed a strong negative correlation with pH in pregnant women and non-pregnant women (P < 0.05. Conclusion: A difference was observed between the salivary parameters of pregnant and non-pregnant women in this sample. However, all the values were within the normal range. A significant inverse relation was found between salivary pH and dental caries for both the groups.

  1. Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis.

    Science.gov (United States)

    Kirby, E Will; Wiener, Laura Elizabeth; Rajanahally, Saneal; Crowell, Karen; Coward, Robert M

    2016-11-01

    To evaluate how varicocele repair (VR) impacts pregnancy (PRs) and live birth rates in infertile couples undergoing assisted reproduction wherein the male partner has oligospermia or azoospermia and a history of varicocele. Systematic review and meta-analysis. Not applicable. Azoospermic and oligospermic males with varicoceles and in couples undergoing assisted reproductive technology (ART) with IUI, IVF, or testicular sperm extraction (TESE) with IVF and intracytoplasmic sperm injection (ICSI). Measurement of PRs, live birth, and sperm extraction rates. Odds ratios for the impact of VR on PRs, live birth, and sperm extraction rates for couples undergoing ART. Seven articles involving a total of 1,241 patients were included. Meta-analysis showed that VR improved live birth rates for the oligospermic (odds ratio [OR] = 1.699) and combined oligospermic/azoospermic groups (OR = 1.761). Pregnancy rates were higher in the azoospermic group (OR = 2.336) and combined oligospermic/azoospermic groups (OR = 1.760). Live birth rates were higher for patients undergoing IUI after VR (OR = 8.360). Sperm retrieval rates were higher in persistently azoospermic men after VR (OR = 2.509). Oligospermic and azoospermic patients with clinical varicocele who undergo VR experience improved live birth rates and PRs with IVF or IVF/ICSI. For persistently azoospermic men after VR requiring TESE for IVF/ICSI, VR improves sperm retrieval rates. Therefore, VR should be considered to have substantial benefits for couples with a clinical varicocele even if oligospermia or azoospermia persists after repair and ART is required. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  2. [Effect of sexual abstinence on pregnancy rates after an intrauterine insemination].

    Science.gov (United States)

    Kably-Ambe, Alberto; Carballo-Mondragón, Esperanza; Durán-Monterrosas, Leonor; Soriano-Ortega, Karla Patricia; Roque-Sánchez, Armando Miguel

    2015-02-01

    There are many studies showing that more days of sexual abstinence increased sperm concentration, however, the direct influence between the days of abstinence and pregnancy rates has not been evaluated. The usual recommendation is 3-4 days prior to intrauterine insemination; this based on the interval that maximizes the number of motile sperm in the ejaculate. There are some reports with better success rate when abstinence is less than three days. To evaluate the pregnancy rate post-intrauterine insemination according to days of sexual abstinence prior to obtaining semen sample. A retrospective, observational and transversal study in patients attending the Mexican Center for Fertility (CEPAM) to intrauterine insemination. For analysis patients were grouped by age group, success rate and days of sexual abstinence. Continuous variables are reported as means and standard deviations; to determine statistical significance univariate logistic regression was performed. Categorical variables were evaluated in frequencies and percentages. The calculations were performed using JMP software program. 3,123 couples were included and increased success rate for intrauterine insemination was obtained with less than seven days of sexual abstinence. The rate of sperm retrieval is inversely proportional to the days of abstinence. A better pregnancy rate in intrauterine insemination was achieved with less than seven days of sexual abstinence and sperm retrieval rate was also recorded with fewer days of abstinence.

  3. Influencing factors in the pregnancy rate in obese women undergoing artificial insemination

    Directory of Open Access Journals (Sweden)

    Carolina Sánchez-Cruzat Albertín

    2013-01-01

    Full Text Available The impact of obesity on the outcome of assisted reproduction treatments is debatable. Several studies show that obese women have worse outcomes after undergoing fertility treatment. The researches show a worse response to ovulation induction. In the ovarian stimulation stage these women produce fewer follicles. Fertilization rates are poorer and the embryo quality is lower in young women suffering from obesity. According to some studies, pregnancy rates are lower in obese women and there is an increased risk of early pregnancy loss. Weight loss increases the chance of spontaneous ovulation and conception in women that suffer from overweight and obesity.The aim of this study is to describe the different influencing factors related to body mass index in pregnancy rate achieved by artificial insemination in our population.The results of this study show significant results in patients with higher body mass index was positively associated with duration of infertility, lower levels of luteinizing hormone and intrauterine artificial insemination indication increased .It appears more frequently, but without significant result, anovulation and unexplained cause of infertility among obese women, longer cycles, fewer antral follicles and get fewer mature follicles. The average of pregnancy rates was 12.6% but it did not differ significantly among the body mass index categories.

  4. Progesterone supplementation during the time of pregnancy recognition after artificial insemination improves conception rates in high-producing dairy cows.

    Science.gov (United States)

    Garcia-Ispierto, I; López-Helguera, I; Serrano-Pérez, B; Paso, V; Tuono, T; Ramon, A; Mur-Novales, R; Tutusaus, J; López-Gatius, F

    2016-04-15

    This study examines the possible effects of progesterone (P4) supplementation during the time of pregnancy recognition, from Days 15 to 17 post-artificial insemination (AI), on reproductive performance in high-producing dairy cows. Cows in their 15th day post-AI were alternately assigned to a control, no-treatment group (C: n = 257) or treatment group (P4: n = 287) on a weekly rotational basis according to the chronologic order of their gynecologic visit. On the basis of the odds ratio, the interaction treatment × previous placenta retention had a significant effect (P = 0.02) on conception rate. Thus, cows in P4 that had not suffered a retained placenta were 1.6 times more likely to conceive 28 to 34 days post-AI than the remaining cows. In nonpregnant cows, treatment had no effect on subsequent return to estrus or AI interval and neither were any effects of treatment observed on twin pregnancy and early fetal loss rates. The results of this study demonstrate the efficacy of P4 supplementations during the time of pregnancy recognition after AI in cows without a clinical history of placenta retention. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. A medical management of interstitial ectopic pregnancy: a 5-year clinical study.

    Science.gov (United States)

    Tang, Amy; Baartz, David; Khoo, Soo Keat

    2006-04-01

    Medical treatment of the rare interstitial ectopic pregnancy with methotrexate has been considered an alternative to surgical resection. To determine the treatment success rate with a single-dose intravenous methotrexate/folinic acid regimen and to identify predictors of treatment outcome. A 5-year audit (April 2000-August 2005) was carried out, collecting clinical imaging data and serum beta-human chorionic gonadotrophin (beta-hCG). Time taken for complete beta-hCG resolution was recorded, and a negative beta-hCG result was used as an endpoint of successful outcome. Of the 13 cases, two required urgent surgery for rupture on presentation. In the remaining 11 cases, intravenous methotrexate (300 mg) was used, with oral folinic acid rescue (15 mg x 4 doses). There were no side-effects. Complete beta-hCG resolution was achieved in 10 of the 11 medically treated cases (91% success rate), requiring 21-129 days. Successful outcome was seen with initial beta-hCG level as high as 106 634 IU/L and gestation sac as large as 6 cm and a live fetus. The methotrexate/folinic acid regimen used as a one-dose treatment is safe and effective for unruptured interstitial pregnancy, with no side-effects and the advantage of avoiding invasive surgery. Subsequent tubal patency and reproductive function are yet to be ascertained.

  6. Clinical characteristics of acute pancreatitis in pregnancy: experience based on 121 cases.

    Science.gov (United States)

    Luo, Lingyu; Zen, Hao; Xu, Hongrong; Zhu, Yin; Liu, Pi; Xia, Liang; He, Wenhua; Lv, Nonghua

    2018-02-01

    Acute pancreatitis in pregnancy (APIP) is a rare condition; however, it markedly affects maternal and fetal health. This study aimed to describe the types, clinical characteristics, mortality, and the safety and necessity of gestation termination of acute pancreatitis in pregnancy (APIP). We retrospectively reviewed 121 APIP cases in the Gastroenterology Department of The First Affiliated Hospital of Nanchang University. APIP diagnosis were based on 2012 Atlanta Criteria. The correlation between APIP types, severity, biochemical parameters and mortality was analyzed. The most common symptoms for APIP were abdominal pain (86.8%) and vomiting (73.6%). The most common causes for APIP were gallstone (36.4%) and hypertriglyceridemia (32.2%) and hypertriglyceridemic APIP was correlated with a higher rate for local complication (P = 0.012). Serum calcium level was negatively correlated with the severity of APIP (P < 0.01). The overall maternal and fetal mortality rate were 3.3% (4/121) and 11.6% (14/121), respectively. The severity of APIP was significantly correlated with higher risks for maternal and fetal death (P < 0.01). 72.7% of moderate-to-severe APIP patients underwent Cesarean section to terminate gestation safely. The most common causes of APIP were gallstone and hypertriglyceridemia. Lower level of serum calcium could be used as an indicator for the severity of the APIP. The severity of APIP was associated with higher risk for neonate asphyxia, and maternal and fetal death.

  7. Non-conventional antiphospholipid antibodies in patients with clinical obstetrical APS: Prevalence and treatment efficacy in pregnancies.

    Science.gov (United States)

    Mekinian, Arsène; Bourrienne, Marie-Charlotte; Carbillon, Lionel; Benbara, Amélie; Noémie, Abisror; Chollet-Martin, Sylvie; Tigaizin, Ahmed; Montestruc, Francois; Fain, Olivier; Nicaise-Roland, Pascale

    2016-10-01

    To describe the prevalence of non-conventional APL in patients with obstetrical APS without conventional APL and the impact of treatment on pregnancy outcome. Patients with clinical obstetrical criteria were tested for anti-phosphatidylethanolamine (aPE) IgG/M, anti-prothrombin/phosphatidylserine (anti-PS/PT) IgG/M, and anti-annexin V IgG. Pregnancy losses rates were compared between APS, non-conventional APS, and non-APL and in untreated pregnancies to treated ones for each group. Using the cutoffs (ROC), 65/96 (68%) patients have been considered as non-conventional APS and compared to 83 APS and 31 patients without APL. The obstetrical history in non-conventional APS did not differ in comparison to confirmed APS. The frequencies of anti-annexin V IgG antibodies tended to be more frequent in non-conventional APS (88% versus 73%; p = 0.06), and those of anti-PE IgG and M were similar. The anti-PS/PT IgG and M antibodies were more frequent in confirmed APS than in non-conventional APS (63% and 37% versus 4% and 5%, respectively, p APS were compared with 81 pregnancies of confirmed APS and 132 pregnancies from non-APL group. Out of 474, 136 (29%) patients have been treated during pregnancies, and treatment significantly increased the rate of live birth (26% in untreated versus 72% in treated pregnancies, p APS and non-conventional APS, with odds ratio at 3.3 (95% CI: 1.8-6.1) and 6.9 (95% CI: 3.9-12.3) (p = 0.49) and significantly more important for the 2 APS groups pooled versus non-APL group [OR at 1.9 (95% CI: 1.1-3.5) for non-APL group versus 5.3 (95% CI: 3.5-8.1) for APS groups, p = 0.0025]. In this study, 68% of patients with clinical criteria for obstetrical APS seronegative for conventional APL have non-conventional APL. These patients have a significant decrement of pregnancy losses if they receive treatment for APS during their pregnancy. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Myasthaenia Gravis : Clinical management issues before, during and after pregnancy

    Directory of Open Access Journals (Sweden)

    Ali Hassan

    2017-08-01

    Full Text Available Myasthaenia gravis (MG is an autoimmune neuromuscular disorder which is twice as common among women, often presenting in the second and third decades of life. Typically, the first trimester of pregnancy and first month postpartum are considered high-risk periods for MG exacerbations. During pregnancy, treatment for MG is usually individualised, thus improving its management. Plasma exchange and immunoglobulin therapies can be safely used to treat severe manifestations of the disease or myasthaenic crises. However, thymectomies are not recommended because of the delayed beneficial effects and possible risks associated with the surgery. Assisted vaginal delivery—either vacuum-assisted or with forceps—may be required during labour, although a Caesarean section under epidural anaesthesia should be reserved only for standard obstetric indications. Myasthaenic women should not be discouraged from attempting to conceive, provided that they seek comprehensive counselling and ensure that the disease is under good control before the start of the pregnancy.

  9. Risk of inflammatory bowel disease according to self-rated health, pregnancy course, and pregnancy complications: a study within the Danish National Birth Cohort.

    Directory of Open Access Journals (Sweden)

    Maria C Harpsøe

    Full Text Available BACKGROUND: Poor self-rated health (SRH has been connected to immunological changes, and pregnancy complications have been suggested in the etiology of autoimmune diseases including inflammatory bowel disease (IBD. We evaluated the impact of self-rated pre-pregnancy health and pregnancy course, hyperemesis, gestational hypertension, and preeclampsia on risk of IBD. METHODS: Information was collected by questionnaires from The Danish National Birth Cohort (enrolment 1996-2002 at 16(th and 30(th week of pregnancy and 6 months postpartum. A total of 55,699 women were followed from childbirth until development of IBD (using validated National Hospital Discharge Register diagnoses, emigration, death, or end of follow-up, 31(st of October, 2011. Hazard ratios (HR with 95% confidence intervals (CI were calculated using Cox proportional hazards models adjusting for age and evaluating pre-pregnancy BMI, parity, alcohol and tobacco consumption, and socio-occupational status as potential confounders. RESULTS: Risk of IBD increased with decreasing level of self-rated pre-pregnancy health (p = 0.002 and was elevated in women with poor self-rated pregnancy course (HR, 1.61, 95% CI 1.22-2.12. Associations persisted for more than 5 years postpartum. Hyperemesis and preeclampsia were not significantly associated with risk of IBD. CONCLUSIONS: This is the first prospective observational study to suggest that poor self-rated health--in general and in relation to pregnancy--is associated with increased risk of IBD even in the long term though results needs further confirmation. Symptoms of specific pregnancy complications were, on the other hand, not significantly associated with risk of IBD.

  10. Bell's facial nerve palsy in pregnancy: a clinical review.

    Science.gov (United States)

    Hussain, Ahsen; Nduka, Charles; Moth, Philippa; Malhotra, Raman

    2017-05-01

    Bell's facial nerve palsy (FNP) during pregnancy and the puerperium can present significant challenges for the patient and clinician. Presentation and prognosis can be worse in this group of patients. This article reviews the background, manifestation and management options of FNP. In particular, it focuses on the controversies that exist regarding corticosteroid use during pregnancy and outlines approaches to diagnosis and treatment. Based on this review, we recommend an early evidence-based approach using guidelines derived from non-pregnant populations. This includes assessment for atypical causes, a multidisciplinary input and early introduction of corticosteroids to limit progression and improve prognosis.

  11. Teenage pregnancies in Mozambique: the experience of "Servicios Amigos dos Adolescentes" clinics in Beira.

    Science.gov (United States)

    Pizzol, Damiano; Di Gennaro, Francesco; Boscardin, Chiara; Putoto, Giovanni; Cuppini, Elena; Pita, Graciana; George, Alexandra; Monno, Laura; Saracino, Annalisa; Da Dalt, Liviana; De Palma, Angela

    2018-03-01

    The purpose of this article is to provide insights into the demand for pregnancy-related health services by adolescent girls and young women in Mozambique. We analysed the patient registers for the first year of operation (2014) of the Servicios Amigos dos Adolescentes (SAAJ) [Friendly Services for Adolescents] clinics in Beira, Mozambique. These registers provide details of the service demands of, and services provided to the 8 290 adolescent girls and young women who accessed the 6 SAAJ clinics in 2014. Analysis of that record, with disaggregation of the patients according to age (9 years or less; 10-14; 15-19; 20-24; 25 and older), show that 3 021 (36%) were pregnant or had previously been pregnant; most being girls in the 15-19 age band (59%). Being pregnant or having been pregnant previously was associated with dropping out of school. Of all the girls and women, 60% agreed to HIV testing and counselling; the HIV prevalence rate amongst this group was 4-5% amongst adolescents and 25% amongst women 25 years and older. A minority of the girls and women who were pregnant or had been pregnant previously agreed to HIV testing and counselling. Notwithstanding the limitations for analysis, the results were alarming: substantially high HIV prevalence rates were indicated (2% amongst 10-14 year old girls; 8% amongst 15-19 year olds; 10% amongst 20-24 year olds; and 28% amongst >24 year olds). The data from the SAAJ clinics and results pertain only to conditions in Beira. However, as the first empirical assessment of pregnancy-related service demand amongst adolescent girls and young women in the country and involving a relatively large sample, we contend that this study affirms the need for expansion of sexual and reproductive health (SRH) services, including HIV services, for adolescent girls and young women in Mozambique.

  12. Pregnancies complicated by obesity: clinical approach and nutritional management.

    Science.gov (United States)

    Guelinckx, I; Devlieger, R; Vansant, G

    2010-01-01

    This PhD thesis indicated by a literature review and a prospective study that maternal obesity is associated with serious complications for both mother and child. This is a problem since already 9% of the pregnant women at the antenatal department of the University Hospital Leuven was obese during 2006. A prospective study with 142 women showed that maternal obesity is also associated with a lower diet quality during pregnancy compared to normal weight pregnant women. To reduce the high prevalence of excessive gestational weight gain among obese pregnant women and to improve their low diet quality, a randomized controlled trial with 2 intervention groups with a different intensity of nutritional guidance was set up. Both interventions improved dietary habits, but affecting physical activity level and gestational weight gain remains a challenge. During this thesis 2 practical tools for all pregnant women and their health care providers were developed: weight gain percentile charts for each body mass index category and a website giving information on nutrition, physical activity, and weight gain during pregnancy. Besides obese pregnant women, pregnant women with a history of bariatric surgery are also a high-risk population. Even though the obesity related pregnancy complications decrease after the surgery induced weight loss, other complications such as internal hernias and nutritional deficiencies with potential lethal consequences have been identified. A multidisciplinary follow-up during pregnancy with routine screening for nutritional deficiencies with attention for the fat-soluble vitamins and patient tailored nutritional supplementation seems required.

  13. Cancer in pregnancy: a survey of current clinical practice.

    NARCIS (Netherlands)

    Han, S.N.; Kesic, V.I.; Calsteren, K. van; Petkovic, S.; Amant, F.; Ottevanger, N.; et al.,

    2013-01-01

    OBJECTIVE: To evaluate physicians' attitudes and knowledge regarding the treatment possibilities for patients with cancer in pregnancy. STUDY DESIGN: A 30-item questionnaire was mailed electronically to physicians across Europe, who were potentially involved in care of pregnant patients and/or

  14. Brucellosis in pregnancy: clinical aspects and obstetric outcomes

    Directory of Open Access Journals (Sweden)

    Gustavo Vilchez

    2015-09-01

    Conclusions: This is the largest series of brucellosis in pregnancy reported in the literature. Brucella presents adverse obstetric outcomes including fetal and maternal/neonatal death. Cases with unexplained spontaneous abortion should be investigated for brucellosis. Prompt treatment is paramount to decrease the devastating outcomes.

  15. Clinical Significance of Monitoring Serum β-HCG in the Conservative Treatment of Ectopic Pregnancy

    International Nuclear Information System (INIS)

    Chen Xue

    2010-01-01

    To explore the clinical value of the serum β-HCG (human chorionic gonadotrophin) in the conservative treatment of ectopic pregnancy, the serum β-HCG levels in 118 patients with ectopic pregnancy were measured with RIA. The results showed that the serum β-HCG levels in patients with successful conservative treatment of ectopic pregnancy were all less than 200mIU/mL. The patients require a surgical treatment to reach <200mIU/mL serum β-HCG concentration were only 26.3%. There was significant difference between two groups (P<0.01). The monitoring of serum β-HCG was very useful in the diagnosis, the choice of treatment measures and the evaluation of conservative treatment effect of ectopic pregnancy. In the course of treatment of ectopic pregnancy, serum β-HCG is a good marker in determining the success or failure of treatment. (authors)

  16. The Role of Infertility Etiology in Success Rate of Intrauterine Insemination Cycles: An Evaluation of Predictive Factors for Pregnancy Rate

    Science.gov (United States)

    Ashrafi, Mahnaz; Rashidi, Mandana; Ghasemi, Afsaneh; Arabipoor, Arezoo; Daghighi, Sara; Pourasghari, Parisa; Zolfaghari, Zahra

    2013-01-01

    Background: The objective of this study was to identify the prognostic factors that influence the outcome of ovarian stimulation with intrauterine insemination (IUI) cycles in couples with different infertility etiology. Materials and Methods: This retrospective study was performed in data of 1348 IUI cycles with ovarian stimulation by clomiphene citrate (CC) and/or gonadotropins in 632 women with five different infertility etiology subgroups at Akbarabbadi Hospital, Tehran, Iran. Results: The pregnancy rate (PR)/ cycle was highest (19.9%) among couples with unexplained infertility and lowest (10.6%) in couples with multiple factors infertility. In cases of unexplained infertility, the best PRs were seen after CC plus gonadotropins stimulation (26.3%) and with inseminated motile sperm count>30×106 (21.9%), but the tendency didn’t reach statistical significant. In the ovarian factor group, the best PRs were observed in women aged between 30 and 34 years (20.8%), with 2-3 preovulatory follicles (37.8%) and infertility duration between 1and 3 years (20.8%), while only infertility duration (p=0.03) and number of preovulatory follicles (p=0.01) were statistically significant. Multiple logistic regression analysis determined that number of preovulatory follicles (p=0.02), duration of infertility (p=0.015), age (p=0.019), infertility etiology (p=0.05) and stimulation regimen (p=0.01) were significant independent factors in order to predict overall clinical PR. Conclusion: The etiology of infertility is important to achieve remarkable IUI success. It is worth mentioning that within different etiologies of infertility, the demographic and cycles characteristics of couples did not show the same effect. Favorable variables for treatment success are as follows: age infertility ≤5 years and a cause of infertility except of multiple factors. PMID:24520471

  17. Clinical audit of foetomaternal outcome in pregnancies with fibroid uterus

    International Nuclear Information System (INIS)

    Sarwar, I.; Habib, S.; Bibi, A.; Malik, N.; Parveen, Z.

    2012-01-01

    Background: Leiomyoma, myoma, leiomyoma or fibroids are synonymous terms. They may be present in as many as 1 in 5 women over age 35 years. If pregnancy is associated with fibroids, it leads to multiple complications. Objectives of this study were to evaluate the maternal and foetal outcome in women having pregnancy with fibroids in uterus and the complications associated with fibroids during the pregnancy. Methods: This descriptive study was conducted in the Department of Obstetrics and Gynaecology, Ayub Teaching Hospital Abbottabad from March 2009 to March 2010. Data were collected on proforma regarding demographic variables, obstetrical history, mode of delivery, maternal outcome, maternal complications, and foetal outcome. Mean and standard deviation was calculated for age, period of gestation, and obstetrical history. Frequency and percentages was calculated for booking status, maternal outcome, maternal complications and foetal outcome. Results: Thirty patients were included in this study who had pregnancy with fibroid. Normal delivery was achieved in 14 (46.66%) patients. Eight (26.67%) patients had caesarean section and eight (26.67%) had miscarriages. Seven (23.33%) patients had no complications while 8 (26.67%) had miscarriages, 8 (26.67%) had postpartum haemorrhage, 10 (33.33%) had preterm delivery, and 3 patients had ante-partum haemorrhage. Two (10%) patients had premature rupture off membranes and 1 patient (3.33%) had pain abdomen and technical difficulty during caesarean section. There were 12 (40%) healthy babies. Five (16.67%) babies delivered with morbidity but recovered. There were 4 (13.33%) intrauterine deaths and one early neonatal death. Conclusion: Fibroid in pregnancy, especially multiple intramural fibroids and fibroids larger than 10 Cm, cause miscarriage and preterm labour. (author)

  18. Pregnancy

    DEFF Research Database (Denmark)

    Palmer, Keith T; Bonzini, Matteo; Bonde, Jens Peter Ellekilde

    2013-01-01

    physical workload). The adverse outcomes considered are: miscarriage, preterm delivery, small for gestational age, low birth weight, pre-eclampsia and gestational hypertension. Systematic review of the literature indicates that these exposures are unlikely to carry much of an increased risk for any...... of the outcomes, since small apparent effects might be explicable in terms of chance, bias, or confounding, while larger and better studies yield lower estimated risks compared with smaller and weaker studies. In general, patients can be reassured that such work is associated with little, if any, adverse effect...... on pregnancy. Moreover, moderate physical exercise is thought to be healthy in pregnancy and most pregnant women undertake some physical work at home. The guidelines provide risk estimates and advice on counselling....

  19. Embryo transfer simulation improves pregnancy rates and decreases time to proficiency in Reproductive Endocrinology and Infertility fellow embryo transfers.

    Science.gov (United States)

    Heitmann, Ryan J; Hill, Micah J; Csokmay, John M; Pilgrim, Justin; DeCherney, Alan H; Deering, Shad

    2017-05-01

    To design and evaluate an ET simulator to train Reproductive Endocrinology and Infertility (REI) fellows' techniques of ET. Simulation model development and retrospective cohort analysis. Not applicable. Patients undergoing IVF. Simulation model evaluation and implementation of ET simulation training. Pregnancy rates. The REI fellow and faculty evaluation responses (n = 19/21 [90%]) of the model demonstrated realistic characteristics, with evaluators concluding the model was suitable for training in almost all evaluated areas. A total of 12 REI fellows who performed ET were analyzed: 6 before ET trainer and 6 after ET trainer. Pregnancy rates were 31% in the initial 10 ETs per fellow before simulator vs. 46% after simulator. One of six pre-ET trainer fellows (17%) had pregnancy rates ≥40% in their first 10 ETs; whereas four of six post-ET trainer fellows had pregnancy rates ≥40% in their first 10 ETs. The average number of ETs to obtain >40% pregnancy efficiency was 27 ETs before trainer vs. 15 ETs after trainer. Pregnancy rates were similar in the two groups after 20 ETs, and collective terminal pregnancy rates were >50% after 40 ETs. Embryo transfer simulation improved REI fellow pregnancy rates in their first 10 transfers and led to a more rapid ET proficiency. These data suggest potential value in adopting ET simulation, even in programs with a robust history of live ET in fellowship training. Published by Elsevier Inc.

  20. Failure Rate of Single Dose Methotrexate in Managment of Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Feras Sendy

    2015-01-01

    Full Text Available Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure. Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in the seventh day after administration of methotrexate. Results. 225 patients had methotrexate. Most of the patients (151 (67% received methotrexate based on the following formula: f 50 mg X body surface area. Single dose of methotrexate was successful in 72% (162/225 of the patients. 28% (63/225 were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63 of failure received a second dose of methotrexate, and 37% (23/63 underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound. Conclusion. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate.

  1. The association between maltreatment in childhood and pre-pregnancy obesity in women attending an antenatal clinic in Australia.

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    Katharine Hollingsworth

    Full Text Available INTRODUCTION: Obesity in pregnancy is associated with increased risk of complications and adverse outcomes in mother and child. Childhood adverse experiences are known to have numerous negative physical and emotional sequelae. We aimed to examine if exposure to abuse and/or neglect in childhood increased the likelihood of pre-pregnancy obesity. METHODS: Demographic and clinical data including weight, height, mental health as measured by the General Health Questionnaire and exposure to childhood trauma as measured by the childhood trauma questionnaire was collected from 239 women attending antenatal care at an Australian tertiary hospital. RESULTS: More than one quarter of women were obese prior to pregnancy and approximately 20% of women self reported experiencing moderate to severe physical, sexual or emotional abuse. Almost 60% of women scored in the clinical range on the GHQ. Pre-pregnancy obesity in women attending antenatal care was associated with a self-reported history of emotional or physical abuse with those exposed to moderate or severe emotional or physical abuse having increased odds of being obese prior to pregnancy (O.R. and 95% CI: 2.40; 1.19-4.84 and 2.38; 1.18-4.79 respectively. There was no significant association between other forms of childhood maltreatment, demographic or current mental health status and pre-pregnancy obesity. CONCLUSIONS: The high rates of obesity, mental health problems and self reported childhood maltreatment in the Australian antenatal population are serious public health concerns due to the extra health risks conferred on mother and offspring. Exposure to physical or emotional abuse during childhood increases the likelihood of obesity in women attending antenatal care. Further research is required to determine reasons for this association.

  2. Clinical analysis of 16 patients with acute pancreatitis in the third trimester of pregnancy.

    Science.gov (United States)

    Sun, Yanmei; Fan, Cuifang; Wang, Suqing

    2013-01-01

    Acute pancreatitis (AP), in particular, severe acute pancreatitis (SAP), is a rare but challenging complication during pregnancy in terms of diagnosis and management. The objective of this paper is to investigate the causes and therapeutic strategies of AP in patients during the third trimester of pregnancy. We performed a retrospective analysis of the clinical features, laboratory data, and outcomes in 16 patients with acute pancreatitis during the third trimester of pregnancy. Information was collected on admission, management, and outcome. A total 16 patients were diagnosed with acute pancreatitis during pregnancy. In 7 of 9 patients with mild AP, pregnancy was terminated by cesarean section and all 9 cases were cured. In 4 out of 7 patients with SAP, pregnancy was terminated by cesarean section in conjunction with peritoneal irrigation and drainage, and the mothers and infants survived. In the remaining 3 patients with SAP, there was one case of intrauterine death in which Induced labor was performed and 2 patients died of multiple organ failure. A high-fat diet and cholelithiasis are the triggers of AP in pregnancy. Conservative treatment is the preferred therapeutic method; in particular, for mild AP. Endoscopic surgery and peritoneal drainage are effective for acute biliary pancreatitis. Patients with hyperlipidemic pancreatitis should undergo lipid-lowering therapy, and hemofiltration should be done as soon as it becomes necessary. For patients with SAP, termination of pregnancy should be carried out as early as possible.

  3. Comparative evaluation of pregnancy outcome in gonadotrophin-clomiphene combination vs clomiphene alone in polycystic ovarian syndrome and unexplained infertility-A prospective clinical trial

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    Shiuli Mukherjee

    2010-01-01

    Full Text Available Objectives: A large prospective clinical trial was conducted to compare the efficacy of single dose uFSH and clomiphene citrate combination with clomiphene citrate alone for ovulation induction to improve the pregnancy rate. Materials and Methods: The study was a randomized, prospective clinical trial. Totally, 1527 infertile women (4381 cycles with polycystic ovarian syndrome (PCOS (n=911/2573 cycles and unexplained infertility (n=616/1808 cycles were randomized into two groups. Group A received single dose of uFSH on D 3 of menstrual cycle along with clomiphene. Group B received clomiphene only for ovulation induction. We compared the pregnancy rate and miscarriage rate between two groups. Results: Group A had a pregnancy rate of 17% compared to 8.3% of Group B which was significantly higher (P=0.0001. The miscarriage rate was 11% in Group A and 10% in Group B which was not significant (P=0.99. Pregnancy rates in PCOS women were 22% in Group A and 9.3% in Group B which shows significantly higher pregnancy rate (P=0.0001 in anovulatory infertility. But in unexplained infertility, there was no significant difference in pregnancy rate between Group A (11% and Group B(6.3%. Miscarriage rates were 8.8% and 9.5% in Group A and Group B, respectively, in PCOS women and 14% and 13% in women with unexplained infertility. Conclusion: Addition of single dose of uFSH improves pregnancy outcome particularly in anovulatory infertility (WHO II. Correction of unexplained infertility may need more than simple correction of possible subtle ovulatory effect.

  4. [Breast cancer developing during pregnancy--clinical cases and review of the literature].

    Science.gov (United States)

    Alexandrova, E; Sergieva, S; Kostova, P; Michailova, I; Timcheva, K; Taushanova, M; Milev, A

    2015-01-01

    The goal of the present paper is to discuss diagnosis, treatment approaches and histopathologic characteristics of breast cancer developing during pregnancy, based on our results and published literature data. We retrospectively evaluated clinical and pathologic features of tumors, treatment methods, decisions related to pregnancy and final outcome by eight pregnant patients with breast cancer. The patients' age varied from 26 to 36 years. At the last medical examination in October 2013, three among all eight patients were alive, two of them were without local and distant recurrence, and one patient has distant metastases and is carrying out a treatment. The aim of this paper was to discuss the characteristics of breast cancer developing during pregnancy. Retrospectively have been analyzed clinical-pathological characteristics of the tumors in eight pregnant women with breast cancer, the treatment, the management of the pregnancy, and the final outcome. The results are analyzed by comparing with data published in the literature.

  5. ANAMNESIS AND CLINIC FINDINGS OF THE PATIENTS SUSPECTED OF HAVING ECTOPIC PREGNANCY

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    Stanoje Pesic

    2000-09-01

    Full Text Available An analysis has been done of a series of 573 patients suffering from extrauterinepregnancy, namely those found suspect upon entering the hospital. Thediagnosis of extra-uterine pregnancy was confirmed in 322 (56% patients. Theleading symptom of extra-uterine pregnancy is metrorrhagia (63,41%. As for theoperation time, 3 1% of them were immediately operated. The ultrasound techniqueadds to the diagnostic certainty. Our results show that carefully taken anamnesis inaddition to symptom recording and a careful clinic examination can make possiblethe extra-uterine pregnancy diagnosis.

  6. Aerobic exercise during pregnancy and presence of fetal-maternal heart rate synchronization.

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    Peter Van Leeuwen

    Full Text Available It has been shown that short-term direct interaction between maternal and fetal heart rates may take place and that this interaction is affected by the rate of maternal respiration. The aim of this study was to determine the effect of maternal aerobic exercise during pregnancy on the occurrence of fetal-maternal heart rate synchronization.In 40 pregnant women at the 36th week of gestation, 21 of whom exercised regularly, we acquired 18 min. RR interval time series obtained simultaneously in the mothers and their fetuses from magnetocardiographic recordings. The time series of the two groups were examined with respect to their heart rate variability, the maternal respiratory rate and the presence of synchronization epochs as determined on the basis of synchrograms. Surrogate data were used to assess whether the occurrence of synchronization was due to chance.In the original data, we found synchronization occurred less often in pregnancies in which the mothers had exercised regularly. These subjects also displayed higher combined fetal-maternal heart rate variability and lower maternal respiratory rates. Analysis of the surrogate data showed shorter epochs of synchronization and a lack of the phase coordination found between maternal and fetal beat timing in the original data.The results suggest that fetal-maternal heart rate coupling is present but generally weak. Maternal exercise has a damping effect on its occurrence, most likely due to an increase in beat-to-beat differences, higher vagal tone and slower breathing rates.

  7. Clinical Presentation, Management, and Outcomes of Primary Hyperparathyroidism during Pregnancy

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    Ya Hu

    2017-01-01

    Full Text Available Background. Primary hyperparathyroidism (pHPT in pregnancy is a rare event, but it poses a significant risk to mothers and fetuses. The optimal treatment strategy remains controversial. Methods. We present a consecutive series of twelve pregnant women with pHPT. Results. Twelve women were diagnosed with pHPT during pregnancy or in the postpartum period. Four of them presented no symptoms or mild symptoms. Four patients experienced serious complications, including hypercalcaemic crisis, acute pancreatitis, and eclampsia. Another four patients were identified postpartum as the result of neonatal convulsion with hypocalcaemia. Minimally invasive parathyroidectomy (MIP under cervical plexus block was successfully performed in 11 of them during pregnancy or postpartum. The serum levels of ionized calcium and intact parathyroid hormone (iPTH were much higher in patients with severe complications in this cohort than those in the group of patients with no symptoms or mild symptoms and patients who were diagnosed postpartum. Conclusions. MIP under cervical plexus block might be a safe and effective treatment for pregnant women with pHPT. Even though both conservative and surgical treatments are applicable for most mothers and fetuses with asymptomatic and mild hyperparathyroidism, serious complications may have catastrophic consequences for both.

  8. Low-dose metformin improves pregnancy rate in in vitro fertilization repeaters without polycystic ovary syndrome: prediction of effectiveness by multiple parameters related to insulin resistance.

    Science.gov (United States)

    Jinno, Masao; Kondou, Kenichi; Teruya, Koji

    2010-01-01

    Insulin resistance is associated with aging and stress, both common among patients repeatedly failing to conceive with in vitro fertilization (IVF repeaters). In the present study we examined whether low-dose metformin could improve the outcome in IVF repeaters without polycystic ovary syndrome (PCOS). Study I was a preliminary clinical trial aiming at defining indications for therapy; study II was a prospective randomized study. The studies involved a university hospital and a private infertility clinic. We studied 232 women without PCOS who had failed at least twice to conceive by previous IVF. Metformin (500 mg/ day) was administered for 8 to 12 weeks before and during ovarian stimulation (metformin IVF). In study I, IVF outcomes with metformin (n = 33) were compared to outcomes without metformin of previous IVF in the same subjects. A discriminant score (DS) was determined from nine parameters assessed before metformin administration to predict achievement of ongoing pregnancy by metformin IVF. In study II (n = 199), ongoing pregnancy rates were compared prospectively between groups with/without metformin and with DS above/below 0.6647. Study I. Ongoing pregnancy rate improved significantly with metformin compared with previous IVF, and pregnancy correlated significantly with a DS at an optimal threshold of 0.6647 (sensitivity, 0.90; specificity, 0.91). Study II. Ongoing pregnancy and implantation rates were significantly higher in women with a DS above 0.6647 who received metformin (56% and 33%) compared with those having a DS below 0.6647 with metformin (14% and 11%) and those having a DS above/below 0.6647 without metformin (20% and 7.1%/15% and 11%, respectively). Low-dose metformin improved pregnancy rate in IVF repeaters without PCOS, probably by decreasing insulin resistance. Indication can be determined from insulin-resistance-related multiple parameters assessed before metformin administration.

  9. Linking Changes in Contraceptive Use to Declines in Teen Pregnancy Rates

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    Jennifer Manlove

    2015-12-01

    Full Text Available Using a unique microsimulation tool, Teen FamilyScape, the present study explores how changes in the mix of contraceptive methods used by teens contributed to the decline in the U.S. teen pregnancy rate between 2002 and 2010. Results indicate that changes in contraceptive use contributed to approximately half of the decline in the teen pregnancy rate during this time period (48% and that a little more than half of this “contraceptive effect” was due to an increase in teen condom use (58%. The remaining share of the contraceptive effect can be attributed to an increase in the use of more effective hormonal (pill, patch, ring and long-acting reversible contraceptive (LARC/injectable methods (Intrauterine Devices (IUD, implant and injectable. Results from an additional counterfactual analysis suggest that the contraceptive effect was driven by the fact that the percentage of teens using no birth control fell during the study time period, rather than by the fact that some teens switched from less effective methods (condoms to more effective hormonal and LARC/injectable methods. However, very high typical use failure rates for teen condom users suggest the need for a two-pronged approach for continuing reductions in teen pregnancy for sexually active teens: first, targeting the youth most at risk of not using contraception and helping them choose contraception, and second, increasing the effectiveness of method use among existing contraceptors.

  10. Pregnancy rates after artificial insemination with cooled stallion spermatozoa either with or without single layer centrifugation.

    Science.gov (United States)

    Morrell, J M; Richter, J; Martinsson, G; Stuhtmann, G; Hoogewijs, M; Roels, K; Dalin, A-M

    2014-11-01

    A successful outcome after artificial insemination with cooled semen is dependent on many factors, the sperm quality of the ejaculate being one. Previous studies have shown that spermatozoa with good motility, normal morphology, and good chromatin integrity can be selected by means of colloid centrifugation, particularly single layer centrifugation (SLC) using species-specific colloids. The purpose of the present study was to conduct an insemination trial with spermatozoa from "normal" ejaculates, i.e., from stallions with no known fertility problem, to determine whether the improvements in sperm quality seen in SLC-selected sperm samples compared with uncentrifuged controls in laboratory tests are reflected in an increased pregnancy rate after artificial insemination. In a multicentre study, SLC-selected sperm samples and uncentrifuged controls from eight stallions were inseminated into approximately 10 mares per treatment per stallion. Ultrasound examination was carried out approximately 16 days after insemination to detect an embryonic vesicle. The pregnancy rates per cycle were 45% for controls and 69% for SLC-selected sperm samples, which is statistically significant (P < 0.0018). Thus, the improvement in sperm quality reported previously for SLC-selected sperm samples is associated with an increase in pregnancy rate, even for ejaculates from stallions with no known fertility problem. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Letrozole and misoprostol versus misoprostol alone for termination of pregnancy: a randomized clinical trial

    OpenAIRE

    Zahra Rezai; Seydeh Sareh Heydari Bazardehi; Azizeh Ghasemi Nezhad; Amir Saeid Sadeghi; Batool Ghorbani Yekta

    2014-01-01

    Background: To compare the success rate and side effects of letrozole and misoprostol versus misoprostol alone for medical termination of early pregnancy. Methods: The patients requesting termination of pregnancy up to 63 days of gestation were randomized into two groups. The letrozole group received letrozole 10 mg daily for 3 days followed by 800 micrograms of vaginal misoprostol, while the placebo group received placebo for 3 days followed by the same dosage of misoprostol. The complete...

  12. Association between long-acting reversible contraceptive use, teenage pregnancy, and abortion rates in England

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    Connolly A

    2014-11-01

    Full Text Available Anne Connolly,1 Guilhem Pietri,2 Jingbo Yu,3 Samantha Humphreys4 1The Ridge Medical Practice, Cousen Road, Bradford, UK; 2HERON – A PAREXEL® Company, London, UK; 3Merck & Co, Inc., Whitehouse Station, NJ, USA; 4Merck Sharp & Dohme Limited, Hertfordshire, UK Background: Since the late 1990s, the British government has launched major strategies to address high teenage pregnancy and abortion rates in England. These have focused in part on improving access to contraception through national campaigns. This study assessed teenage pregnancy and abortion rate trends since 1998 and possible associations with usage of long-acting reversible contraceptives (LARCs. Methods: Teenage conception rates and age-specific abortion rates were obtained from the Office for National Statistics and the Department of Health. LARC usage data was obtained for Depo-Provera, Implanon/Nexplanon, intrauterine devices, Mirena, and Noristerat from the IMS British Pharmaceutical Index, IMS Hospital Pharmacy Audit, IMS Disease Analyzer, and KT-31 reports. Through linear regression methods, changes in conception and abortion-related outcomes during 1998–2011 and the associations with LARC usage were assessed. Results: Conception rates for girls younger than 18 years of age decreased significantly between 1998–2011, from 46.6 to 30.7 per 1,000 girls. A statistically significant association was observed between this decrease and increased LARC usage (P=0.0024 in this population. Abortion rates among females aged <18 years or aged 18–19 years decreased between 1998–2011, and their associations with increased LARC usage were statistically significant (P=0.0029 and P=0.0479, respectively. The pattern in older women was complex; abortion rates in women aged 20–24 years or 25–34 years increased slightly from 1998 to 2011, with stabilization during 2007–2011. Conclusion: Increased LARC usage in England was significantly associated with decreased teenage pregnancy rates

  13. Effect of the use dinoprost tromethamine on pregnancy rate in Mangalarga Marchador mares

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    Flávia Crespo Vieira de Leal Fonseca

    2016-12-01

    Full Text Available ABSTRACT. Fonseca F.C.V.L., Jacob J.C.F., Sá M.A.F., Dutra G.A., Guerson Y.B. & Jesus V.L.T. [Effect of the use dinoprost tromethamine on pregnancy rate in Mangalarga Marchador mares.] Efeito do uso de dinoprost trometamina sobre a taxa de gestação em éguas da raça Mangalarga Marchador. Revista Brasileira de Medicina Veterinária, 38(Supl.2:164-168, 2016. Departamento de Reprodução e Avaliação Animal, Universidade Federal Rural do Rio de Janeiro, BR 465, Km 7, Seropédica, RJ 23890-000, Brasil. E-mail: fvieira.vet@hotmail.com The aim of this study was to determine if the use of Dinoprost Tromethamine during diestrus affected the pregnancy rate in Mangalarga Marchador mares. A retrospective study through analyzing records of 173 Mangalarga Marchador mares totaling 669 estrous cycles. The data were separated into four groups: group I (n = 53 cycles: not submitted to hormonetherapy (control; Group II (n = 86 cycles: cycles submitted induction of ovulation using 1000 IU of hCG; Group III (n = 222 cycles: cycles submitted to oestrus induction with 5.0 mg of Dinoprost Tromethamine; Group IV (n = 308 cycles: estrus cycles induced with 5.0 mg Dinoprost tromethamine and ovulation induced using 1000 IU of hCG. Induction of ovulation occurs when the dominant follicle reached ≥ 35mm diameter. The use of PGF2a was from the seventh day after ovulation. Pregnancy diagnosis was performed 15 days after the ovulation detection in matrix mares. For embryo donors, was considered as a positive result the uterine washed resulting in embryo recovery. Was used the chi-square test (5% significance and Fisher exact test, when recommended. The pregnancy rate obtained in the group I was 54.71% (29/53 in group II 59.3% (51/86 in group III 49.55% (110/222 and Group IV 59, 41% (183/308. There was no statistical difference (p = 0.132 for the pregnacy rate among the groups. Thus, use of Dinoprost Tromethamine in the seventh day after ovulation did not influence the

  14. Study of Continuance Rate and Related Causes of Discontinuance of Pregnancy Prevention Methods among Women in Yazd

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    H Fallahzadeh

    2008-04-01

    Full Text Available Introduction: From maturity to menopause, women are worried about pregnancy. Abstinence from sex or use of pregnancy prevention methods are choices for them. As abstinence is impossible, the only remaining choice is use of pregnancy prevention methods. Effective control of pregnancy is really essential for the health of mother and infant and also control of unplanned increase in population. Regarding the importance of continuance rate of pregnancy prevention methods (OCP, IUD, Condom &DMPA & the reasons for their disruption, this study was carried out with the aim of determining the continuance rate and reasons for discontinuance of pregnancy prevention methods in Yazd women. Methods: This was a cross-sectional study. Six urban health care centers of Yazd were selected as study clusters and information of 15-49 year old women using the pregnancy prevention methods (OCP, IUD, Condom& injection was collected via a questionnaire. The data collected was analyzed by Coplan- Mayer statistic method and variance analysis test. Results: Pregnancy prevention methods were most prevalent in the 25-34 years old age group (57%. Mean duration of pregnancy prevention method usage was 27.98 months using Caplan-mayer method with a median of 24 months. 86.3% for 6 months, 72.8% for 12 months, 62.5% for 18 months, 47.9% for 24 months, 39.9% for 30 months and 37% for 37 months had used four certain methods of pregnancy prevention (OCP, IUD, Condom and Injection. The reasons of discontinuance were disease (15.6% for OCPS, bleeding (27% for IUD, unwanted pregnancy (21% for Condoms and also disease (75% for Injection method. Discussion: According to the results, not only education programs regarding family planning before starting each pregnancy prevention method to women is recommended, but a complete incentive consultation about these methods is essential. This educational & consultation programs should be implemented initially for women using OCP method.

  15. Rate of teenage pregnancy in Jordan and its impact on maternal and neonatal outcomes.

    Science.gov (United States)

    Khader, Yousef S; Batieha, Anwar; Al Fursan, Rana Kareem; Al-Hader, Rami; Hijazi, Sa'ad S

    2017-07-26

    Objective Research regarding the adverse outcomes of adolescent childbearing has suffered from many limitations such as a small sample size and non-representative samples. This study was conducted to determine the rate of teenage pregnancy among Jordanian adolescents and its associated adverse maternal and neonatal outcomes. Methods The study is a part of a comprehensive national study of perinatal mortality that was conducted between 2011 and 2012 in Jordan. All women who gave birth after 20 weeks of gestation in 18 maternity hospitals in Jordan between 2011 and 2012 were invited to participate in the study. Consenting women were interviewed by the trained midwives in these hospitals using a structured questionnaire prepared for the purpose of this study. Additional information was also collected based on the physical examination by the midwife and the obstetrician at admission and at discharge. Data on the newborn were also collected by the pediatric nurses and the neonatologists in these hospitals. Results The overall rate of teenage pregnancy [95% confidence interval (CI) was 6.2% (5.9%, 6.5%)]. Of the studied maternal and neonatal outcomes, women aged Teenage pregnancy was associated with increased risk of premature delivery, apart from the effects of socioeconomic factors.

  16. Pregnancy outcomes in women with diabetesd lessons learned from clinical research

    DEFF Research Database (Denmark)

    Mathiesen, Elisabeth R.

    2016-01-01

    in fetal overgrowth are explored, and restricting maternal gestationalweight gain is a promising treatment area. The optimal carbohydrate content of the diet is discussed. In summary, the lessons learned from this clinical research are that glycemic control, gestational weight gain, and antihypertension...... treatment all are of importance for improving pregnancy outcomes in pregnant women with preexisting diabetes. An example of how to use app technology to share the recent evidence-based clinical recommendations for women with diabetes who are pregnant or planning pregnancy is given....

  17. Effects of Metformin on Ovulation and Pregnancy Rate in Women with Clomiphene Resistant Poly Cystic Ovary Syndrome

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    Mahnaz Ashrafi

    2007-01-01

    Full Text Available Background: To evaluate the effect of metformin on ovulation and pregnancy rate in clomiphene citrateresistant women with polycystic ovary syndrome (PCOS.Material & Methods: In this clinical trial each patient, regarding her previous resistance to Clomiphene,served as her own control. A total of 35 clomiphene citrate resistant PCOS patients, referring to Royan institutewere studied. Clomiphene citrate resistance was defined as having failure of ovulation during at least threecycles using clomiphene citrate doses up to 200 mg/day on cycle days 3-7 after a withdrawal bleeding withprogesterone. Metformin was used alone or in combination with clomiphene citrate. First, the patients receivedmetformin up to 1500 mg/day for 8 weeks. During the next 2-3 cycle if the patients did not become pregnant,clomiphene was added with increments of 100 mg (up to 150 mg/day. Follicular development and ovulationwere monitored by ultrasound scans and mid-luteal progesterone level. Menstrual pattern, ovulation, andpregnancy rate were evaluated during the two stages of treatment.Results: After 8 weeks of meformin monotherapy, ovulation occurred in 23 cases (65.7% and 7 patients (20%became pregnant. Among other patients (28/35 who were treated with Clomiphene Cirate and metformin for64 cycles, 19 patients (67.8% had proper ovulation and five of them (17.8% became pregnant. Totally,metformin induced ovulation in 31 of 35 patients (88.6% and twelve (34.3% of them achieved pregnancy.Conclusion: Metformin alone or in combination with clomiphene is a very effective treatment in inducingovulation and pregnancy in clomiphene resistant women with PCOS.

  18. Pregnancy rate in Bulgarian White milk goats with natural and synchronized estrus after artificial insemination by frozen semen during breeding season

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    Stanimir A. Yotov

    2016-04-01

    Conclusion: The goats with natural estrus and GnRH treatment tend to enhance pregnancy rate after double artificial insemination 8 h apart. The insemination number has no significant impact on pregnancy rate in synchronized goats as the overall pregnancy rate is better than in animals with natural estrus without GnRH administration.

  19. How education changes clinical documentation in early pregnancy.

    Science.gov (United States)

    Ali, Fida; Higgins, Mary F

    2016-05-01

    The aim of this audit was to record medical history taking in the records of women attending with early pregnancy issues in order to assess the effect of training in this area. The medical education intervention comprised of a 30-min interactive tutorial. Retrospective chart review at three time points: pre education (July 2013, n = 45), immediately post-education (August 2013, n = 45) and longer term post-intervention (October 2013, n = 20). Pre-education, medical history was missing in 77.8% of charts compared to 13.4% immediately post-intervention and 10% long-term post-intervention (p Education in requirements for medical history taking can improve documentation.

  20. Ebola Virus Disease in Pregnancy: Clinical, Histopathologic, and Immunohistochemical Findings.

    Science.gov (United States)

    Muehlenbachs, Atis; de la Rosa Vázquez, Olimpia; Bausch, Daniel G; Schafer, Ilana J; Paddock, Christopher D; Nyakio, Jean Paul; Lame, Papys; Bergeron, Eric; McCollum, Andrea M; Goldsmith, Cynthia S; Bollweg, Brigid C; Prieto, Miriam Alía; Lushima, Robert Shongo; Ilunga, Benoit Kebela; Nichol, Stuart T; Shieh, Wun-Ju; Ströher, Ute; Rollin, Pierre E; Zaki, Sherif R

    2017-01-01

    Here we describe clinicopathologic features of Ebola virus disease in pregnancy. One woman infected with Sudan virus in Gulu, Uganda, in 2000 had a stillbirth and survived, and another woman infected with Bundibugyo virus had a live birth with maternal and infant death in Isiro, the Democratic Republic of the Congo in 2012. Ebolavirus antigen was seen in the syncytiotrophoblast and placental maternal mononuclear cells by immunohistochemical analysis, and no antigen was seen in fetal placental stromal cells or fetal organs. In the Gulu case, ebolavirus antigen localized to malarial parasite pigment-laden macrophages. These data suggest that trophoblast infection may be a mechanism of transplacental ebolavirus transmission. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  1. Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies.

    Science.gov (United States)

    Festin, Mario Philip R; Peregoudov, Alexandre; Seuc, Armando; Kiarie, James; Temmerman, Marleen

    2017-01-01

    To estimate the effect of increased body weight and body mass index (BMI) on pregnancy rates with levonorgestrel (LNG) 1.5mg used as emergency contraception (EC). The study reviewed data from 6873 women in four WHO-HRP randomized trials on EC conducted between 1993 and 2010. Participants took either 1.5mg of LNG as a single dose or in two doses 12h apart, up to 120h of unprotected intercourse. Contraceptive efficacy (pregnancy rates) at different weight and BMI categories was evaluated. Overall pregnancy rate was low at 1.2%. Pregnancy rates were also low in women weighing over 80kg (0.7%) and who were obese (BMI over 30kg/m 2 ) (2.0%). The pooled analyses for pregnancy demonstrated that BMI over 30kg/m 2 decreased efficacy significantly (odds ratio 8.27, 95% confidence interval = 2.70-25.37) when compared to women in lower BMI categories, mainly influenced by pregnancies in obese women from one study site. Sensitivity analyses excluding that site showed that obesity was no longer a risk factor; however, the other studies included too few obese women in the sample to exclude a substantial decrease in efficacy. Pregnancy rates with use of LNG 1.5mg for EC were low at less than 3% across different weight and BMI categories. Pooled analyses showed an increase in pregnancy rates among obese women (BMI more than 30kg/m 2 ) compared to women with normal BMI levels, influenced by pregnancies all coming from one study site. Access to LNG as EC should still be promoted to women who need them, and not be restricted in any weight or BMI category, with additional attention for counselling and advice for obese women. Copyright © 2016. Published by Elsevier Inc.

  2. Pregnancy rates in HIV-positive women using contraceptives and efavirenz-based or nevirapine-based antiretroviral therapy in Kenya: a retrospective cohort study.

    Science.gov (United States)

    Patel, Rena C; Onono, Maricianah; Gandhi, Monica; Blat, Cinthia; Hagey, Jill; Shade, Starley B; Vittinghoff, Eric; Bukusi, Elizabeth A; Newmann, Sara J; Cohen, Craig R

    2015-11-01

    Concerns have been raised about efavirenz reducing the effectiveness of contraceptive implants. We aimed to establish whether pregnancy rates differ between HIV-positive women who use various contraceptive methods and either efavirenz-based or nevirapine-based antiretroviral therapy (ART) regimens. We did this retrospective cohort study of HIV-positive women aged 15-45 years enrolled in 19 HIV care facilities supported by Family AIDS Care and Education Services in western Kenya between Jan 1, 2011, and Dec 31, 2013. Our primary outcome was incident pregnancy diagnosed clinically. The primary exposure was a combination of contraceptive method and efavirenz-based or nevirapine-based ART regimen. We used Poisson models, adjusting for repeated measures, and demographic, behavioural, and clinical factors, to compare pregnancy rates among women receiving different contraceptive and ART combinations. 24,560 women contributed 37,635 years of follow-up with 3337 incident pregnancies. In women using implants, adjusted pregnancy incidence was 1.1 per 100 person-years (95% CI 0.72-1.5) for nevirapine-based ART users and 3.3 per 100 person-years (1.8-4.8) for efavirenz-based ART users (adjusted incidence rate ratio [IRR] 3.0, 95% CI 1.3-4.6). In women using depot medroxyprogesterone acetate, adjusted pregnancy incidence was 4.5 per 100 person-years (95% CI 3.7-5.2) for nevirapine-based ART users and 5.4 per 100 person-years (4.0-6.8) for efavirenz-based ART users (adjusted IRR 1.2, 95% CI 0.91-1.5). Women using other contraceptive methods, except for intrauterine devices and permanent methods, had 3.1-4.1 higher rates of pregnancy than did those using implants, with 1.6-2.8 higher rates in women using efavirenz-based ART. Although HIV-positive women using implants and efavirenz-based ART had a three-times higher risk of contraceptive failure than did those using nevirapine-based ART, these women still had lower contraceptive failure rates than did those receiving all other

  3. A retrospective cohort analysis comparing pregnancy rates among HIV-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in Kenya

    Science.gov (United States)

    PATEL, Rena C.; ONONO, Maricianah; GANDHI, Monica; BLAT, Cinthia; HAGEY, Jill; SHADE, Starley B.; VITTINGHOFF, Eric; BUKUSI, Elizabeth A.; NEWMANN, Sara J.; COHEN, Craig R.

    2015-01-01

    SUMMARY Background Given recent concerns of efavirenz reducing the efficacy of contraceptive implants, we sought to determine if pregnancy rates differ among HIV-positive women using various contraceptive methods and efavirenz- or nevirapine-based antiretroviral therapy (ART) regimens. Methods We conducted a retrospective cohort analysis of HIV-positive women aged 15–45 years enrolled in HIV care facilities in western Kenya from January 2011 to December 2013. Pregnancy was diagnosed clinically and the primary exposure was a combination of contraceptive method and ART regimen. We used Poisson models, adjusting for repeated measures, as well as demographic, behavioral and clinical factors, to compare pregnancy rates among women on different contraceptive/ART combinations. Findings 24,560 women contributed 37,635 years of follow-up with 3,337 incident pregnancies. Among women using implants, adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 1·1 (95% CI 0·72–1·5) and 3·3 (95% CI 1·8–4·8) per 100 women-years (w-y), respectively (adjusted incidence rate ratio (aIRR) 3·0, 95% CI 1·3–4·6). Among women using depomedroxyprogesterone acetate (DMPA), adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 4·5 (95% CI 3·7–5·2) and 5·4 (95% CI 4·0–6·8) per 100 w-y, respectively (aIRR 1·2, 95% CI 0·91–1·5). Women using other contraceptive methods, except for intrauterine devices and permanent methods, experienced 3·1–4·1 higher rates of pregnancy than women using implants, with 1·6–2·8 higher rates specifically among women using efavirenz-based ART. Interpretation While HIV-positive women using implants on efavirenz-based ART faced three times higher risk of contraceptive failure than those on nevirapine-based ART, these women still experienced lower contraceptive failure rates than women on all other contraceptive methods, except for intrauterine devices and permanent methods

  4. Outcome of Membrane Sweeping in Reducing Induction Rates in Post-Date Pregnancies

    International Nuclear Information System (INIS)

    Saleem, U.; Mustafa, N.; Akhtar, S.

    2013-01-01

    Objectives: To determine the effectiveness of membrane sweeping in reducing need for induction of labour in post-date pregnancies and to enlist types and frequencies of complications experienced with membrane sweeping. Study Design: Randomized Control trial. Setting and Duration of Study: The study was carried out at Department of Obstetrics and Gynaecology, Combined Military Hospital, Lahore from February 2007 to April 2008. Patients and Methods: One hundred primi or second gravidas with uncomplicated singleton pregnancies having cephalic presentation at 40+1-5 weeks of gestation were enrolled after informed consent, and divided randomly into two groups of fifty each. Biophysical profile of 8/8 for each case was ensured. Group A underwent membrane sweeping while group B did not. All patients not having spontaneous labour were induced at 40+5 weeks. Data regarding number of patients having spontaneous labour or induction of labour was recorded. Mode of delivery either vaginal or cesarean birth was also recorded. In group A occurence of complications i.e vaginal bleeding or leaking, discomfort, irregular pains, fever and neonatal sepsis was recorded. Results: The difference in rate of spontaneous labor, induction rate and mode of delivery was insignificant between both the groups (p>0.05). In group A, 44% felt discomfort, 4% had bleeding per vaginum, 2% had leaking per vaginum and 28% had more than one complication. There were no cases of maternal or neonatal sepsis. Twenty percent did not have any side effects. Conclusion: Sweeping of membranes is not effective in reducing induction rates in post dates pregnancies. It does not improve the spontaneous labour rate and there is no effect on the mode of delivery. Therefore, any potential benefits of this intervention must be balanced against risk of maternal discomfort and other adverse effects. (author)

  5. Informative content of clinical symptoms of acute appendicitis in different terms of pregnancy

    Directory of Open Access Journals (Sweden)

    Kutovoy A.B.

    2015-09-01

    Full Text Available With the purpose to evaluate diagnostic efficacy of some clinical symptoms of acute appendicitis 75 women in different terms of pregnancy were examined. Informative content of such symptoms as Kocher- Volkovich, Rovsing, Bartomje - Michelson, Sitkovsky, Gabay, Brendo, Michelson, Ivanov was studied. Pain syndrome was fixed in all examined women. Pain localization was various and depended on the pregnancy term. During the I trimester of pregnancy the most often pain was manifestated in epigastrium and right lower quadrant, rarely in other abdomen regions. In the II trimester in majority of cases pain occurred in right lower quadrant. During III trimester pain prevailed in right upper quadrant of abdomen. Analyzing informative component of researching symptoms there was noted significant decrease (р<0,05; р<0,01; р<0,001 of their diagnostic value with growth of pregnancy term. Therefore Kocher – Volkovich and Rovsing symptoms were the most informative in the I trimester of pregnancy. Diagnostic efficacy of Brendo(67,3%, Michelson(55,7%, Ivanov(59,6% symptoms was higher than that of Kocher – Volkovich (36,5%, Rovsing (28,8%, Sitkovsky (51,9%, Bartomje – Michelson (55,7% symptoms, their value was diminishing together with increase of pregnancy terms.

  6. Clinical application of fetal urine production rate in unexplained polyhydramnios.

    Science.gov (United States)

    Touboul, C; Picone, O; Levaillant, J M; Boithias, C; Frydman, R; Boulvain, M; Senat, M V

    2009-11-01

    To evaluate the clinical use of hourly fetal urine production rate (HFUPR) in polyhydramnios. This was a retrospective review of 33 singleton pregnancies with polyhydramnios, 30 of them unexplained and three due to gastrointestinal atresia. HFUPR was estimated using three-dimensional ultrasound and was compared with recently established nomograms. Abnormal midterm outcome, defined as diagnosis or persistence of pathology after the neonatal period until the age of 2 years, was analyzed according to prenatal HFUPR measurements and other polyhydramnios characteristics. Seventeen of the 30 fetuses with unexplained polyhydramnios had an HFUPR above the 95(th) centile, and five (29.4%) of them developed midterm disorders. None of the 13 with normal HFUPR developed midterm disorders. The HFUPR was 1.9 (SD, 0.7) multiples of the median (MoM) in fetuses with an adverse childhood outcome and 1.4 (SD, 1.2) in fetuses with normal childhood outcome (P = 0.34). In the three fetuses with gastrointestinal atresia, the HFUPR was significantly lower than in those with unexplained polyhydramnios (P = 0.003). HFUPR was associated with the mechanism of polyhydramnios but failed to help in the prognosis of unexplained polyhydramnios because of lack of power. Children with prenatal unexplained polyhydramnios and HFUPR above the 95(th) centile should nevertheless receive detailed pediatric follow-up. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

  7. Teen pregnancy: an update.

    Science.gov (United States)

    McCracken, Katherine A; Loveless, Meredith

    2014-10-01

    To provide clinicians with a review of recent research and clinically applicable tools regarding teen pregnancy. Teen pregnancy rates have declined but still remain a significant problem in the USA. Teen pregnancy prevention was identified by Centers for Disease Control and Prevention as one of its top six priorities, which is increasing research and intervention data. Long-acting contraceptive methods are acceptable to teens and have been shown to reduce teen birth rates. Pregnant teens need special attention to counseling on pregnancy options and reducing risk during pregnancy with regular prenatal care. Postpartum teens should be encouraged and supported to breastfeed, monitored for depression, and have access to reliable contraception to avoid repeat undesired pregnancy. This review highlights important issues for all providers caring for female adolescents and those who may encounter teen pregnancy. Foremost prevention of teen pregnancy by comprehensive sexual education and access to contraception is the priority. Educating patients and healthcare providers about safety and efficacy of long-acting reversible contraception is a good step to reducing undesired teen pregnancies. Rates of postpartum depression are greater in adolescents than in adults, and adolescent mothers need to be screened and monitored for depression. Strategies to avoid another undesired pregnancy shortly after delivery should be implemented.

  8. National rates, trends and determinants of inpatient surgical management of tubal ectopic pregnancy in the United States, 1998-2011.

    Science.gov (United States)

    Mikhail, Emad; Salemi, Jason L; Schickler, Robyn; Salihu, Hamisu M; Plosker, Shayne; Imudia, Anthony N

    2018-04-01

    To describe the frequency and temporal trends of inpatient hospitalization for tubal ectopic pregnancy as well as patients' characteristics, determinants and the current national trends in surgical management of ectopic pregnancy. We conducted a retrospective, cross-sectional analysis of patients who were treated for tubal ectopic pregnancy in an inpatient hospital setting in the United States from 1998 to 2011 using data from the Nationwide Inpatient Sample databases. National frequency and significant changes in the rate of surgical management of tubal ectopic pregnancy in the inpatient setting are described. The study included 334 639 tubal ectopic pregnancies for women aged 18-50 in the United States from 1998 to 2011. The rate of tubal ectopic pregnancy (per 10 000 maternal admissions) decreased from 77.2 in 1998 to 40.5 in 2011. The proportion of tubal ectopic pregnancies for which salpingostomy was performed decreased from 17.0% in 1998 to 7.0% in 2011, while the rate of salpingectomy increased from 69.3% in 1998 to 80.9% in 2011. The temporal change in surgical choice was not different in states with comprehensive in vitro fertilization insurance mandates. The rate of tubal ectopic pregnancy managed in the inpatient setting in the United States decreased 5% annually between 1998 and 2011. The rate of salpingectomies performed annually increased whereas that of salpingostomy decreased over time. The surgical approach selected for the management of tubal ectopic pregnancies was not influenced by a state's in vitro fertilization mandate status. © 2018 Japan Society of Obstetrics and Gynecology.

  9. Recurrence rates of arrhythmias during pregnancy in women with previous tachyarrhythmia and impact on fetal and neonatal outcomes.

    Science.gov (United States)

    Silversides, Candice K; Harris, Louise; Haberer, Kym; Sermer, Mathew; Colman, Jack M; Siu, Samuel C

    2006-04-15

    In women with heart disease, sustained arrhythmias can result in an increased risk to the mother and fetus. The purpose of this study was to determine the recurrence rates of arrhythmias during pregnancy in women with cardiac rhythm disorders and examine the impact on fetal and neonatal outcomes. Women with tachyarrhythmias before pregnancy who underwent obstetric care at the Toronto General and Mount Sinai Hospitals from 1990 to 2002 were included. The recurrence rates of arrhythmias were calculated. A multivariate logistic model was used to identify predictors of fetal complications. Seventy-three women had 87 pregnancies; 36 pregnancies were in women with a history of paroxysmal supraventricular tachycardia, 23 with paroxysmal atrial fibrillation or atrial flutter (AF/Afl), 6 with persistent AF/Afl, and 22 with ventricular tachycardia. In the women in sinus rhythm at baseline, 44% (36 of 81 pregnancies) developed recurrences of tachyarrhythmias during pregnancy or in the early postpartum period. The specific recurrence rates during pregnancy in women with a history of supraventricular tachycardia, paroxysmal AF/Afl, and ventricular tachycardia were 50%, 52%, and 27%, respectively. The 6 women in AF/Afl at baseline remained in this rhythm throughout their pregnancy. Adverse fetal events occurred in 17 of the 87 pregnancies (20%). Adverse fetal events occurred more commonly in women who developed antepartum arrhythmias (RR 3.4, 95% confidence interval 1.0 to 11.0, p = 0.045) compared with those who did not. In conclusion, in women with preexisting cardiac rhythm disorders, exacerbation of arrhythmia during pregnancy is common. Recurrence of arrhythmia during the antepartum period increases the risk of adverse fetal complications, independent of other maternal and fetal risk factors.

  10. Dating of Pregnancy in First versus Second Trimester in Relation to Post-Term Birth Rate

    DEFF Research Database (Denmark)

    Thagaard, Ida Näslund; Krebs, Lone; Lausten-Thomsen, Ulrik

    2016-01-01

    with spontaneous delivery was performed from 2006 to 2012 at Copenhagen University Hospital, Holbæk, Denmark. We determined the duration of pregnancy calculated by last menstrual period, crown rump length (CRL), biparietal diameter (1st trimester), BPD (2nd trimester), and head circumference and compared mean.......3% when BPD (2nd trimester) is used. Calibration for these discrepancies resulted in a lower post-term birth rate, from 3.1-1.4%, when first compared to second trimester dating was used. CONCLUSIONS: Systematic discrepancies were identified when biometric formulas were used to determine duration...

  11. Clinical Study of Ectopic Pregnancy in a Tertiary Care Hospital in Nepal

    Directory of Open Access Journals (Sweden)

    Narinder Kaur

    2014-12-01

    seventh postoperative day. Conclusion: Ectopic pregnancy can be suspected clinically by history and associated risk factors. Women presenting with acute pain abdomen with a positive urine β-hCG test should be promptly diagnosed and treated without undue delay to reduce maternal morbidity and mortality.

  12. Building Competency in Infant Mental Health Practice: The Edith Cowan University Pregnancy to Parenthood Clinic

    Science.gov (United States)

    Matacz, Rochelle; Priddis, Lynn

    2016-01-01

    This article describes a unique Australian infant mental health (IMH) service for families from pregnancy through to early parenthood (0-3 years) and training center for postgraduate clinical psychology students. The Australian Association for Infant Mental Health Incorporated, West Australia Branch (AAIMHI WA) "Competency Guidelines"®…

  13. Successful prevention of preeclampsia in a high-risk pregnancy using progestogen dydrogesterone: a clinical case.

    Science.gov (United States)

    Tskhay, Vitaly B; Kovtun, Natalya M; Schindler, Adolf E

    2016-09-01

    The presented clinical example convincingly demonstrates the efficacy of dydrogesterone (30 mg) in the prevention of severe preeclampsia in a high-risk patient (early development of preeclampsia and preterm Cesarean section in her first pregnancy, arterial hypertension). This case suggests using dydrogesterone as an option to prevent preeclampsia, as previously shown in a prospective randomized study.

  14. Initial study of wild horse and burro demography: determination of pregnancy and lactation rates in various herds. Final report

    International Nuclear Information System (INIS)

    Wolfe, M.L.; Ellis, L.C.

    1982-01-01

    Blood serum concentrations of reproductive hormones were used to estimate pregnancy rates in 558 wild and free-roaming horses (Equus caballus) from Nevada, Oregon, and Wyoming; and 165 burros from California. Levels of progesterone, pregnant mares' serum gonadotropin (PMSG), and estradiol 17B were determined by radioimmunoassay procedures. Based on comparison with the results of pregnancy diagnosis from rectal palpations (n =124), the following endocrine concentrations were established as criteria sufficient to indicate pregnancy: progesterone, 0.05 ng/ml; and/or PMSG, 3.0 mg/ml; and/or estradiol, 300 pg/ml. Estimated accuracy of pregnancy diagnoses from endocrine criteria was 80 to 85 percent. The mean incidence of pregnancy among mares sampled from Nevada, Oregon, and Wyoming was 58.4 percent, 69.2 percent, and 85.3 percent respectively

  15. Failure rate of no-scalpel vasectomy in prevention of pregnancy in Shiraz, Southern Iran

    Directory of Open Access Journals (Sweden)

    S Shakeri

    2006-07-01

    Full Text Available BACKGROUND: Bilateral vasectomy is the most effective method of male contraception but there are still some reports on its failure. This study was undertaken to determine the failure rate of the no-scalpel vasectomy in Shiraz Vasectomy Center, Southern Iran. METHODS: From 2001 to 2003, 3900 no-scalpel vasectomies were done in Nader Kazemi Health Center. The records were studied for any failure in the method. Presence of any live sperm 6 months after surgery or any report of pregnancy post-vasectomy were considered as vasectomy failure. RESULTS:Among 3900 cases, 2928 patients had a complete follow up file while failure in the method was visible among 109 (3.72% cases. CONCLUSION: The low failure rate of no-scalpel method indicated its high efficacy to control the fertility in males but there is still need of performance by expert surgeons in well organized centers. KEYWORDS: Iran, no-scalpel vasectomy, failure rate.

  16. Pregnancy rate of gonadotrophin therapy and laparoscopic ovarian electrocautery in polycystic ovary syndrome resistant to clomiphene citrate: a comparative study

    Directory of Open Access Journals (Sweden)

    Ghafarnegad M

    2010-01-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Polycystic ovary syndrome (PCOS is a common cause of ovulation insufficiency and then infertility. Therapeutic options to induce ovulation in anovulatory PCOS patients are clomiphene citrate, metformin, tamoxifen, dopamine agonists (bromocriptin, Gonadotrophin and laparoscopic ovarian electrocautery (LOE. Gonadotrophin and LOE are important options in anovulatory clomiphene citrate-resistant patients with PCOS. Literature data regarding compare of the efficacy of these two treatments are few. Therefore we aimed to study the pregnancy rates of these treatments in infertile clomiphene citrate-resistant patients with PCOS."n"nMethods: A randomized clinical trial study was carried out in infertile clomiphene citrate-resistant patients with PCOS, referred to infertility clinic of Mirza Koochackhan Hospital of Tehran University of Medical Science in Tehran, Iran, between 2003 and 2008."n"nResults: A total of 100 patients women were randomly allocated in two groups. There were no differences in age and pimary and secondary infertility duration. In LOE treatment group, eight cases (16% were pregnant and all delivered at term. in gonadotrophin treatment 14 cases (28% were pregnant, 10 cases (20% delivered at term

  17. Does adding metformin to clomifene citrate lead to higher pregnancy rates in a subset of women with polycystic ovary syndrome?

    NARCIS (Netherlands)

    Moll, E.; Korevaar, J. C.; Bossuyt, P. M. M.; van der Veen, F.

    2008-01-01

    BACKGROUND: An RCT among newly diagnosed, therapy naive women with polycystic ovary syndrome (PCOS) showed no significant differences in ovulation rate, ongoing pregnancy rate or spontaneous abortion rate in favour of clomifene citrate plus metformin compared with clomifene citrate. We wanted to

  18. A novel embryo culture media supplement that improves pregnancy rates in mice.

    Science.gov (United States)

    Highet, A R; Bianco-Miotto, T; Pringle, K G; Peura, A; Bent, S; Zhang, J; Nottle, M B; Thompson, J G; Roberts, C T

    2017-03-01

    The preimplantation embryo in vivo is exposed to numerous growth factors in the female reproductive tract, which are not recapitulated in embryo culture media in vitro The IGF2 and plasminogen activator systems facilitate blastocyst development. We hypothesized that the addition of IGF2 in combination with urokinase plasminogen activator (uPA) and plasminogen could improve rates of blastocyst hatching and implantation in mice. B6BcF1 and CBAB6F2 mouse embryos were divided into one of four supplemented culture media treatment groups: (1) control (media only); (2) 12.5 nM IGF2; (3) 10 µg/mL uPA and 5 µg/mL plasminogen; or (4) a combination of IGF2, uPA and plasminogen treatments. Embryo development to blastocyst stage and hatching were assessed before transfer to pseudopregnant recipient females and implantation, pregnancy rates and postnatal growth were assessed. After 90.5 h of culture, IGF2 + U + P treatment increased the percentage of B6BcF1 embryos that were hatching/hatched and percentage developing to blastocyst stage compared with controls (P culture, IGF2, uPA and plasminogen supplementation of culture media can improve pregnancy success, but the effect of treatment is dependent on the mouse strain. © 2017 Society for Reproduction and Fertility.

  19. Factors influencing the adolescent pregnancy rate in the Greater Giyani Municipality, Limpopo Province – South Africa

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    Lenny Mushwana

    2015-01-01

    Full Text Available A quantitative, descriptive and explorative survey was conducted to determine factors that influence adolescent pregnancy rate among teenage girls (n = 147 attending four high schools in the Greater Giyani Municipality in South Africa. Data was collected using a validated questionnaire which had a reliability of 0.65. Response frequency distributions, two-way frequency tables, Chi-square tests and Cochran–Armitage Trend Tests were used to determine the effect with the demographic characteristics of participants. Participants reported that health services were not conveniently available for them. Their relationship with nurses was poor (p < 0.05 as reported by 73% of participants with regard to maintenance of confidentiality. Participants reported key psychosocial variables such as inadequate sexual knowledge (61%, changing attitudes towards sex (58.9% and peer pressure (56.3% as contributory to high pregnancy rate. Recommendations were made to improve school health services, reproductive education in school curricula focussing on reproductive health, sexuality and guidance for future research.

  20. The clinical impact of mild carbohydrate intolerance in pregnancy

    DEFF Research Database (Denmark)

    Jensen, Dorte Møller; Damm, P; Sørensen, B

    2001-01-01

    OBJECTIVE: The objective was to study the clinical impact of mild carbohydrate intolerance in pregnant women with risk factors for gestational diabetes mellitus. STUDY DESIGN: This was a historical cohort study of 2904 pregnant women examined for gestational diabetes on the basis of risk factors...

  1. Video laparoscopic intervention for an interstitial pregnancy after failure of clinical treatment

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    Nilson Abrão Szylit

    Full Text Available CONTEXT: Interstitial pregnancy is a rare form of ectopic pregnancy for which the best therapeutic course of action has yet to be determined. Surgical intervention entails a high risk of hemorrhage due to the great vascularization of the cornual region of the uterus. Case descriptions facilitate the analysis of results and aid clinicians in determining the most appropriate course of action in these situations. CASE REPORT: In a patient with an ultrasound diagnosis of interstitial pregnancy, clinical treatment using methotrexate was chosen. However, after one week, there was a marked decline in the serum level of the β subunit of chorionic gonadotropin hormone, although an ultrasound examination revealed embryonic cardiac activity. A second dose of the chemotherapy was administered. Embryonic cardiac activity persisted 48 hours later. Video laparoscopy was performed to achieve right-side cornual resection, which resulted in satisfactory resolution of the case.

  2. Sonographic findings and clinical significance of uterine synechiae in pregnancy: Report of 6 cases

    International Nuclear Information System (INIS)

    Lee, Jung Hyung; Kim, Jung Sik

    1994-01-01

    We analyzed the sonograms of 6 cases with uterine synechiae in pregnancy. The diagnosis was based on the clinical and sonographic findings. Previous curret age during the artificial abortion and/or after the spontaneous abortion had been done in 5 cases (83.3%). In all cases, uterine synechia in pregnancy was recognized asintra-amniotic sheet containing hypoechoic central zone and an hyperechoic outer layers. Y-shaped splitting of thehyperechoic outer layers was seen against the uterine wall. The placenta extended along the sheet in 4 cases. Uterine synechiae in pregnancy should be distinguished from amniotic band syndrome by the characteristic snographic findings, and unwarranted abortion of normal fetus should be avoided

  3. Correlation of clinical and biological evidence - a dominant therapeutic element of succeeding in ectopic pregnancy.

    Science.gov (United States)

    NeamŢu, Simona Daniela; DiŢescu, Damian; ForŢofoiu, Maria; Stanca, Liliana; Tigae, Cristian; Niculescu, Mihaela; NeamŢu, Cristian Ovidiu; Manolea, Maria Magdalena; Siminel, Mirela Anişoara; Şurtea, Leontina Eugenia; NeamŢu, Adela Valeria; Novac, Marius Bogdan; Vasile, Liviu; Gluhovschi, Adrian

    2017-01-01

    Tubal pathology, smoking, pelvic inflammatory disease, miscarriage, medical or surgical abortion, usage of intrauterine devices (IUDs) for women with salpingitis latent injuries, older than 40 years, are risk factors for ectopic pregnancy. The objective of this study concerns the correlation of the clinical and biological evidence for the early diagnosis of the ectopic pregnancy and, as soon as possible, for the estimation for eventual risk of complications that may appear. The transvaginal ultrasound test, minimal increases in serum beta-human chorionic gonadotropin (β-hCG) dynamics and blood counts are investigations of choice in achieving our objective. Overcoming β-hCG critical level (>1198 IU÷mL), the decrease of platelets and changes in platelet constants announce the imminent risk of ectopic pregnancy rupture and the need to take a quick decision on the course of treatment.

  4. Designing a clinical audit tool to measure processes of pregnancy care

    Directory of Open Access Journals (Sweden)

    Wallace EM

    2011-12-01

    Full Text Available Suzanne V Sinni1, Wendy M Cross2, Euan M Wallace1,31Department of Obstetrics and Gynaecology, Monash University and Southern Health, Monash Medical Centre, Clayton, Victoria, 2School of Nursing and Midwifery, Monash University, Clayton, Victoria, 3The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, AustraliaAbstract: This paper reports the development of a clinical audit tool as part of a larger project to evaluate a new maternity service, underpinned by a patient safety framework.Aim: The aim of this work is to describe the development of a clinical audit tool that measures the process of pregnancy care, and its application.Background: There are many reports about outcomes of healthcare provision, however there are limited studies examining the process of care. There is also limited evidence linking clinical audit with improvements in care delivery. Pregnancy care was chosen because there are well defined and agreed clinical standards against which to measure the delivery of pregnancy care. A clinical audit using these standards addresses both gaps in the literature.Methods: Standard methodological processes were used to develop the audit tool. Literature informed the processes. Data were collected in 2009–2010 using the tool described in the paper. Reliability testing was completed in September 2011.Results: An audit tool to measure pregnancy care was developed and applied to 354 health records to enable analysis of adherence to organizational expectations of care. Reliability testing of the tool achieved an overall kappa of 0.896.Conclusion: Developing an audit tool based on processes described in the literature is labor intensive and resource dependent, however it results in a robust, reliable, valid tool that can be used in diverse maternity services. Stakeholder participation from the outset ensures ongoing engagement for the duration of a clinically based project spanning several years

  5. [Teenage pregnancy rates and socioeconomic characteristics of municipalities in São Paulo State, Southeast Brazil: a spatial analysis].

    Science.gov (United States)

    Martinez, Edson Zangiacomi; Roza, Daiane Leite da; Caccia-Bava, Maria do Carmo Gullaci Guimarães; Achcar, Jorge Alberto; Dal-Fabbro, Amaury Lelis

    2011-05-01

    Teenage pregnancy is a common public health problem worldwide. The objective of this ecological study was to investigate the spatial association between teenage pregnancy rates and socioeconomic characteristics of municipalities in São Paulo State, Southeast Brazil. We used a Bayesian model with a spatial distribution following a conditional autoregressive (CAR) form based on Markov Chain Monte Carlo algorithm. We used data from the Live Birth Information System (SINASC) and the Brazilian Institute of Geography and Statistics (IBGE). Early pregnancy was more frequent in municipalities with lower per capital gross domestic product (GDP), higher poverty rate, smaller population, lower human development index (HDI), and a higher percentage of individuals with State social vulnerability index of 5 or 6 (more vulnerable). The study demonstrates a significant association between teenage pregnancy and socioeconomic indicators.

  6. ENDOCRINOLOGY OF PREGNANCY: Gestational diabetes mellitus: definition, aetiological and clinical aspects.

    Science.gov (United States)

    Baz, Baz; Riveline, Jean-Pierre; Gautier, Jean-François

    2016-02-01

    Gestational diabetes (GDM) is defined as a glucose intolerance resulting in hyperglycaemia of variable severity with onset during pregnancy. This review aims to revisit the pathogenesis and aetiology of GDM in order to better understand its clinical presentation and outcomes. During normal pregnancy, insulin sensitivity declines with advancing gestation. These modifications are due to placental factors, progesterone and estrogen. In a physiological situation, a compensatory increase in insulin secretion maintains a normal glucose homeostasis. GDM occurs if pancreatic β-cells are unable to face the increased insulin demand during pregnancy. GDM is most commonly a forerunner of type 2 diabetes (T2D) - the most prevalent form of diabetes. These women share similar characteristics with predisposed subjects to T2D: insulin resistance before and after pregnancy, and carry more T2D risk alleles. Auto-immune and monogenic diabetes are more rare aetiologies of GDM. Adverse pregnancy outcomes of GDM are mainly related to macrosomia caused by fetal hyperinsulinism in response to high glucose levels coming from maternal hyperglycaemia. Screening recommendations and diagnosis criteria of GDM have been recently updated. High risk patients should be screened as early as possible using fasting plasma glucose, and if normal, at 24-28 weeks of gestation using 75 g oral glucose tolerance test. The treatment of GDM is based on education with trained nurses and dieticians, and if necessary insulin therapy. © 2016 European Society of Endocrinology.

  7. [Pregnancy, CKD and solitary kidney: kidney donation between clinical logic and taboos].

    Science.gov (United States)

    Piccoli, Giorgina

    2015-01-01

    On the occasion of the Congress of the American Society of Nephrology, the yearly issue of the NEJM introduces a selection of articles of interest for Nephrology, drawing attention to the incidence of hypertensive disorders of pregnancy in kidney donors. The article reconsiders this issue five years after two studies that described an increase in risk for adverse pregnancy outcomes after kidney donation. It disproves a previous assumption of "non-interference" between kidney donation and pregnancy outcomes. Meanwhile,CKD has been recognized as a risk factor for pregnancy, regardless of the presence of reduced renal function, hypertension and proteinuria, although these factors modulate the risk. In the discussion, the authors help to dispel the taboos that donor women are substantially different from women born with a solitary kidney or were so as an effect of a disease. Beside the issue of transplantation,the study indicates that we have to pay attention to all patients with CKD in pregnancy, giving us a very interesting clue for counselling. The risk of complications is greater in the donor population compared to a "low risk" population, but it is roughly equal to that of the general population, if the latter is not subject to a careful clinical work-up. Control and follow-up offset the risk: in a time when economic cuts to health care are almost killing the prevention programs, this is probably the most important message.

  8. Association of State-Mandated Abstinence-only Sexuality Education with Rates of Adolescent HIV Infection and Teenage Pregnancy.

    Science.gov (United States)

    Elliot, L M; Booth, M M; Patterson, G; Althoff, M; Bush, C K; Dery, M A

    2017-01-01

    Abstinence-only sexuality education (AOSE); is required in the public school systems of many states, raising public health concerns and perpetuating health disparities through school systems. This study aimed to determine the correlations between state-mandated AOSE and the rates of adolescent HIV and teen pregnancy. Using publicly available data on all 50 United States' laws and policies on AOSE, states were ranked according to their level of abstinence emphasis on sexuality education (Level 0 - Level 3);. We calculated the relative proportion of Black students in public schools and the proportion of families below the federal poverty line then ranked them by state. We compared the states' ranks to the incidence of adolescent HIV and teen pregnancy in those states to identify associations between variables. The majority of states (~44 percent ); have legally mandated AOSE policies (Level 3); and adolescent HIV and teen pregnancy rates were highest in these Level 3 states. There were significant, positive correlations between HIV incidence rates of 13-19 year olds, HIV rates of 20-24 year olds, teen pregnancy rates, and AOSE level, with the proportion of the population that lives below the federal poverty level, and whether they attended schools that had a greater than 50 percent of an African American population. These data show a clear association between state sexuality education policies and adolescent HIV and teen pregnancy rates not previously demonstrated. Our data further show that states that have higher proportions of at-risk populations, with higher adolescent HIV and teen pregnancy rates, are more likely to also have restrictive AOSE policies. These populations may be more likely to attend public schools where AOSE is taught, increasing their risk for HIV and teen pregnancy. The World Health Organization considers fact-based Comprehensive Sexuality Education a human right, and the authors believe it is past time to end harmful, discriminatory sexuality

  9. Consensus clinical practice guidelines for the diagnosis and treatment of restless legs syndrome/Willis-Ekbom disease during pregnancy and lactation.

    Science.gov (United States)

    Picchietti, Daniel L; Hensley, Jennifer G; Bainbridge, Jacquelyn L; Lee, Kathryn A; Manconi, Mauro; McGregor, James A; Silver, Robert M; Trenkwalder, Claudia; Walters, Arthur S

    2015-08-01

    Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is common during pregnancy, affecting approximately one in five pregnant women in Western countries. Many report moderate or severe symptoms and negative impact on sleep. There is very little information in the medical literature for practitioners on the management of this condition during pregnancy. Accordingly, a task force was chosen by the International RLS Study Group (IRLSSG) to develop guidelines for the diagnosis and treatment of RLS/WED during pregnancy and lactation. A committee of nine experts in RLS/WED and/or obstetrics developed a set of 12 consensus questions, conducted a literature search, and extensively discussed potential guidelines. Recommendations were approved by the IRLSSG executive committee, reviewed by IRLSSG membership, and approved by the WED Foundation Medical Advisory Board. These guidelines address diagnosis, differential diagnosis, clinical course, and severity assessment of RLS/WED during pregnancy and lactation. Nonpharmacologic approaches, including reassurance, exercise and avoidance of exacerbating factors, are outlined. A rationale for iron supplementation is presented. Medications for RLS/WED are risk/benefit rated for use during pregnancy and lactation. A few are rated "may be considered" when RLS/WED is refractory to more conservative approaches. An algorithm summarizes the recommendations. These guidelines are intended to improve clinical practice and promote further research. Copyright © 2014. Published by Elsevier Ltd.

  10. The effect of slow release insemination on pregnancy rates: report of two randomized controlled pilot studies and meta-analysis.

    Science.gov (United States)

    Marschalek, Julian; Franz, Maximilian; Gonen, Yael; Kruessel, Jan-Steffen; Weichselbaum, Amnon; Kuessel, Lorenz; Trofaier, Marie-Louise; Ott, Johannes

    2017-04-01

    A modified application technique of intrauterine insemination (IUI) is slow release insemination (SRI), first described by Muharib et al. (Hum Reprod 7(2):227-229, 1992), who postulated higher pregnancy rates with a slow release of spermatozoa for 3 h. To investigate this approach, two randomized controlled, cross-over pilot studies were performed from 2004 to 2006 in Israel and Germany to compare SRI with the standard bolus IUI. We aimed to present the results and perform a meta-analysis on available data for SRI. Univariate comparisons of pregnancy rates were performed using one-tailed z tests for method superiority. For meta-analysis, a fixed-effect Mantel-Haentzel weighted average of relative risk was performed. Fifty treatment cycles (IUI: n = 25, SRI: n = 25) were performed in Germany, achieving four pregnancies (IUI: 4%, SRI: 12%, p > 0.05). Thirty-nine treatment cycles (IUI: n = 19, SRI: n = 20) were performed in Israel achieving six pregnancies (IUI: 10.5%, SRI: 20%; p > 0.05). Meta-analysis of all eligible studies for SRI (n = 3) revealed a combined relative risk for pregnancy after SRI of 2.64 (95% CI 1.04-6.74), p = 0.02). In conclusion, these results lend support to the hypothesis that the pregnancy rate might be improved by SRI compared to the standard bolus technique.

  11. Effect of music therapy on the anxiety levels and pregnancy rate of women undergoing in vitro fertilization-embryo transfer: A randomized controlled trial.

    Science.gov (United States)

    Aba, Yilda Arzu; Avci, Dilek; Guzel, Yilmaz; Ozcelik, Semanur Kumral; Gurtekin, Basak

    2017-08-01

    The aim of this study was to determine the effect of music therapy on the anxiety levels and pregnancy rates of women who underwent in vitro fertilization-embryo transfer. This prospective randomized controlled trial was conducted with 186 infertile women who presented to the In Vitro Fertilization Unit at the American Hospital in Turkey between April 2015 and April 2016. The infertile women who met the inclusion criteria were assigned to the music therapy group or the standard therapy group through block randomization. The study data were collected using the Personal Information Form, and State-Trait Anxiety Inventory. Early treatment success was determined by serum beta human chorionic gonadotrophin levels seven or ten days after the luteal day zero. For the analysis, descriptive statistics, chi-square test, Fisher's exact test, independent sample t-test were used. After the embryo transfer, the mean state anxiety scores decreased in both groups, and the mean trait anxiety score decreased in the music therapy group; however, the difference was not statistically significant (p>0.05). Clinical pregnancy rates did not differ between the music (48.3%) and standard (46.4%) therapy groups. After the two sessions of music therapy, state and trait anxiety levels decreased and pregnancy rates increased, but the difference was not significant. Therefore, larger sample sizes and more sessions are needed to evaluate whether music therapy has an effect on clinical outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Alexithymia ratings in bulimia nervosa: clinical correlates.

    Science.gov (United States)

    Jimerson, D C; Wolfe, B E; Franko, D L; Covino, N A; Sifneos, P E

    1994-01-01

    Previous reports indicate that some patients with eating disorders have alexithymic characteristics, including affect deficit states and paucity of imagination. This study evaluated whether nonhospitalized patients with bulimia nervosa had elevated ratings of alexithymia in comparison to age-matched controls, and whether severity of bulimic symptoms was correlated with elevations in alexithymia ratings. Because alexithymia may be secondary to concurrent depression, this study was limited to patients with bulimia nervosa who were free of major depression. The authors compared alexithymia ratings for nonhospitalized normal weight women meeting DSM-III-R criteria for bulimia nervosa (N = 20) to healthy female volunteers (N = 20), utilizing the Toronto Alexithymia Scale (TAS) as the primary assessment instrument. Subjects also completed standardized rating scales for bulimic symptoms, depression, and anxiety. Alexithymia rating scale scores were significantly higher for patients with bulimia nervosa than for controls. In comparison to controls, patients had significant elevations on TAS factors reflecting affect deficit states, but normal scores for factors reflecting imagination and abstract thinking. Frequency of binge eating or purging behaviors was not correlated with alexithymia ratings. These data indicate that some patients with bulimia nervosa have alexithymic characteristics. Affect dysregulation was more prominent than limitation in fantasy or metaphorical thought. Additional studies are needed to assess whether presence of alexithymic characteristics may be predictive of response to treatment in patients with bulimia nervosa.

  13. Longitudinal study on clinical and microbial analysis of periodontal status in pregnancy

    Directory of Open Access Journals (Sweden)

    Fernanda Campos MACHADO

    Full Text Available Abstract This study was aimed to provide a longitudinal overview of the subgingival bacterial microbiome using fluorescence in situ hybridization (FISH technique, in women in the second trimester of pregnancy (between 14 and 24 weeks, and 48 h and 8 weeks postpartum. Of 31 women evaluated during pregnancy, 24 returned for the 48-h and 18 for their 8-week exams postpartum. Probing depth (PD, bleeding on probing, clinical attachment level, and presence of calculus were recorded. Subgingival plaque samples were collected, and FISH was used to identify the numbers of eight periodontal pathogens. Friedman test was used to compare differences between follow-up examinations, followed by a multiple comparison test for a post hoc pairwise comparison. Clinically, a significantly greater number of teeth with PD = 4–5 mm were found during pregnancy than on postpartum examinations. Microbial analysis showed a statistically significant decrease in cell count over the study period for Prevotella nigrescens. P. intermedia, Campylobacter rectus, and Porphyromonas gingivalis also decrease, although not significantly, and Aggregatibacter actinomycetemcomitans increased. No significant changes were found for Fusobacterium nucleatum, Treponema denticola, or Tannerella forsythia. Our data demonstrate a change in the subgingival microbiota during pregnancy, at least for P. nigrescens.

  14. Bicornuate Uterus with Abdominal Pregnancy; Diagnostic ...

    African Journals Online (AJOL)

    Both bicornuate uterus and abdominal pregnancies are rarely encountered incidences in the clinical practice of Obstetrics and Gynaecology. Abdominal pregnancy is a life threatening form of ectopic pregnancy with a high maternal mortality and even higher perinatal mortality rates. Bicornuate uterus is associated with ...

  15. Sociodemographic disparities and behavioral factors in clinical oral health status during pregnancy.

    Science.gov (United States)

    Chung, Lisa H; Gregorich, Steven E; Armitage, Gary C; Gonzalez-Vargas, Judy; Adams, Sally H

    2014-04-01

    Although oral health (OH) problems are common during pregnancy, little is known about individual characteristics or behaviors relating to clinically assessed OH during pregnancy. This cross-sectional study describes the clinical OH status of a sample of pregnant women, examines relationships between sociodemographic factors and OH, behavioral factors and OH, and the influence of behavior on the relationships between sociodemographic clusters and OH. Baseline data were utilized from a pilot intervention study promoting OH during pregnancy. Participants (n = 99), recruited from CenteringPregnancy(®) prenatal care groups completed questionnaires addressing race/ethnicity, income, education, dental insurance, oral hygiene practices, and dental care utilization; and clinical examinations for periodontal probing depths (PD), bleeding on probing (BOP), plaque assessment, and visual detection of untreated decay. Chi-squares and one-way anovas with Tukey's studentized range test of planned comparisons were conducted to examine bivariable relationships between both sociodemographic and behavioral characteristics to OH status. Multivariable logistic regression analyses tested whether the effects of sociodemographic variables on OH status might be mediated by behaviors, including self-reported oral hygiene and recent dental visits. Forty-five percent of the sample had untreated decay and the mean percentage of sites with BOP = 18%. Bivariable analyses of sociodemographic factors indicated that compared with Whites, Hispanic women had greater % of sites with: BOP, PD ≥5 mm plus BOP, and Plaque Index (PI) scores of ≥2, all P = 0.05; and greater untreated decay (Chi-square 13.3, P pregnancy, the importance of dental care, and provides useful findings for tailoring interventions for expectant mothers and their infants. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. [Genital herpes and pregnancy: Epidemiology, clinical manifestations, prevention and screening. Guidelines for clinical practice from the French College of Gynecologists and Obstetrician (CNGOF)].

    Science.gov (United States)

    Picone, O

    2017-12-01

    To analyze the consequences of genital herpes infections in pregnant women. The PubMed database and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. The symptomatology of herpes genital rash is often atypical (NP2) and not different during pregnancy (Professional consensus). It is most often due to HSV2 (NP2). Seventy percent of pregnant patients have a history of infection with Herpes simplex virus, without reference to genital or labial localization, and this is in most cases type 1 (NP2). The prevalence of clinical herpes lesions at birth in the event of recurrence is about 16% compared with 36% in the case of initial infection (NP4). In HSV+ patients, asymptomatic herpetic excretion is 4 to 10%. The rate of excretion increases in HIV+ patients (20 to 30%) (NP2). The risk of HSV seroconversion during pregnancy is 1 to 5% (NP2), but can reach 20% in case of sero-discordant couple (NP2). Questioning is not always sufficient to determine the history of herpes infection of a patient and her partner (NP2) and the clinical examination is not always reliable (NP2). Herpetic hepatitis and encephalitis are rare and potentially severe (NP4). These diagnoses should be discussed during pregnancy and antiviral therapy should be started as soon as possible (Professional consensus). There is no established link between herpes infection and miscarriages (NP3). There appears to be an association between untreated herpes infection and premature delivery (NP3) but not in the case of treated infections (NP4). Herpetic fetopathies are exceptional (NP4). There is no argument for recommending specific prenatal diagnosis for herpes infection during pregnancy (Professional consensus). Condom use reduces the risk of initial infection in women who are not pregnant (NP3). There is no evidence to justify routine screening during pregnancy (Professional consensus). There is a strong discrepancy between the prevalence of herpetic excretion

  17. Ectopic Pregnancy: Reasons for The High Tubal Rupture Rates In A ...

    African Journals Online (AJOL)

    Context: Nigeria has a high incidence of ruptured ectopic pregnancy. Identification of predisposing factors will help reduce morbidity and mortality. Aim: To determine the reasons for the high incidence of ruptured ectopic pregnancy. Methods: All cases of ectopic pregnancies managed at Wesley Guild Hospital, Ilesha, ...

  18. Validity for assisted hatching on pregnancy rate in assisted reproductive technology: analysis based on results of Japan Assisted Reproductive Technology Registry System 2010.

    Science.gov (United States)

    Nakasuji, Takashi; Saito, Hidekazu; Araki, Ryuichiro; Nakaza, Aritoshi; Kuwahara, Akira; Ishihara, Osamu; Irahara, Minoru; Kubota, Toshiro; Yoshimura, Yasunori; Sakumoto, Tetsuro

    2014-06-01

    The aim of this study was to assess the efficacy of assisted hatching (AH) in assisted reproductive technology (ART) treatment. In this retrospective observational study, the data of patients who were registered in the National ART Registry System of Japan between January and December 2010 were analyzed. The descriptive statistics and validity of AH in fresh embryo transfer (ET) and frozen-thawed ET were assessed by using multiple logistic regression analyses. From a total of 105,450 single ET, 46,029 (43.7%) cycles underwent AH. A total of 9737 (21.3%) and 36,292 (60.9%) cycles underwent AH from 45,818 fresh single ET and 59,632 frozen-thawed single ET, respectively. In the fresh ET patients that underwent AH, the clinical pregnancy and live birth rate were significantly decreased in patients of all ages compared with that of the non-AH group. In the frozen-thawed ET patients, there was no significant difference in pregnancy and live birth rate between the AH group and the non-AH group. AH treatment was more frequently performed in frozen-thawed ET patients than in fresh ET patients, and in the blastocyst stage than in the early cleavage stage. A significantly decreased pregnancy and live birth rate was observed in the fresh ET patients who underwent AH. In the frozen-thawed ET patients who underwent AH, improvement in the clinical pregnancy and live birth rate was not observed. Further studies on the indication and application of AH in ART treatment are required. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  19. The effect of school-based health clinics on teenage pregnancy and parenting outcomes: an integrated literature review.

    Science.gov (United States)

    Strunk, Julie A

    2008-02-01

    Teenage pregnancy outcomes have become an increasing concern in the United States. Education and support of pregnant teens are critical factors that may determine good or poor pregnancy outcomes. Poor outcomes may include low birth weight, developmental delays, and poor academic performance. Although the number of teenagers experiencing pregnancy and parenting has declined in the U.S., school-based health clinics can be used to provide support and guidance designed to avoid the negative outcomes associated with teenage pregnancy and parenting. By having school-based health clinics, nurse practitioners and school nurses can provide much needed services to pregnant and parenting teens. These services should include educational support, counseling, and community resources. This inquiry provides a metasynthesis of the literature and will review, examine, and summarize the literature relating to the effect of school-based clinics on teenage pregnancy and parenting outcomes.

  20. Prevalence of rape-related pregnancy as an indication for abortion at two urban family planning clinics.

    Science.gov (United States)

    Perry, Rachel; Zimmerman, Lindsay; Al-Saden, Iman; Fatima, Aisha; Cowett, Allison; Patel, Ashlesha

    2015-05-01

    We sought to estimate the prevalence of rape-related pregnancy as an indication for abortion at two public Chicago facilities and to describe demographic and clinical correlates of women who terminated rape-related pregnancies. We performed a cross-sectional study of women obtaining abortion at the Center for Reproductive Health (CRH) at University of Illinois Health Sciences Center and Reproductive Health Services (RHS) at John H. Stroger, Jr. Hospital between August 2009 and August 2013. Gestational age limits at CRH and RHS were 23+6 and 13+6weeks, respectively. We estimated the prevalence of rape-related pregnancy based on billing code (CRH) or data from an administrative database (RHS), and examined relationships between rape-related pregnancy and demographic and clinical variables. Included were 19,465 visits for abortion. The majority of patients were Black (85.6%). Prevalence of abortion for rape-related pregnancy was 1.9%, and was higher at CRH (6.9%) than RHS (1.5%). Later gestational age was associated with abortion for rape-related pregnancy (median 12days, prape-related pregnancy at CRH only (prape-related pregnancy than among those terminating for other indications. Rape-related pregnancy as an indication for abortion had a low, but clinically significant prevalence at two urban Chicago family planning centers. Later gestational age was associated with abortion for rape-related pregnancy. Rape-related pregnancy may occur with higher prevalence among some subgroups of women seeking abortion than others. Efforts to address rape-related pregnancy in the abortion care setting are needed. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Tocilizumab use in pregnancy: Analysis of a global safety database including data from clinical trials and post-marketing data.

    Science.gov (United States)

    Hoeltzenbein, Maria; Beck, Evelin; Rajwanshi, Richa; Gøtestam Skorpen, Carina; Berber, Erhan; Schaefer, Christof; Østensen, Monika

    2016-10-01

    Analyze the cumulative evidence for pregnancy outcomes after maternal exposure to tocilizumab, an anti-interleukin-6-receptor monoclonal antibody used for the treatment of rheumatoid arthritis and juvenile idiopathic arthritis. At present, published experience on tocilizumab use during pregnancy is very limited. We have analyzed all pregnancy-related reports documented in the Roche Global Safety Database until December 31, 2014 (n = 501). After exclusion of ongoing pregnancies, duplicates, and cases retrieved from the literature, 399 women were found to have been exposed to tocilizumab shortly before or during pregnancy, with pregnancy outcomes being reported in 288 pregnancies (72.2%). Of these 288 pregnancies, 180 were prospectively reported resulting in 109 live births (60.6%), 39 spontaneous abortions (21.7%), 31 elective terminations of pregnancy (17.2%), and 1 stillbirth. The rate of malformations was 4.5%. Co-medications included methotrexate in 21.1% of the prospectively ascertained cases. Compared to the general population, an increased rate of preterm birth (31.2%) was observed. Retrospectively reported pregnancies (n = 108) resulted in 55 live births (50.9%), 31 spontaneous abortions (28.7%), and 22 elective terminations (20.4%). Three infants/fetuses with congenital anomalies were reported in this group. No increased risks for adverse pregnancy outcomes were observed after paternal exposure in 13 pregnancies with known outcome. No indication for a substantially increased malformation risk was observed. Considering the limitations of global safety databases, the data do not yet prove safety, but provide information for physicians and patients to make informed decisions. This is particularly important after inadvertent exposure to tocilizumab, shortly before or during early pregnancy. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S.

    Science.gov (United States)

    Stanger-Hall, Kathrin F; Hall, David W

    2011-01-01

    The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005) from all U.S. states with information on sex education laws or policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future.

  3. Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S

    Science.gov (United States)

    Stanger-Hall, Kathrin F.; Hall, David W.

    2011-01-01

    The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005) from all U.S. states with information on sex education laws or policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future. PMID:22022362

  4. Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S.

    Directory of Open Access Journals (Sweden)

    Kathrin F Stanger-Hall

    Full Text Available The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005 from all U.S. states with information on sex education laws or policies (N = 48, we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future.

  5. Sperm morphology and chromatin integrity in Swedish warmblood stallions and their relationship to pregnancy rates.

    Science.gov (United States)

    Morrell, Jane M; Johannisson, Anders; Dalin, Anne-Marie; Hammar, Linda; Sandebert, Thomas; Rodriguez-Martinez, Heriberto

    2008-01-07

    Artificial insemination is not as widely used in horses as in other domestic species, such as dairy cattle and pigs, partly because of the wide variation in sperm quality between stallion ejaculates and partly due to decreased fertility following the use of cooled transported spermatozoa. Furthermore, predictive tests for sperm fertilising ability are lacking. The objective of the present study was to assess sperm morphology and chromatin integrity in ejaculates obtained from 11 warmblood breeding stallions in Sweden, and to evaluate the relationship of these parameters to pregnancy rates to investigate the possibility of using these tests predictively. Aliquots from fortyone ejaculates, obtained as part of the normal semen collection schedule at the Swedish National Stud, were used for morphological analysis by light microscopy, whereas thirtyseven were used for chromatin analysis (SCSA) by flow cytometry. The outcome of inseminations using these ejaculates was made available later in the same year. Ranges for the different parameters were as follows; normal morphology, 27-79.5%; DNA-fragmentation index (DFI), 4.8-19.0%; standard deviation of DNA fragmentation index (SD_DFI) 41.5-98.9, and mean of DNA fragmentation index (mean_DFI), 267.7-319.5. There was considerable variation among stallions, which was statistically significant for all these parameters except for mean_DFI (P morphology and DFI (P morphology and SD_DFI (P morphology and mean_DFI (P morphological analysis or chromatin analysis was able to identify abnormalities in spermiogenesis that could compromise DNA-integrity. A positive relationship was found between normal morphology and pregnancy rate following insemination (r = 0.789; P morphology and sperm chromatin integrity, seem to be useful in predicting the fertilising ability of stallion ejaculates, particularly in determining cases of sub-fertility.

  6. Rates of fetal polydrug exposures in methadone-maintained pregnancies from a high-risk population.

    Directory of Open Access Journals (Sweden)

    Kaitlyn Delano

    Full Text Available Methadone maintenance treatment (MMT is the standard of care during pregnancy for opioid-dependency, showing efficacy in improving prenatal care and reducing risk of relapse. By design, however, MMT is only intended to prevent withdrawal thus facilitating cognitive behavioural interventions. In order to maximize the benefits of MMT, it is essential that methadone is both properly prescribed and that additional addiction treatment is concurrently administered. This study aims to determine the effectiveness of MMT engagement in high-risk pregnant women in reducing polydrug use by objective laboratory examination of neonatal meconium.Over a 29-month period, the Motherisk Laboratory at the Hospital for Sick Children in Toronto analyzed meconium samples as per request by social services and hospitals for drugs of abuse.Of the 904 meconium samples received, 273 were tested for methadone with 164 positive and 109 negative for methadone. Almost half of the methadone positive samples (46.34% were also positive for at least one other opioid compound, which did not differ statistically from the methadone-negative control samples (46.79%; Chi square test, p=0.94. No differences were found between the methadone positive and negative groups in rates of concurrent amphetamines, cocaine, cannabis, and alcohol use indicating a similar risk of polydrug use between pregnant women taking or not taking methadone in this population.The high rates of additional opioid and other drug use in the MMT group, suggest that MMT is failing this population of patients. It is possible that methadone doses during pregnancy are not appropriately adjusted for changes in pharmacokinetic parameters (e.g. blood volume, renal function during the second and third trimesters. This may result in sub-therapeutic dosing creating withdrawal symptoms leading to additional substance use. Alternatively, these results may be demonstrating a substantial lack in delivery of addiction support

  7. The clinical outcome of cesarean scar pregnancies implanted "on the scar" versus "in the niche".

    Science.gov (United States)

    Kaelin Agten, Andrea; Cali, Giuseppe; Monteagudo, Ana; Oviedo, Johana; Ramos, Joanne; Timor-Tritsch, Ilan

    2017-05-01

    The term cesarean scar pregnancy refers to placental implantation within the scar of a previous cesarean delivery. The rising numbers of cesarean deliveries in the last decades have led to an increased incidence of cesarean scar pregnancy. Complications of cesarean scar pregnancy include morbidly adherent placenta, uterine rupture, severe hemorrhage, and preterm labor. It is suspected that cesarean scar pregnancies that are implanted within a dehiscent scar ("niche") behave differently compared with those implanted on top of a well-healed scar. To date there are no studies that have compared pregnancy outcomes between cesarean scar pregnancies implanted either "on the scar" or "in the niche." The purpose of this study was to determine the pregnancy outcome of cesarean scar pregnancy implanted either "on the scar" or "in the niche." This was a retrospective 2-center study of 17 patients with cesarean scar pregnancy that was diagnosed from 5-9 weeks gestation (median, 8 weeks). All cesarean scar pregnancies were categorized as either implanted or "on the scar" (group A) or "in the niche" (group B), based on their first-trimester transvaginal ultrasound examination. Clinical outcomes based on gestational age at delivery, mode of delivery, blood loss at delivery, neonate weight and placental histopathologic condition were compared between the groups with the use of the Mann-Whitney U test. Myometrial thickness overlying the placenta was compared among all the patients who required hysterectomy and those who did not with the use of the Mann-Whitney U test. Myometrial thickness was also correlated with gestational age at delivery with the use of Spearman's correlation. Group A consisted of 6 patients; group B consisted of 11 patients. Gestational age at delivery was lower in group B (median, 34 weeks; range, 20-36 weeks) than in group A (median, 38 weeks; range, 37-39 weeks; P=.001). In group A, 5 patients were delivered via cesarean delivery (with normal placenta), and

  8. Clinical indicators for success of misoprostol treatment after early pregnancy failure.

    Science.gov (United States)

    Robledo, C; Zhang, J; Troendle, J; Barnhart, K; Creinin, M D; Westhoff, C; Huang, X; Frederick, M

    2007-10-01

    To identify clinical indicators for success of misoprostol treatment after early pregnancy failure. A total of 473 women with early pregnancy failure received 800 microg of vaginal misoprostol on treatment day 1. At the follow-up visit on day 3, a second dose was given if expulsion was incomplete. On day 8, vacuum aspiration was offered if expulsion had not occurred. Ultrasonography was used as gold standard for success. A Classification and Regression Tree analysis was undertaken to derive two decision trees for the success of misoprostol treatment on study days 3 and 8. Heavy bleeding after the first dose and an open cervical os were identified as clinical indicators of treatment success on day 3. Treatment success occurred in 84% of women with either or both indicators. Reporting passage of tissue after a second misoprostol dose and old blood in the vagina were potential indicators of treatment success or failure on day 8. A woman with either of these indicators has a 65% chance of treatment success after the second dose. Conversely, a woman with neither indicator on day 8 has a 94% chance of treatment failure. Standard clinical findings may be useful as indicators for success or failure of medical management of early pregnancy failure in settings with limited or no access to ultrasonography. More research to identify even better indicators is warranted.

  9. Management practices associated with the incidence rate of clinical mastitis.

    Science.gov (United States)

    Barkema, H W; Schukken, Y H; Lam, T J; Beiboer, M L; Benedictus, G; Brand, A

    1999-08-01

    Risk factors for the incidence rate of clinical mastitis were studied in 274 Dutch dairy herds. Variables that were associated with resistance to disease were the feeding, housing, and milking machine factors. Variables that were associated with exposure were grazing, combined housing of dry cows and heifers, and calving area hygiene. Postmilking teat disinfection in herds with a low bulk milk somatic cell count and years of practicing dry cow therapy were positively associated with the incidence rate of clinical mastitis. Herds with a low bulk milk somatic cell count and in which postmilking teat disinfection was not used had lower incidence rates of clinical mastitis than did other herds. The incidence rate of clinical mastitis caused by Escherichia coli was mostly related to housing conditions, hygiene, and machine milking. The incidence rate of clinical mastitis caused by Staphylococcus aureus was mostly related to factors associated with bulk milk somatic cell count and factors that might be due to cause and effect reversal. A strong positive correlation existed between the incidence rate of clinical mastitis caused by Streptococcus dysgalactiae and the incidence rate of clinical mastitis caused by Staph. aureus. The incidence rate of clinical mastitis caused by Streptococcus dysgalactiae was related to nutrition, milking technique, and machine milking. The incidence rate of clinical mastitis caused by Streptococcus uberis was associated with factors related to housing, nutrition, and machine milking.

  10. Effect of Folic Acid Supplementation in Pregnancy on Preeclampsia: The Folic Acid Clinical Trial Study

    Directory of Open Access Journals (Sweden)

    Shi Wu Wen

    2013-01-01

    Full Text Available Preeclampsia (PE is hypertension with proteinuria that develops during pregnancy and affects at least 5% of pregnancies. The Effect of Folic Acid Supplementation in Pregnancy on Preeclampsia: the Folic Acid Clinical Trial (FACT aims to recruit 3,656 high risk women to evaluate a new prevention strategy for PE: supplementation of folic acid throughout pregnancy. Pregnant women with increased risk of developing PE presenting to a trial participating center between 80/7 and 166/7 weeks of gestation are randomized in a 1 : 1 ratio to folic acid 4.0 mg or placebo after written consent is obtained. Intent-to-treat population will be analyzed. The FACT study was funded by the Canadian Institutes of Health Research in 2009, and regulatory approval from Health Canada was obtained in 2010. A web-based randomization system and electronic data collection system provide the platform for participating centers to randomize their eligible participants and enter data in real time. To date we have twenty participating Canadian centers, of which eighteen are actively recruiting, and seven participating Australian centers, of which two are actively recruiting. Recruitment in Argentina, UK, Netherlands, Brazil, West Indies, and United States is expected to begin by the second or third quarter of 2013. This trial is registered with NCT01355159.

  11. Clinical accuracy of inflationary oscillometry in pregnancy and pre-eclampsia: Omron-MIT Elite.

    Science.gov (United States)

    Chung, Y; Brochut, M C; de Greeff, A; Shennan, A H

    2012-10-01

    To evaluate the accuracy of the Omron MIT Elite in pregnancy and pre-eclampsia according to the British Hypertension Society protocol (BHS). Prospective observational study. Antenatal clinics and wards at St. Thomas' Hospital (London, UK). Forty-five pregnant women including 15 with pre-eclampsia. Nine sequential same arm blood pressure (BP) measurements were taken from each woman by trained observers, alternating between mercury sphygmomanometry and the test device. Grading criteria of the BHS protocol (A/B grade=pass; C/D=fail). The Omron MIT Elite achieved a grade A/A in both pregnancy and pre-eclampsia. The mean difference (SD) between the mercury standard and the device in pregnancy was -1.1 (5.2)mmHg and 1.5 (4.8)mmHg for systolic and diastolic BP respectively compared to 0.2 (5.3)mmHg and 2.2 (5.5)mmHg in pre-eclampsia. The Omron MIT Elite can be recommended for use in pregnancy and pre-eclampsia according to the BHS protocol. To date, this is the most accurate automated BP device validated in pre-eclampsia. Copyright © 2012. Published by Elsevier B.V.

  12. The global threat of Zika virus to pregnancy: epidemiology, clinical perspectives, mechanisms, and impact.

    Science.gov (United States)

    Boeuf, Phillipe; Drummer, Heidi E; Richards, Jack S; Scoullar, Michelle J L; Beeson, James G

    2016-08-03

    Zika virus (ZIKV) is a mosquito-borne flavivirus that has newly emerged as a significant global threat, especially to pregnancy. Recent major outbreaks in the Pacific and in Central and South America have been associated with an increased incidence of microcephaly and other abnormalities of the central nervous system in neonates. The causal link between ZIKV infection during pregnancy and microcephaly is now strongly supported. Over 2 billion people live in regions conducive to ZIKV transmission, with ~4 million infections in the Americas predicted for 2016. Given the scale of the current pandemic and the serious and long-term consequences of infection during pregnancy, the impact of ZIKV on health services and affected communities could be enormous. This further highlights the need for a rapid global public health and research response to ZIKV to limit and prevent its impact through the development of therapeutics, vaccines, and improved diagnostics. Here we review the epidemiology of ZIKV; the threat to pregnancy; the clinical consequences and broader impact of ZIKV infections; and the virus biology underpinning new interventions, diagnostics, and insights into the mechanisms of disease.

  13. Clinic access and teenage birth rates: Racial/ethnic and spatial disparities in Houston, TX.

    Science.gov (United States)

    Wisniewski, Megan M; O'Connell, Heather A

    2018-02-14

    Teenage motherhood is a pressing issue in the United States, and one that is disproportionately affecting racial/ethnic minorities. In this research, we examine the relationship between the distance to the nearest reproductive health clinic and teenage birth rates across all zip codes in Houston, Texas. Our primary data come from the Texas Department of State Health Services. We use spatial regression analysis techniques to examine the link between clinic proximity and local teenage birth rates for all females aged 15 to 19, and separately by maternal race/ethnicity. We find, overall, limited support for a connection between clinic distance and local teenage birth rates. However, clinics seem to matter most for explaining non-Hispanic white teenage birth rates, particularly in high-poverty zip codes. The racial/ethnic and economic variation in the importance of clinic distance suggests tailoring clinic outreach to more effectively serve a wider range of teenage populations. We argue social accessibility should be considered in addition to geographic accessibility in order for clinics to help prevent teenage pregnancy. Copyright © 2018. Published by Elsevier Ltd.

  14. High rate of unplanned pregnancy in the context of integrated family planning and HIV care services in South Africa.

    Science.gov (United States)

    Adeniyi, Oladele Vincent; Ajayi, Anthony Idowu; Moyaki, Mayowa Gabriel; Goon, Daniel Ter; Avramovic, Gordana; Lambert, John

    2018-02-27

    Integration of family planning services into HIV care was implemented in South Africa as a core strategy aimed at reducing unintended pregnancies among childbearing women living with HIV. However, it is unclear whether this strategy has made any significant impact at the population level. This paper describes the prevalence and correlates of self-reported unplanned pregnancy among HIV-infected parturient women attending three large maternity centres in the Eastern Cape, South Africa. We also compare unplanned pregnancy rates between HIV-infected parturient women already in care (who have benefitted from services' integration) and newly diagnosed parturient women (who have not benefitted from services' integration). Drawing from the baseline data of the East London Prospective Cohort Study (ELPCS), data of 594 parturient women living with HIV in the Eastern Cape were included. Chi-square statistics and binary logistics regression were employed to determine the correlates of unplanned pregnancy among the cohort. The prevalence of unplanned pregnancy was 71% (n = 422) with a higher rate among parturient women newly diagnosed during the index pregnancy (87%). Unplanned pregnancy was significantly associated with younger age, single status, HIV diagnosis at booking, high parity and previous abortion. Women who reported unplanned pregnancy were more likely to book late and have lower CD4 counts. After adjusting for confounding variables, having one child and five to seven children (AOR = 2.2; CI = 1.3-3.1), age less than 21 years (AOR = 3.3; CI = 1.1-9.8), late booking after 27 weeks (AOR = 2.7; CI = 1.5-5.0), not married (AOR = 4.3; CI = 2.7-6.8) and HIV diagnosis at booking (AOR = 3.0; CI = 1.6-5.8) were the significant correlates of unplanned pregnancy in the cohort. Unplanned pregnancy remains high overall among parturient women living with HIV in the region, however, with significant reduction among those who were

  15. Randomised clinical trials of fish oil supplementation in high risk pregnancies. Fish Oil Trials In Pregnancy (FOTIP) Team

    DEFF Research Database (Denmark)

    Olsen, S F; Secher, N J; Tabor, A

    2000-01-01

    To test the postulated preventive effects of dietary n-3 fatty acids on pre-term delivery, intrauterine growth retardation, and pregnancy induced hypertension.......To test the postulated preventive effects of dietary n-3 fatty acids on pre-term delivery, intrauterine growth retardation, and pregnancy induced hypertension....

  16. Spontaneous first trimester miscarriage rates per woman among parous women with 1 or more pregnancies of 24 weeks or more.

    Science.gov (United States)

    Cohain, Judy Slome; Buxbaum, Rina E; Mankuta, David

    2017-12-22

    The purpose of this study was to quantify spontaneous first trimester miscarriage rates per woman among parous women. A vast amount of data has accumulated regarding miscarriage rates per recognized pregnancy as well as about recurrent miscarriage. This is the second study of miscarriage rates per woman in a parous population and the first study of recurrent and non-recurrent, spontaneous first trimester miscarriage rates per woman in a large parous population. Extraction of the following variables from all delivery room admissions from both Hadassah Medical Centers in Jerusalem Israel, 2004-2014: # of first trimester spontaneous miscarriages, # live births; # living children; age on admission, pre-pregnancy height and weight, any smoking this pregnancy, any alcohol or drug abuse this pregnancy, blood type, history of ectopic pregnancy, history of cesarean surgery (CS) and use of any fertility treatment(s). Among 53,479 different women admitted to labor and delivery ward, 43% of women reported having had 1 or more first trimester spontaneous miscarriages; 27% reported having had one, 10% two, 4% three, 1.3% four, 0.6% five and 0.05% reported having 6-16 spontaneous first trimester miscarriages. 18.5% had one or more first trimester miscarriages before their first live birth. Eighty-one percent of women with 11 or more living children experienced one or more first trimester miscarriages. First trimester miscarriage rates rose with increasing age, increasing parity, after previous ectopic pregnancy, after previous cesarean surgery, with any smoking during pregnancy and pre-pregnancy BMI ≥30. Miscarriages are common among parous women; 43% of parous women report having experienced one or more first trimester spontaneous miscarriages, rising to 81% among women with 11 or more living children. One in every 17 parous women have three or more miscarriages. Depending on her health, nutrition and lifestyle choices, even a 39 year old parous woman with a history of 3 or

  17. Pregnancy risk assessment monitoring system in Ireland: methods and response rates

    LENUS (Irish Health Repository)

    O’Keeffe, Linda M.

    2014-06-01

    To describe response rates and characteristics associated with response to the Pregnancy Risk Assessment Monitoring System study in Ireland (PRAMS Ireland). Using hospital discharge records of live births at a large, urban, obstetric hospital, a sampling frame of approximately 2,400 mother-infant pairs were used to alternately sample 1,200 women. Mothers’ information including name, address, parity, age and infant characteristics such as sex and gestational age at delivery were extracted from records. Modes of contact included an invitation letter with option to opt out of the study, three mail surveys, a reminder letter and text message reminder for remaining non-respondents. Sixty-one per cent of women responded to the PRAMS Ireland survey over a 133 day response period. Women aged <30, single women, multiparous women and women with a preterm delivery were less likely to respond. Women participating in PRAMS Ireland were similar to the national birth profile in 2011 which had a mean age of 32, were 40 % primiparous, 33 % single or never married and had a 28 % caesarean section rate. Survey and protocol changes are required to increase response rates above recommended Centers for Disease Control and Prevention (CDC) thresholds of 65 % within the recommended 90 day data collection cycle. Additional efforts such as stratification and over-sampling are required to increase representativeness among hard to reach groups such as younger, single and multiparous women before expanding the project to an ongoing, national surveillance system in Ireland.

  18. [Clinical guideline for the diagnosis and treatment of subclinical thyroid dysfunction in pregnancy. Working Group on Subclinical Thyroid Dysfunction of the Spanish Endocrinology Society].

    Science.gov (United States)

    Galofré Ferrater, Juan Carlos; Corrales Hernández, Juan José; Pérez Corral, Begoña; Cantón Blanco, Ana; Alonso Pedrol, Núria; Pérez Pérez, Antonio; Lajo Morales, Teresa; Tortosa Henzi, Frederic

    2009-02-01

    Subclinical thyroid disease is a biochemical diagnosis and is common during pregnancy. Because of the physiological hormonal changes that take place during pregnancy and the absence of normal ranges for thyroid hormones during this period, subclinical thyroid disease is difficult to interpret during pregnancy. Subclinical hyperthyroidism during pregnancy has few clinical consequences and no treatment is required. In contrast, subclinical hypothyroidism seems to improve with thyroxine treatment. Iodine supplements during pregnancy and lactation, even in iodine-sufficient areas, are also indicated.

  19. Trends in teenage fertility, abortion, and pregnancy rates in Iceland compared with other Nordic countries, 1976-99.

    Science.gov (United States)

    Bender, Sóley; Geirsson, Reynir T; Kosunen, Elise

    2003-01-01

    Iceland is often considered very similar to the other Nordic countries. The purpose of this study was to explore trends in teenage fertility, abortion, and pregnancy rates in Iceland, compare these trends with corresponding rates in Denmark, Finland, Norway, and Sweden during the period 1976-99, and to evaluate similarities and dissimilarities. The study is based on data about fertility, abortion, and pregnancy rates obtained from the Icelandic and Nordic national population and abortion registers for the age group 15-19 years years. Teenage fertility and pregnancy rates in the five Nordic countries declined over the study period by 57-67% and 31-50%, respectively, and in Iceland they remained significantly higher than in the Nordic countries. In 1999 almost every other teenage pregnancy in Iceland (45.9/1000) resulted in a childbirth (24.4/1000). Regional fertility rates were highest in the countryside. While the abortion rate has been declining in the four Nordic countries by 20-41%, they have concurrently been rising in Iceland by 133% (9.4/1000 in 1976-80, 21.9/1000 in 1996-99) and are presently higher than in the other Nordic countries. Regionally, abortion rates in Iceland were highest in the Capital area. The teenage pregnancy rate is higher in Iceland than in the other Nordic countries. This may be explained by cultural norms in Iceland's society regarding childbearing, early initiation of sexual intercourse, more limited sex education, and less effective delivery and use of contraceptive methods. There is a need to promote sexual and reproductive health to young people in Iceland by combining diverse preventive approaches.

  20. Controlling Rater Stringency Error in Clinical Performance Rating: Further Validation of a Performance Rating Theory.

    Science.gov (United States)

    Cason, Gerald J.; And Others

    Prior research in a single clinical training setting has shown Cason and Cason's (1981) simplified model of their performance rating theory can improve rating reliability and validity through statistical control of rater stringency error. Here, the model was applied to clinical performance ratings of 14 cohorts (about 250 students and 200 raters)…

  1. A comprehensive review of the clinical approach to pregnancy and systemic lupus erythematosus.

    Science.gov (United States)

    Lazzaroni, Maria Grazia; Dall'Ara, Francesca; Fredi, Micaela; Nalli, Cecilia; Reggia, Rossella; Lojacono, Andrea; Ramazzotto, Francesca; Zatti, Sonia; Andreoli, Laura; Tincani, Angela

    2016-11-01

    Nowadays, most of the young women affected by Systemic Lupus Erythematosus (SLE) can carry out one or more pregnancies thanks to the improvement in treatment and the consequent reduction in morbidity and mortality. Pregnancy outcome in these women has also greatly improved in the last decades. A correct timing for pregnancy (tailored on disease activity and established during a preconception counselling), together with a tight monitoring during the three trimesters and the post-partum period (to timely identify and treat possible obstetric complications or maternal disease flares), as well as the concept of multidisciplinary management, are currently milestones of the management of pregnancy in SLE patients. Nevertheless, the increasing knowledge on the compatibility of drugs with pregnancy has allowed a better treatment of these patients, by choosing medications that control maternal disease activity without harming the foetus. However, particular attention and strict monitoring should be dedicated to SLE pregnant women in particular clinical settings: patients with lupus nephritis and patients with aPL positivity or Antiphospholipid syndrome, who are at higher risk for maternal and foetal complications, but also patients with anti-Ro/SSA and/or anti-La/SSB antibodies, because of the risk of neonatal lupus. A discussion on family planning, as well as counselling on contraception, should be part of the everyday-practice for physicians caring for SLE women during their reproductive age. Another issue is the possible reduction of fertility in these women, that can be due to different reasons. Consequently, the request for assisted reproduction techniques has been increasing in the last years, so that rheumatologists and gynaecologists should be prepared to counsel SLE patients also in this particular setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Impact of embryo co-culture with cumulus cells on pregnancy & implantation rate in patients undergoingin vitrofertilization using donor oocyte.

    Science.gov (United States)

    Bhadarka, Harsha K; Patel, Nayana H; Patel, Niket H; Patel, Molina; Patel, Kruti B; Sodagar, Nilofar R; Phatak, Ajay G; Patel, Jagdish S

    2017-09-01

    Cumulus cell co-culture of embryo had been found to be beneficial for achieving better pregnancy and implantation rate (IR). The present study was aimed to evaluate efficiency of cumulus co-culture technique over simple culture of embryo in terms of pregnancy rate (PR) and IR in patients undergoing treatment for infertility using donor oocytes fertilized by intracytoplasmic sperm injection. This was a quasi-experimental study between control and study groups. The primary endpoint was achievement of pregnancy. Control group included 508 women who underwent embryo development without cumulus cell co-culture and study group included 394 women who underwent embryo development with cumulus cell co-culture using donor's cumulus cells. The present study demonstrated a significant increase in the IR (37.2 vs 24.2%, Pculture technique was found to be more effective than simple culture technique for embryo development in women undergoing treatment for infertility using donor oocytes fertilized by intracytoplasmic sperm injection.

  3. Trends in ectopic pregnancy rates following assisted reproductive technologies in the UK: a 12-year nationwide analysis including 160 000 pregnancies.

    Science.gov (United States)

    Santos-Ribeiro, Samuel; Tournaye, Herman; Polyzos, Nikolaos P

    2016-02-01

    Have the advancement of assisted reproductive technologies (ART) and changes in the incidence of specific causes of infertility-altered ectopic pregnancy (EP) rates following ART over time in the UK? EP rates in the UK following IVF/ICSI have progressively decreased, and this appears to be associated with a reduction in the incidence of tubal factor infertility and the increased use of both a lower number of embryos transferred and extended embryo culture. Historically, EP rates following ART are known to have increased over time. However, the impact of progress in ART procedures and changes in both policy and the incidence of specific causes of infertility on the overall EP rate in the UK has yet to be studied. A population-based retrospective analysis was carried out on all pregnancies following ART cycles carried out in the UK between 2000 and 2012 included in the anonymized database of the Human Fertilisation and Embryology Authority. Overall, 161 967 treatment cycles resulting in a pregnancy were included in the analysis. Among them, 8852 pregnancies occurred after intrauterine insemination (IUI) and 153 115 following IVF/ICSI. During this period of 12 years, ∼1.4% (n = 2244) of all pregnancies following ART were an EP. Crude EP rates were significantly higher after IVF/ICSI when compared with following IUI (1.4 versus 1.1%, P = 0.043). The incidence of EP decreased significantly over time for IVF/ICSI cycles [incidence rate ratios (IRR) 0.96 per year, 95% confidence interval (CI) 0.94-0.97], but not after IUI (IRR 0.96 per year, 95% CI 0.91-1.03).Among pregnancies resulting from IVF/ICSI, multivariable logistic regression analysis demonstrated that the major risk factor for EP was the presence of tubal infertility [adjusted odds ratio (aOR) 2.23, 95% CI 1.93-2.58), followed by the increased number of embryos transferred (aOR 1.29 for 2 versus 1 embryo transferred, 95% CI 1.11-1.49; aOR 1.69 for 3 or more versus 1 embryo transferred, 95% CI 1.35-2.11). The

  4. [Intra-uterine insemination at either 24 or 48hours after ovulation induction: Pregnancy and birth rates].

    Science.gov (United States)

    Haller, L; Severac, F; Rongieres, C; Ohl, J; Bettahar, K; Lichtblau, I; Pirrello, O

    2017-04-01

    Comparing rates of pregnancy and childbirth between IUI at either 24 or 48hours after injection of HCG. This is a single-center retrospective study of couples who underwent intrauterine insemination between January 2013 and December 2014 at Medical-Surgical Obstetrical Centre of Schiltigheim. Stimulation of ovulation was done by FSH or HMG, and ovulation induction by 250μg of recombinant HCG. The insemination was performed after 2 days (group D2) or the day after (group D1). Among the 1092 intrauterine insemination cycles included in our study, 62 were done the day after ovulation induction by HCG (D1), and 1030 the day after (D2). Our study showed no significant difference in the rate of biological pregnancy, defined by a rate of BHCG>15IU/L, between the group D1 (19.35%) and the group D2 (18.12%), P=0.94, and no difference in live birth rate: respectively 14,50% and 11.75%, P=0.18. Our study reported similar rates of pregnancy and childbirth in the group who underwent IUI at D1 and D2 of ovulation induction, suggesting the possibility of IUI on day 1 when the organization of the service needs it, without loss of opportunity for pregnancy. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. The Association Between LH Serum Levels at the time of hCG Injection and Clinical Pregnancy during IVF

    Directory of Open Access Journals (Sweden)

    Budi Wiweko

    2015-12-01

    Full Text Available Some studies showed that recombinant follicle stimulating hormone (r-FSH administration without LH supplementation has a good success rate on in vitro fertilization (IVF. However, LH role in IVF has been controversial. This study was conducted to evaluate the association between serum LH levels at the time of hCG injection and clinical pregnancy during IVF. This retrospective study included 136 patients underwent long protocol IVF from January 2005 to December 2009 in Yasmin Clinic, Cipto Mangunkusumo Hospital, Jakarta. The controlled ovarian hyper-stimulation protocol used in this study was gonadotropin-releasing hormone (GnRH agonist and r-FSH.  Serum LH level was measured on the day of hCG administration and the outcome evaluated was the clinical pregnancy following IVF cycles. There were 32 IVF cycles resulted in pregnancy out of 136 cycles (23.5%. There was significant difference between serum LH levels on the day of hCG administration and clinical pregnancy outcome (p=0.036. LH serum level cut-off value of ≥1.050 IU/l was the best value to predict pregnancy outcome with 62.5% sensitivity, 59.4% specificity, 83.3% positive predictive value, and 32.76% negative predictive value. It was concluded that there was an association between serum LH levels at the time of hCG injection and clinical pregnancy during IVF. Keywords: IVF cycles, LH levels serum, hCG administration   Hubungan Kadar LH saat Penyuntikan hCG dengan Kejadian Kehamilan pada Fertilisasi In vitro Abstrak Pemberian follicles stimulating hormone rekombinan (r-FSH tanpa suplementasi LH memiliki tingkat keberhasilan fertilisasi in vitro (FIV yang baik namun, peran LH pada FIV masih kontroversial. Tujuan penelitian ini adalah untuk mengevaluasi hubungan antara kadar serum LH pada hari penyuntikan hCG dengan kehamilan klinis selama FIV. Penelitian retrospektif ini melibatkan 136 perempuan yang menjalani FIV siklus pertama dengan protokol panjang mulai bulan Januari 2005 sampai

  6. Clinical predictors of failing one dose of methotrexate for ectopic pregnancy after in vitro fertilization.

    Science.gov (United States)

    Brady, Paula C; Missmer, Stacey A; Farland, Leslie V; Ginsburg, Elizabeth S

    2017-03-01

    The aim of this study is to investigate the clinical predictors of failure of a single dose of methotrexate (MTX) for management of ectopic pregnancy after in vitro fertilization (IVF). A retrospective cohort study was performed of women who conceived ectopic pregnancies following fresh or frozen IVF cycles at an academic infertility clinic between 2007 and 2014, and received intramuscular MTX (50 mg/m 2 ). Successful single-dose MTX treatment was defined as a serum beta-human chorionic gonadotropin (hCG) decline ≥15% between days 4 and 7 post-treatment. Logistic regression models adjusted for oocyte age, number of embryos transferred, and prior ectopic pregnancy were used to estimate the adjusted odds ratio (OR) (95% confidence interval [CI]) of failing one dose of MTX. Sixty-four patients with ectopic pregnancies after IVF were included. Forty required only one dose of MTX (62.5%), while 15 required additional MTX alone (up to four total doses, 23.4%), and 9 required surgery (14.1%). By multivariable logistic regression, the highest tertiles of serum hCG at peak (≥499 IU/L, OR = 9.73, CI 1.88-50.25) and at first MTX administration (≥342 IU/L, OR = 4.74, CI 1.11-20.26), fewer embryos transferred (OR = 0.37 per each additional embryo transferred, CI 0.19-0.74), and adnexal mass by ultrasound (OR = 3.65, CI 1.10-12.11) were each correlated with greater odds of requiring additional MTX and/or surgery. This is the first study to report that in women with ectopic pregnancies after IVF, higher hCG-though well below treatment failure thresholds previously described in spontaneous pregnancies-fewer embryos transferred, and adnexal masses are associated with greater odds of failing one dose of MTX. These findings can be used to counsel IVF patients regarding the likelihood of success with single-dose MTX.

  7. Acute pancreatitis in pregnancy: a 6-year single center clinical experience.

    Science.gov (United States)

    Li, Hua-ping; Huang, Ya-juan; Chen, Xuan

    2011-09-01

    The acute abdomen remains a challenge for all obstetricians and physicians who take part in the care of women in pregnancy. To add substantially to our understanding of acute pancreatitis (AP) in pregnancy, in particular affirming the increased risks for mother and fetus associated with AP, we explored features of clinical manifestation and the strategy of management of this disease during pregnancy, and its effects on maternal and fetal outcomes. A retrospective review of medical records of all pregnant patients diagnosed with AP admitted to the Department of Obstetrics and Gynecology, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University between 2005 and 2010 was performed. Information was collected from presentation, management, and outcome from medical records. There were 11 cases in 2010, accounting for 44% of 25 cases. Among these cases, mild AP (MAP) occurred in 15 cases (60%), while the rest cases were severe AP (SAP) (40%). The major etiology of AP in pregnancy was due to gallstone and cholecystitis. Clinical features together with elevation of the plasma concentrations of pancreatic enzymes were the cornerstones of diagnosis. Positive conservative treatment was taken in most of the cases (21 cases, 84%) with a favorable outcome. Seven cases of critically ill patients were monitored in intensive care unit, and 4 patients underwent surgical interventions. As a result, all of 25 patients had better prognosis, no maternal death was observed. There were 8 preterm labors and 2 fetal losses, accounting for the perinatal mortality of 8%. Fetal malformation was not observed. While a pregnant woman suffers acute abdominal pain, early diagnosis and severity assessment of AP are very important. Conservative comprehensive treatment with intensive care is recommended. Surgical intervention should be performed as late as possible.

  8. Clinical application of uterine artery embolization in treating uterine scar pregnancy

    International Nuclear Information System (INIS)

    Li Tonghuai; Zheng Hongfeng

    2011-01-01

    Objective: To evaluate uterine artery embolization in treating uterine scar pregnancy. Methods: During the period from November 2007 to February 2010, 11 patients with uterine scar pregnancy were encountered in authors' hospital. All the patients had a history of lower uterine segment cesarean section. Four patients had to receive an emergency uterine artery embolization due to acute massive vaginal bleeding. The other 7 patients received intravenous chemotherapy with MTX (0.4 mg/kg/day, every 5 days as a treatment course). Emergency uterine artery embolization had to be carried out in three patients as they developed acute massive vaginal bleeding (blood loss ≥ 100 ml/hour) during the course of chemotherapy, while subsequent uterine artery embolization was performed in the remaining 4 patients after they had completed two courses of treatment when their blood HCG showed no significant decrease. The clinical results were analyzed. Results: Remarkable decrease in serum HCG was seen in all 11 patients after interventional management. The vaginal bleeding in 7 patients was significantly reduced within half an hour after uterine artery embolization. The uterus together with intact fertility was successfully preserved in all 11 patients. Conclusion: For the treatment of uterine scar pregnancy complicated by massive vaginal bleeding (blood loss ≥ 500 ml/24 h) and/or abnormal elevation of serum HCG (blood β-HCG ≥ 20000 IU/L), ectopic pregnancy with the mass diameter ≥ 5 cm, uterine artery embolization treatment is very safe and effective. This technique can well preserve female patient's uterus and fertility ability. It is of value to employ this treatment in clinical practice. (authors)

  9. The BRAzil MAGnesium (BRAMAG) trial: a randomized clinical trial of oral magnesium supplementation in pregnancy for the prevention of preterm birth and perinatal and maternal morbidity.

    Science.gov (United States)

    Alves, Joao Guilherme B; de Araújo, Carla Adriane Fonseca Leal; Pontes, Isabelle E A; Guimarães, Angélica C; Ray, Joel G

    2014-07-08

    Preterm birth is the leading cause of infant mortality globally, including Brazil. We will evaluate whether oral magnesium citrate reduces the risk of placental dysfunction and its negative consequences for both the fetus and mother, which, in turn, should reduce the need for indicated preterm delivery. We will complete a multicenter, randomized double-blind clinical trial comparing oral magnesium citrate 150 mg twice daily (n = 2000 women) to matched placebo (n = 1000 women), starting at 121/7 to 206/7 weeks gestation and continued until delivery. We will include women at higher risk for placental dysfunction, based on clinical factors from a prior pregnancy (e.g., prior preterm delivery, stillbirth or preeclampsia) or the current pregnancy (e.g., chronic hypertension, pre-pregnancy diabetes mellitus, maternal age > 35 years or pre-pregnancy maternal body mass index > 30 kg/m2). The primary perinatal outcome is a composite of preterm birth  20 weeks gestation, neonatal death rates of prematurity and limited resources for acute newborn and maternal care. ClinicalTrials.gov Identifier NCT02032186, registered December 19, 2013.

  10. Differences in teenage pregnancy rates among five developed countries: the roles of sexual activity and contraceptive use.

    Science.gov (United States)

    Darroch, J E; Singh, S; Frost, J J

    2001-01-01

    Adolescent pregnancy, birth, abortion and sexually transmitted disease (STD) rates are much higher in the United States than in most other developed countries. Government statistics or nationally representative survey data were supplemented with data collected by private organizations or for regional or local populations to conduct studies of adolescent births, abortions, sexual activity and contraceptive use in Canada, the United States, Sweden, France and Great Britain. Adolescent childbearing is more common in the United States (22% of women reported having had a child before age 20) than in Great Britain (15%), Canada (11%), France (6%) and Sweden (4%); differences are even greater for births to younger teenagers. A lower proportion of teenage pregnancies are resolved through abortion in the United States than in the other countries; however, because of their high pregnancy rate, U.S. teenagers have the highest abortion rate. The age of sexual debut varies little across countries, yet American teenagers are the most likely to have multiple partners. A greater proportion of U.S. women reported no contraceptive use at either first or recent intercourse (25% and 20%, respectively) than reported nonuse in France (11% and 12%, respectively), Great Britain (21% and 4%, respectively) and Sweden (22% and 7%, respectively). Data on contraceptive use are more important than data on sexual activity in explaining variation in levels of adolescent pregnancy and childbearing among the five developed countries; however, the higher level of multiple sexual partnership among American teenagers may help explain their higher STD rates.

  11. Short and long term mortality rates associated with first pregnancy outcome: population register based study for Denmark 1980-2004.

    Science.gov (United States)

    Reardon, David C; Coleman, Priscilla K

    2012-09-01

    There is a growing interest in examining death rates associated with different pregnancy outcomes for time periods beyond one year. Previous population studies, however, have failed to control for complete reproductive histories. In this study we seek to eliminate the potential confounding effect of unknown prior pregnancy history by examining mortality rates associated specifically with first pregnancy outcome alone. We also examine differences in mortality rates associated with early abortion and late abortions (after 12 weeks). Medical records for the entire population of women born in Denmark between 1962 and 1991 and were alive in 1980, were linked to death certificates. Mortality rates associated with first pregnancy outcomes (delivery, miscarriage, abortion, and late abortion) were calculated. Odds ratios examining death rates based on reproductive outcomes, adjusted for age at first pregnancy and year of women's births, were also calculated. A total of 463,473 women had their first pregnancy between 1980 and 2004, of whom 2,238 died. In nearly all time periods examined, mortality rates associated with miscarriage or abortion of a first pregnancy were higher than those associated with birth. Compared to women who delivered, the age and birth year adjusted cumulative risk of death for women who had a first trimester abortion was significantly higher in all periods examined, from 180 days (OR=1.84; 1.11 <95% CI <3.71) through 10 years (1.39; 1.22 <95% CI <1.61), as was the risk for women who had abortions after 12 weeks from one year (OR=4.31; 2.18 <95% CI <8.54) through 10 years (OR=2.41; 1.56 <95% CI <2.41). For women who miscarried, the risk was significantly higher for cumulative deaths through 4 years (OR=1.75; 1.34 <95% CI <2.27) and at 10 years (OR=1.48; 1.18 <95% CI <1.85). Compared to women who delivered, women who had an early or late abortion had significantly higher mortality rates within 1 through 10 years. A lesser effect may also be present

  12. Direct-to-consumer advertising of success rates for medically assisted reproduction: a review of national clinic websites.

    Science.gov (United States)

    Wilkinson, Jack; Vail, Andy; Roberts, Stephen A

    2017-01-12

    To establish how medically assisted reproduction (MAR) clinics report success rates on their websites. Websites of private and NHS clinics offering in vitro fertilisation (IVF) in the UK. We identified clinics offering IVF using the Choose a Fertility Clinic facility on the website of the Human Fertilisation and Embryology Authority (HFEA). Of 81 clinics identified, a website could not be found for 2, leaving 79 for inclusion in the analysis. Outcome measures reported by clinic websites. The numerator and denominator included in the outcome measure were of interest. 53 (67%) websites reported their performance using 51 different outcome measures. It was most common to report pregnancy (83% of these clinics) or live birth rates (51%). 31 different ways of reporting pregnancy and 9 different ways of reporting live birth were identified. 11 (21%) reported multiple birth or pregnancy rates. 1 clinic provided information on adverse events. It was usual for clinics to present results without relevant contextual information such as sample size, reporting period, the characteristics of patients and particular details of treatments. Many combinations of numerator and denominator are available for the purpose of reporting success rates for MAR. The range of reporting options available to clinics is further increased by the possibility of presenting results for subgroups of patients and for different time periods. Given the status of these websites as advertisements to patients, the risk of selective reporting is considerable. Binding guidance is required to ensure consistent, informative reporting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. Pregnancy rates of beef cattle are not affected by Campylobacter fetus subsp. venerealis real-time PCR-positive breeding sires in New Zealand.

    Science.gov (United States)

    Sanhueza, J M; Heuer, C; Jackson, R; Hughes, P; Anderson, P; Kelly, K; Walker, G

    2014-09-01

    Campylobacter fetus subspecies venerealis (C. fetus venerealis) is the causal agent of bovine genital campylobacteriosis, a venereal disease that is asymptomatic in bulls but responsible for reproductive wastage in female cattle. In New Zealand, a commercial real-time PCR assay was introduced in 2007 to identify the DNA of this pathogen in preputial scrapings; however, concerns were raised about the specificity of the test following anecdotal reports of a high number of test-positive bulls with no apparent relationship to reproductive performance. The objective of this study, therefore, was to examine the association between real-time PCR assay results from beef breeding bulls and pregnancy rates in beef herds using these bulls. Veterinarians from four veterinary practices selected beef cattle herds with relatively high and low pregnancy rates between December 2008 and February 2009. Preputial scrapings were collected from bulls used for mating in those herds. Samples were tested using the real-time PCR assay under consideration. Bivariable and multivariable analyses were used to assess the relationship between pregnancy rates in each mob (15-month-old heifers, 27-month-old heifers and mixed-age cows) and the percentage of real-time PCR-positive bulls in each mob. Sixty-four (28.8%) of 222 bulls tested positive, 130 (58.6%) tested negative, and 28 (12.6%) returned an inconclusive result to the real-time PCR assay. The percentage of bulls testing real-time PCR-positive in these mobs was not associated with pregnancy rates (p=0.757) after controlling for mob, average body condition score of cows, cow to bull ratio, length of the mating period, and farm. Real-time PCR assay results were not associated with pregnancy rates, suggesting that the specificity of the real-time PCR assay was too low to be used to reliably detect C. fetus venerealis. This study adds to a growing body of evidence indicating that C. fetus venerealis strains are either absent from, or present at

  14. HCG administration after endogenous LH rise negatively influences pregnancy rate in modified natural cycle for frozen-thawed euploid blastocyst transfer: a pilot study.

    Science.gov (United States)

    Litwicka, Katarzyna; Mencacci, Cecilia; Arrivi, Cristiana; Varricchio, Maria Teresa; Caragia, Alina; Minasi, Maria Giulia; Greco, Ermanno

    2017-11-17

    The aim of the present study was to evaluate whether in a modified natural cycle (modified-NC) for a frozen-thawed single euploid blastocyst transfer, a critical LH value, above which human chorionic gonadotropin (hCG) administration should be avoided, may be defined. One hundred and sixty-seven patients underwent modified natural cycle in order to transfer a single frozen-thawed euploid blastocyst. All embryos were obtained by intracytoplasmic sperm injection and were biopsied at the blastocyst stage and analyzed by means of array comparative genomic hybridization (aCGH). Ovulation was induced using 10.000 IU hCG when the mean follicle diameter was at least of 17 mm, independently from LH values. The primary end points were the hCG-positive test and clinical pregnancy. The interim analysis showed that LH value ≥ 13 mIU/ml on the day of hCG injection may negatively influence the clinical results, suggesting that in this condition, it should be advisable waiting for spontaneous ovulation. Among patients who received hCG for ovulation induction, the hCG-positive test and clinical pregnancy rates in modified-NC were significantly lower in cycles with LH ≥ 13 mIU/ml in respect to those with LH hCG administration led to significantly lower rates of hCG-positive test (45.4 vs 74.5% in hCG administration and spontaneous ovulation groups, respectively) and clinical pregnancy (36.4 vs 64.7% in hCG administration and spontaneous ovulation groups, respectively). The baseline patient characteristics were comparable in all groups. The findings of this study highlight that LH elevation ≥ 13 mIU/ml prior to hCG administration may negatively affect clinical pregnancy rates in modified-NC for single euploid blastocyst transfer. The LH determination should be routinely performed during follicular monitoring. In the presence of LH level ≥ 13 mIU/ml, hCG administration should be avoided, and the embryo transfer should be planned only after spontaneous

  15. Use of complementary and alternative medicines associated with a 30% lower ongoing pregnancy/live birth rate during 12 months of fertility treatment

    DEFF Research Database (Denmark)

    Boivin, J; Schmidt, L

    2009-01-01

    BACKGROUND There seems to be little discussion between patient and physician about the use of complementary and alternative medicines (CAMs), perhaps because they are not perceived to have adverse effects on fertility. We therefore compared ongoing pregnancy and live birth rate in spontaneous users...... and non-users of CAM during a 12-month period of assisted reproduction technique (ART) treatment. Consent was by questionnaire return. METHOD This was a prospective observational cohort study with a 12-month follow-up period, sampling consecutive patients attending five ART clinics in Denmark. N = 728...

  16. Duration of pregnancy in relation to fish oil supplementation and habitual fish intake: a randomised clinical trial with fish oil

    DEFF Research Database (Denmark)

    Olsen, Sjurdur Frodi; Østerdal, M L; Salvig, J D

    2007-01-01

    OBJECTIVE: To examine the effect of fish oil supplementation on duration of pregnancy, conditional on the woman's habitual fish intake. DESIGN: Multicentre 1:1 randomised clinical trial of effect of fish oil in a high-risk population of pregnant women in whom habitual fish intake was assessed...... at randomisation. SETTING: Nineteen university delivery wards in seven European countries. SUBJECTS: Pregnant women with preterm delivery, intrauterine growth retardation (IUGR), or pregnancy-induced hypertension (PIH) in a previous pregnancy (group 1, n=495); with twin pregnancies (group 2, n=367......); or with suspicion of IUGR or threatening preeclampsia in the current pregnancy (group 3, n=106). Women were stratified into low, middle, or high fish consumers. METHODS: The intervention group received fish oil capsules providing 2.7 g long-chain n-3 fatty acids per day (n-3 poly unsaturated fatty acids (PUFA...

  17. The experiences of pregnant women in an interventional clinical trial: Research In Pregnancy Ethics (RIPE) study.

    Science.gov (United States)

    Ballantyne, Angela; Pullon, Susan; Macdonald, Lindsay; Barthow, Christine; Wickens, Kristen; Crane, Julian

    2017-07-01

    There is increasing global pressure to ensure that pregnant women are responsibly and safely included in clinical research in order to improve the evidence base that underpins healthcare delivery during pregnancy. One supposed barrier to inclusion is the assumption that pregnant women will be reluctant to participate in research. There is however very little empirical research investigating the views of pregnant women. Their perspective on the benefits, burdens and risks of research is a crucial component to ensuring effective recruitment. The Research In Pregnancy Ethics (RIPE) study set out to ascertain the views of pregnant women about research participation using an inductive thematic analysis. We conducted semi-structured interviews with 20 women who had participated in a double-blind randomised placebo controlled trial in Wellington (New Zealand) while pregnant. Our results show that at least some pregnant women recognise the value and importance of research during pregnancy. The women we interviewed were deeply invested in the research process and outcomes. Key motivations for participating were altruism, playing a valuable civic role and the importance of research. The main perceived burdens related to inconvenience and time commitment. For some women, possible randomization to the placebo arm was regarded as a burden or disadvantage. © 2017 John Wiley & Sons Ltd.

  18. Clinical Analyses of 66 Cases of Mid-trimester Pregnancy Termination in Women with Prior Cesarean

    Directory of Open Access Journals (Sweden)

    Ping Peng

    2015-01-01

    Full Text Available Background: The rate of cesarean delivery has significantly increased in China in the last decade. Women with prior cesarean history tend to have a higher risk of uterine rupture during termination of the pregnancy in mid-trimester than those without such a history. The aim of our study was to evaluate the influences of the potential risk factors on uterine rupture in women with prior cesarean. Methods: We conducted this retrospective study of women with prior cesarean section, who underwent mid-trimester pregnancy termination between January 2006 and December 2013 in Peking Union Medical College Hospital. The protocol was oral administration of mifepristone and misoprostol for the patients with the gestational ages below 16 weeks or intra-amniotic injection of ethacridine lactate (EL for those with at least 16 weeks of gestational ages. The thickness of the lower uterine segment (LUS was measured before the termination of pregnancy. Logistic regression was used to study the risk factors of uterine rupture. Results: The total rate of successful abortion was 93.9% (62/66. Four patients failed in induction, and one of them received curettage, whereas the other three experienced uterine rupture (4.5%. The successful rates of abortion were 85.7% (30/35 for women treated with mifepristone-misoprostol and 86.1% (31/36 for those treated with EL. There was a significant difference in the mean LUS thickness between the uterine rupture group (3.0 ± 2.0 mm and the nonrupture group (7.0 ± 3.0 mm (P < 0.05. The LUS thickness of <3 mm was associated with uterine rupture during mid-trimester pregnancy termination in women with prior cesarean (odds ratio, 94.0; 95% confidence interval 4.2-2106.1 after adjusted maternal age, gestational age, interdelivery interval and prior cesarean section. Severe bleeding that required transfusion occurred in one case (1.5%. Conclusions: Both the mifepristone-misoprostol and the EL regimens were effective and safe for the

  19. Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S

    OpenAIRE

    Stanger-Hall, Kathrin F.; Hall, David W.

    2011-01-01

    The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005) from all U.S. states with information on sex education laws or po...

  20. Sperm vacuoles negatively affect outcomes in intracytoplasmic morphologically selected sperm injection in terms of pregnancy, implantation, and live-birth rates.

    Science.gov (United States)

    Greco, Ermanno; Scarselli, Filomena; Fabozzi, Gemma; Colasante, Alessandro; Zavaglia, Daniela; Alviggi, Erminia; Litwicka, Katarzyna; Varricchio, Maria Teresa; Minasi, Maria Giulia; Tesarik, Jan

    2013-08-01

    To retrospectively evaluate whether sperm vacuoles influence clinical results, with a particular focus on live-birth rates, in 101 intracytoplasmic morphologically selected sperm injection (IMSI) cycles. Retrospective, observational study. Medical center. A total of 101 couples with at least two failed intracytoplasmic sperm injection (ICSI) attempts and impaired sperm morphology. Patients divided into two groups according to sperm morphology and vacuolization pattern: group A comprising patients with good quality spermatozoa (type I and/or type II spermatozoa) (n = 63 patients); group B comprising patients with low quality spermatozoa (type III and/or IV spermatozoa) (n = 38 patients). Fertilization rate, embryo quality, pregnancy, implantation, and live-birth rates. No statistically significant differences were observed between group A and B with regard to "early" assisted reproduction outcomes (fertilization rate and embryo quality). However, the "late" outcomes (pregnancy, implantation, and live-birth rates) were statistically significantly higher in group A. These results confirm a correlation between sperm vacuoles and a negative IMSI outcome, suggesting that sperm vacuoles are related to the late paternal effect. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Clinical trial considerations on male contraception and collection of pregnancy information from female partners

    Directory of Open Access Journals (Sweden)

    Banholzer Maria

    2012-06-01

    Full Text Available Abstract Background There is little guidance regarding the risk of exposure of pregnant women/ women of childbearing potential to genotoxic or teratogenic compounds via vaginal dose delivered through seminal fluid during sexual intercourse. Method We summarize current thinking and provide clinical trial considerations for a consistent approach to contraception for males exposed to genotoxic and/or teratogenic compounds or to compounds of unknown teratogenicity, and for collection of pregnancy data from their female partners. Results Where toxicity testing demonstrates genotoxic potential, condom use is required during exposure and for 5 terminal plasma half-lives plus 74 days (one human spermatogenesis cycle to avoid conception. For non-genotoxic small molecules and immunoglobulins with unknown teratogenic potential or without a no observed adverse effect level (NOAEL from embryo-fetal development (EFD studies and no minimal anticipated biological effect level (MABEL, condom use is recommended for males with pregnant partner/female partner of childbearing potential. For teratogenic small molecules with estimated seminal fluid concentration and a margin between projected maternal area under the curve (AUC and NOAEL AUC from EFD studies of ≥300 (≥100 for immunoglobulins or in the absence of a NOAEL with a margin between MABEL plasma concentration and maternal Cmax of ≥300 (≥10 for immunoglobulins, condom use is not required. However, condom use is required for margins below the thresholds previously indicated. For small molecules with available seminal fluid concentrations, condom use is required if margins are Pregnancy data should be proactively collected if pregnancy occurs during the condom use period required for males exposed to first-in-class molecules or to molecules with a target/class shown to be teratogenic, embryotoxic or fetotoxic in human or preclinical experiments. Conclusion These recommendations, based on a precaution

  2. [Clinical study of induced abortion of early-early pregnancy: an analysis of 10, 404 cases].

    Science.gov (United States)

    Kang, Jian; Wang, Xue-fen; Zhang, Li; Liu, Jian-hua

    2012-01-03

    To evaluate the advantages and disadvantages of early-early pregnancy induced abortion (EPIA). A total of 10 404 cases of EPIA performed at our hospital from January 1993 to December 2003 were retrospectively analyzed and compared with 9434 cases of common induced abortion (CIA). The amount of hemorrhage and operative duration, degree of pain, rate of induced-abortion syndrome, rate of incomplete abortion, menstrual changes and post-operative onset of Asherman's syndrome were observed and compared between 2 groups. The average age, ratio of parous cases, ratio of the cases of first-pregnancy induced abortion were not different between 2 groups (P > 0.05). The amount of hemorrhage bleeding ((4.9 ± 3.2) ml), operative duration ((90.3 ± 12.4) s), degree of pain, rate of induced-abortion syndrome, menstrual changes and the rate of Asherman's syndrome in the EPIA group were all significantly less than those in the CIA group (P abortion (0.44%) in the EPIA group was significantly higher than that (0.21%) in the CIA group (P abortion stays high.

  3. Emergency contraception with a Copper IUD or oral levonorgestrel: an observational study of 1-year pregnancy rates

    Science.gov (United States)

    Turok, David K.; Jacobson, Janet C.; Dermish, Amna I.; Simonsen, Sara E.; Gurtcheff, Shawn; McFadden, Molly; Murphy, Patricia A.

    2014-01-01

    Objective We investigated the one-year pregnancy rates for emergency contraception (EC) users who selected the copper T380 IUD or oral levonorgestrel (LNG) for EC. Study Design This prospective study followed women for 1 year after choosing either the copper T380 IUD or oral LNG for EC. The study was powered to detect a 6% difference in pregnancy rates within the year after presenting for EC. Results Of the 542 women who presented for EC, agreed to participate in the trial, and meet inclusion criteria, 215 (40%) chose the copper IUD and 327 (60%) chose oral LNG. In the IUD group, 127 (59%) were nulligravid. IUD insertion failed in 42 women (19%). The 1-year follow-up rate was 443/542 (82%); 64% of IUD users contacted at 1 year still had their IUDs in place. The 1-year cumulative pregnancy rate in women choosing the IUD was 6.5% vs. 12.2% in those choosing oral LNG (HR= 0.53, 95% CI: 0.29–0.97, p=0.041). By type of EC method actually received, corresponding values were 5.2% for copper IUD users vs. 12.3% for oral LNG users, HR 0.42 (95% CI: 0.20–0.85, p= 0.017). A multivariable logistic regression model controlling for demographic variables demonstrates that women who chose the IUD for EC had fewer pregnancies in the following year than those who chose oral LNG (HR 0.50, 95% CI: 0.26–0.96, p=0.037). Conclusion One year after presenting for EC women choosing the copper IUD for EC were half as likely to have a pregnancy compared to those choosing oral LNG. PMID:24332433

  4. Pancreatic adenocarcinoma presenting as acute pancreatitis during pregnancy: clinical and radiologic manifestations.

    Science.gov (United States)

    Perera, Dinushi; Kandavar, Ramprasad; Palacios, Enrique

    2011-01-01

    Only seven cases of pancreatic adenocarcinoma diagnosed during pregnancy have been reported. In this article, we describe a case of pancreatic adenocarcinoma presenting clinically as acute pancreatitis in a pregnant patient. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) revealed a pancreatic mass with an inflammatory component and multiple hyperintense metastatic lesions in the liver. The patient was initially treated for biliary pancreatitis, and pancreatic cancer was not suspected given her young age and absence of risk factors. A diagnosis of pancreatic cancer in a pregnant patient requires a high index of suspicion, and pancreatitis can be a mode of presentation.

  5. Single versus repeat doses of misoprostol for treatment of early pregnancy loss-a randomized clinical trial.

    Science.gov (United States)

    Mizrachi, Yossi; Dekalo, Ann; Gluck, Ohad; Miremberg, Hadas; Dafna, Lotem; Feldstein, Ohad; Weiner, Eran; Bar, Jacob; Sagiv, Ron

    2017-06-01

    Does repeat administration of misoprostol for early pregnancy loss increase the treatment success rate? Repeat administration of misoprostol does not increase the treatment success rate, and is associated with more analgesics use. Misoprostol reduces the need for surgical evacuation and shortens the time to complete expulsion in patients with early pregnancy loss. However, the impact of repeat doses of misoprostol is not clear. A randomized clinical trial was conducted in a single tertiary hospital, recruiting women with early pregnancy loss (misoprostol vaginally on Day 1, and were then randomly assigned into two groups: Patients in the single-dose group were evaluated on Day 8. Patients in the repeat-dose group were evaluated on Day 4, when they were given a repeat dose if required, and scheduled for re-evaluation on Day 8. If complete expulsion was not achieved on Day 8 (endometrial thickness >15 mm or the presence of gestational sac on transvaginal sonography), participants underwent surgical evacuation. The primary outcome was treatment success, defined as no need for surgical intervention up to Day 8. Final analysis included 87 participants in the single-dose group and 84 participants in the repeat-dose group, out of whom 41 (48.8%) received a second dose. Treatment succeeded in 67 (77%) patients in the single-dose group and 64 (76%) patients in the repeat-dose group (RR 0.98; 95% CI 0.83-1.16; P = 0.89). Patients in the repeat-dose group reported more use of over the counter analgesics (82.1% versus 69.0%, P = 0.04). The study was not blinded and our definition of complete expulsion may be debated. Follow-up time was not equal in all participants, since some had a complete expulsion on Day 4 and some underwent emergent D&C before Day 8. This, however, should not affect the primary outcome. Our results suggest that a single-dose protocol is superior to a repeat-dose protocol due to a comparable success rate and more favorable outcomes regarding the need for

  6. [Cesarean section incidence and vaginal birth success rate at term pregnancy after myomectomy].

    Science.gov (United States)

    Mekiňová, L; Janků, P; Filipinská, E; Kadlecová, J; Ventruba, P

    To compare the incidence of primary and acute cesarean section (CS) and to compare success rate of vaginal delivery. To determine the frequency of maternal complications and evaluation of post-partum condition of the newborn. Prospective, pilot, cohort study. Department of Gynecology and Obstetrics Masaryk University and University Hospital Brno. Analysis of patients with physiologically ongoing singleton pregnancy and term delivery, vertex presentation. Women from the study group (n = 67) underwent myomectomy because of symptomatic, solitary uterine fibroid. Women from the control group (n = 4079) had no history of myomectomy. Analysis was aimed at comparing the incidence of primary and acute CS and comparing success rate of vaginal delivery in both groups and determing the frequency of maternal complications and evaluation of post-partum condition of the newborn. A significantly higher incidence of primary cesarean section was observed in the study group with a history of myomectomy compared to the control group (n = 20, 29.9%; versus n = 396, 9.7 %, p cesarean section in both groups was recorded (n = 7, 10.4%; versus n = 570, 14.0%, p = 0.079). No statistically significant difference in the success of vaginal delivery in both groups was recorded (n = 40, 85.1%; versus n = 3113, 84.5%, p = 0.079). The excessive blood loss was the most frequent complication in both group (n = 9, 13.4%; versus n = 214, 5.2%, p = 0.057). No statistically significant difference in the incidence of uterine rupture and postpartum hysterectomy was recorded. No maternal or fetal death related to childbirth was observed. The history of myomectomy does not increase the incidence of acute cesarean section in the group of strictly selected patients suitable for vaginal birth and has no impact on the success of vaginal delivery. Careful management of labor is a prerequisite for a low risk of maternal complications and good perinatal outcomes.

  7. Detection and Management of Diabetes during Pregnancy in Low Resource Settings: Insights into Past and Present Clinical Practices

    Directory of Open Access Journals (Sweden)

    Bettina Utz

    2016-01-01

    Full Text Available Background. Timely and adequate treatment is important to limit complications of diabetes affecting pregnancy, but there is a lack of knowledge on how these women are managed in low resource settings. Objective. To identify modalities of gestational diabetes detection and management in low and lower middle income countries. Methods. We conducted a scoping review of published literature and searched the databases PubMed, Web of Science, Embase, and African Index Medicus. We included all articles published until April 24, 2016, containing information on clinical practices of detection and management of gestational diabetes irrespective of publication date or language. Results. We identified 23 articles mainly from Asia and sub-Saharan Africa. The majority of studies were conducted in large tertiary care centers and hospital admission was reported in a third of publications. Ambulatory follow-up was generally done by weekly to fortnightly visits, whereas self-monitoring of blood glucose was not the norm. The cesarean section rate for pregnancies affected by diabetes ranged between 20% and 89%. Referral of newborns to special care units was common. Conclusion. The variety of reported provider practices underlines the importance of promoting latest consensus guidelines on GDM screening and management and the dissemination of information regarding their implementation.

  8. An introduction to the special section on psychotherapy for pregnancy loss: Review of issues, clinical applications, and future research direction.

    Science.gov (United States)

    Markin, Rayna D

    2017-12-01

    This introduction article to the special section on psychotherapy for pregnancy loss reviews important societal and psychological issues, key clinical processes and recommendations, and future research directions. Differences and similarities among the articles in the special section are discussed along with each article's contribution to the higher order goal of viewing pregnancy loss through a psychological rather than solely medical lens. Each article in this section reviews different therapeutic modalities, interventions, and key clinical process issues when working with patients who have suffered the loss of a pregnancy. The important role that psychotherapy can play in helping parents to mourn the loss of a pregnancy is explored in this introductory article and throughout the special section. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  9. Maternal Serum Resistin Is Reduced in First Trimester Preeclampsia Pregnancies and Is a Marker of Clinical Severity

    DEFF Research Database (Denmark)

    Christiansen, Michael; Hedley, Paula L; Placing, Sophie

    2015-01-01

    OBJECTIVE: To examine whether resistin levels in first trimester maternal serum are associated with insulin resistance or preeclampsia (PE). METHODS: A case-control study of maternal serum resistin concentration conducted using 285 normal pregnancies and 123 PE pregnancies matched for gestational...... age, parity and maternal age. Samples were taken in gestational weeks 10(+0)-13(+6). RESULTS: There was a negative correlation between resistin and clinical severity of PE, but no correlation with IS, TNF-α, body mass index, birth weight and pregnancy length. CONCLUSIONS: Resistin is reduced in first...

  10. Systemic lupus erythematosus and pregnancy: clinical evolution, maternal and perinatal outcomes and placental findings

    Directory of Open Access Journals (Sweden)

    Fernanda Garanhani de Castro Surita

    2007-03-01

    Full Text Available CONTEXT AND OBJECTIVE: Systemic lupus erythematosus is a chronic disease that is more frequent in women of reproductive age. The relationship between lupus and pregnancy is problematic: maternal and fetal outcomes are worse than in the general population, and the management of flare-ups is difficult during this period. The aim here was to compare the outcomes of 76 pregnancies in 67 women with lupus, according to the occurrence or absence of flare-ups. DESIGN AND SETTING: An observational cohort clinical study evaluating the evolution of pregnant women with lupus who were receiving care at the prenatal outpatient clinic, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM/Unicamp, between 1995 and 2002. METHODS: Data were collected on a precoded form. The women were divided into two groups according to the occurrence or absence of flare-ups, as defined by the systemic lupus erythematosus disease activity index (SLEDAI. The presence or absence of flare-ups and renal involvement was considered to be the independent variable and the other results were dependent variables. RESULTS: Flare-ups occurred in 85.3% of cases, and were most significant when there was renal involvement. This was related to greater numbers of women with preeclampsia and poor perinatal outcome. Intrauterine growth restriction was more common in the women with active disease. Placental weight was significantly lower in the women with renal involvement. CONCLUSIONS: Flare-ups and renal involvement in lupus patients during pregnancy are associated with increased maternal and perinatal complications.

  11. Imaging Appearance and Clinical Impact of Preoperative Breast MRI in Pregnancy-Associated Breast Cancer.

    Science.gov (United States)

    Myers, Kelly S; Green, Lauren A; Lebron, Lizza; Morris, Elizabeth A

    2017-09-01

    The purpose of this study is to describe the imaging features of pregnancy-associated breast cancer (PABC) on breast MRI and to consider the impact of preoperative MRI on patient management. A retrospective review of medical records from January 1994 to May 2014 identified 183 women who presented with a new diagnosis of breast cancer during pregnancy or within 1 year postpartum. MR images were available for 53 of these patients, all of whom were included in the study. Clinical history and available breast images were reviewed. The clinical impact of preoperative breast MRI was also recorded. Of the 53 women, nine (17%) presented during pregnancy and 44 (83%) presented during the first year postpartum. The sensitivity of MRI was 98% (52/53). Among the 53 patients, the most common findings of PABC on MRI included a solitary mass (29 patients [55%]), nonmass enhancement (12 patients [23%]), and multiple masses (eight patients [15%]). For 12 patients (23%), MRI showed a pathologically proven larger tumor size or greater extent of disease than did mammography or ultrasound, with an additional eight patients (15%) having findings suspicious for greater extent of disease but having unavailable pathologic data. Breast MRI changed surgical management for 15 patients (28%), with four patients (8%) requiring a larger lumpectomy, seven (13%) no longer being considered candidates for lumpectomy, two (4%) having contralateral disease, and two (4%) having unsuspected metastasis. Breast MRI had a high sensitivity for PABC in our study population. MRI may play an important role in PABC because it changed the surgical management of 28% of patients.

  12. Relationship between ovulation rate and embryonic characteristics in gilts at 35 d of pregnancy.

    Science.gov (United States)

    Da Silva, C L A; Broekhuijse, M L W J; Laurenssen, B F A; Mulder, H A; Knol, E F; Kemp, B; Soede, N M

    2017-07-01

    This study investigated the relationship between ovulation rate (OR) and embryonic characteristics in gilts. Landrace ( = 86) and Yorkshire x Landrace ( = 212) gilts were inseminated with semen stored for 3 to 5 d (SS1, = 59), 6 to7 d (SS2, = 133), or 8 to 10 d (SS3, = 106), and slaughtered at 35 d of pregnancy. Ovulation rate was assessed by dissection of the corpora lutea on both ovaries. Embryos were classified as vital (VE) by visual appearance and individually weighed (VEg) and the SD of the weight calculated (SDVEg). Early embryonic mortality (EM) was estimated as the difference between OR and the number of vital plus nonvital embryos. Embryonic characteristics were analyzed with a model that included linear and quadratic terms of OR and fixed class effects of semen storage duration (SS) and genetic line (GL). Landrace gilts had a higher OR than Yorkshire x Landrace gilts (22.1 ± 0.4 vs. 20.3 ± 0.2, ≤ 0.05) and also a higher EM (6.1 ± 0.4 vs. 3.5 ± 0.3, ≤ 0.05). EM was also higher in gilts inseminated with semen stored for more than 8 d. Also, Yorkshire x Landrace gilts had a higher number of VE (16.9 ± 0.7) than the Landrace gilts (13.3 ± 0.8) when inseminations were done with semen stored for up to 5 d. Yorkshire x Landrace gilts had the highest VEg when inseminated with semen stored for 3 to 5 d (SS1: 4.9 ± 0.2 g, SS2: 4.1 ± 0.1 g, and SS3: 4.0 ± 0.2 g; ≤ 0.05). VE and VEg did not differ within Landrace gilts between different SS classes. A quadratic relationship of OR ( ≤ 0.05) was found with VE: a maximum of 16.8 VE was observed at 26 ovulations [(2.5 (± 0.6)*OR- 0.05 (± 0.01)*OR]. A quadratic relationship of OR ( ≤ 0.05) was also found for EM: a minimum of 3.33 EM was observed at 15 ovulations [(-1.1 (± 0.6)*OR -0.03 (± 0.01)*OR]. VEg was not related with OR, but SDVEg had a positive linear relationship with OR [0.01 (± 0.003)*OR, ≤ 0.05]. Results show that Yorkshire x Landrace gilts perform better than Landrace when

  13. Prediabetes in pregnancy, can early intervention improve outcomes? A feasibility study for a parallel randomised clinical trial.

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    Hughes, Ruth C E; Rowan, Janet; Williman, Jonathan

    2018-03-03

    Measurement of glycated haemoglobin (HbA1c) in early pregnancy is routine in New Zealand to identify women with diabetes and prediabetes. However, the benefit of early intervention in women with prediabetes is inconclusive. Our aim was to test the feasibility of a two-arm parallel randomised controlled trial of standard care versus early intervention in pregnancies complicated by prediabetes. Two tertiary referral centres in New Zealand. Women measured at booking, without pre-existing diabetes. Randomisation was done by remote web-based allocation into one of two groups. Women in the early intervention group attended an antenatal diabetes clinic, commenced daily home blood glucose monitoring, and medication was prescribed if lifestyle measures failed to maintain target blood glucose levels. Controls received lifestyle education, continued standard care with their midwife and/or obstetrician, and were asked to perform a 75 g oral glucose tolerance test at 24 weeks' gestation with a referral to clinic if this test was positive. Both groups received lifestyle questionnaires at recruitment and in late pregnancy. Recruitment rate, adherence to protocol and validation of potential primary outcomes. Recruitment rates were lower than expected, especially in Māori and Pacific women. Non-adherence to allocated treatment protocol was significant, 42% (95% CI 24% to 61%) in the early intervention group and 30% (95% CI 16% to 51%) in controls. Caesarean section and pre-eclampsia were signalled as potential primary outcomes, due to both the high observed incidence in the control group and ease of measurement. For a future definitive trial, extending the gestation of eligibility and stepped-wedge cluster randomisation may overcome the identified feasibility issues. Consistent with published observational data, pre-eclampsia and emergency caesarean section could be included as primary outcome measures, both of which have a significant impact on maternal and neonatal morbidity and

  14. Sperm morphology and chromatin integrity in Swedish warmblood stallions and their relationship to pregnancy rates

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    Sandebert Thomas

    2008-01-01

    Full Text Available Abstract Background Artificial insemination is not as widely used in horses as in other domestic species, such as dairy cattle and pigs, partly because of the wide variation in sperm quality between stallion ejaculates and partly due to decreased fertility following the use of cooled transported spermatozoa. Furthermore, predictive tests for sperm fertilising ability are lacking. The objective of the present study was to assess sperm morphology and chromatin integrity in ejaculates obtained from 11 warmblood breeding stallions in Sweden, and to evaluate the relationship of these parameters to pregnancy rates to investigate the possibility of using these tests predictively. Methods Aliquots from fortyone ejaculates, obtained as part of the normal semen collection schedule at the Swedish National Stud, were used for morphological analysis by light microscopy, whereas thirtyseven were used for chromatin analysis (SCSA by flow cytometry. The outcome of inseminations using these ejaculates was made available later in the same year. Results Ranges for the different parameters were as follows; normal morphology, 27–79.5%; DNA-fragmentation index (DFI, 4.8–19.0%; standard deviation of DNA fragmentation index (SD_DFI 41.5–98.9, and mean of DNA fragmentation index (mean_DFI, 267.7–319.5. There was considerable variation among stallions, which was statistically significant for all these parameters except for mean_DFI (P P P P P P P P P Conclusion Either or both of the parameters, sperm morphology and sperm chromatin integrity, seem to be useful in predicting the fertilising ability of stallion ejaculates, particularly in determining cases of sub-fertility.

  15. Effect of the time in administration of clomiphene on follicular growth, endometrium and pregnancy rates in PCOS patients

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    Mahtab Zeinalzadeh

    2017-03-01

    Full Text Available Background: Clomiphene citrate is very successful in inducing ovulation; there is usually a discrepancy between ovulation and pregnancy rate. If treatment is started early in the cycle this negative effect is reduced. The aim of this study was to investigate the effect of the time of administration of clomiphene citrate on follicular growth, endometrial thickness and ovulation and pregnancy rates in PCOS (Polycystic ovary syndrome patients. Methods: This randomized controlled trial study was performed on 115 PCOS (Polycystic ovary syndrome women in Fateme Zahra Fertility and Infertility Research Health Center in April 2012. Patients randomly divided into two groups. Patients in the early group (No. 55 received 100 milligrams of clomiphene citrate tablet daily starting the next day after finishing medroxyprogesterone acetate tablet for 5 day, whereas the patient in the late group (No. 60 received 100 milligrams of clomiphene citrate tablet daily for 5 day starting on day 3 of the menstrual cycle. Then on follicular growth, endometrial thickness and ovulation and pregnancy rates by SPSS software, version 16 (Armonk, NY, USA were compared in two groups. Results: 36.4% of patients of early administration of clomiphene and 60% of patients in the later administration of Clomiphene were able to build dominant follicle. This difference was statistically significant (P<0.011. There was no statistically significant difference between the two groups on age, body mass index, duration of infertility. Findings showed that in the early group 14 (63.6% and in the late groups 8 (36.4% women who made dominant follicle, were pregnant. There was significant difference between these two groups (P<0.001. But, in the number of follicles, endometrial thickness and pregnancy rate, there were no significant difference. In the early administration of clomiphene, the pregnancy rate was 25.5%. However in the later administration of clomiphene it was 13.3% (P=0

  16. Projecting the potential impact of the Cap-Score™ on clinical pregnancy, live births, and medical costs in couples with unexplained infertility.

    Science.gov (United States)

    Babigumira, Joseph B; Sharara, Fady I; Garrison, Louis P

    2018-01-01

    The Cap-Score™ was developed to assess the capacitation status of men, thereby enabling personalized management of unexplained infertility by choosing timed intrauterine insemination (IUI), versus immediate in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in individuals with a low Cap-Score™. The objective of this study was to estimate the differences in outcomes and costs comparing the use of the Cap-Score™ with timed IUI (CS-TI) and the standard of care (SOC), which was assumed to be three IUI cycles followed by three IVF-ICSI cycles. We developed and parameterized a decision-analytic model of management of unexplained infertility for women based on data from the published literature. We calculated the clinical pregnancy rates, live birth rates, and medical costs comparing CS-TI and SOC. We used Monte Carlo simulation to quantify uncertainty in projected estimates and performed univariate sensitivity analysis. Compared to SOC, CS-TI was projected to increase the pregnancy rate by 1-26%, marginally reduce live birth rates by 1-3% in couples with women below 40 years, increase live birth rates by 3-7% in couples with women over 40 years, reduce mean medical costs by $4000-$19,200, reduce IUI costs by $600-$1370, and reduce IVF costs by $3400-$17,800, depending on the woman's age. The Cap-Score™ is a potentially valuable clinical tool for management of unexplained infertility because it is projected to improve clinical pregnancy rates, save money, and, depending on the price of the test, increase access to treatment for infertility.

  17. Molar Pregnancy

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    ... Vaginal bleeding Molar pregnancy Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  18. Pregnancy outcomes decline with increasing recipient body mass index: an analysis of 22,317 fresh donor/recipient cycles from the 2008-2010 Society for Assisted Reproductive Technology Clinic Outcome Reporting System registry.

    Science.gov (United States)

    Provost, Meredith P; Acharya, Kelly S; Acharya, Chaitanya R; Yeh, Jason S; Steward, Ryan G; Eaton, Jennifer L; Goldfarb, James M; Muasher, Suheil J

    2016-02-01

    To examine the effect of recipient body mass index (BMI) on IVF outcomes in fresh donor oocyte cycles. Retrospective cohort study. Not applicable. A total of 22,317 donor oocyte cycles from the 2008-2010 Society for Assisted Reproductive Technology Clinic Outcome Reporting System registry were stratified into cohorts based on World Health Organization BMI guidelines. Cycles reporting normal recipient BMI (18.5-24.9) were used as the reference group. None. Implantation rate, clinical pregnancy rate (PR), pregnancy loss rate, live birth rate. Success rates and adjusted odds ratios with 95% confidence intervals for all pregnancy outcomes were most favorable in cohorts of recipients with low and normal BMI, but progressively worsened as BMI increased. Success rates in recipient cycles are highest in those with low and normal BMI. Furthermore, there is a progressive and statistically significant worsening of outcomes in groups with higher BMI with respect to clinical pregnancy and live birth rate. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  19. Sociodemographic disparities and behavioral factors in clinical oral health status during pregnancy

    Science.gov (United States)

    Chung, Lisa H.; Gregorich, Steven E.; Armitage, Gary C.; Gonzalez-Vargas, Judy; Adams, Sally H.

    2013-01-01

    Objective Although oral health (OH) problems are common during pregnancy, little is known about individual characteristics or behaviors relating to clinically assessed OH during pregnancy. This cross-sectional study describes the clinical OH status of a sample of pregnant women, examines relationships between sociodemographic factors and OH, behavioral factors and OH, and the influence of behavior on the relationships between sociodemographic clusters and OH. Baseline data were utilized from a pilot intervention study promoting OH during pregnancy. Methods Participants (n=99), recruited from CenteringPregnancy® prenatal care groups completed: questionnaires addressing race/ethnicity, income, education, dental insurance, oral hygiene practices, and dental care utilization; and clinical examinations for periodontal probing depths (PD), bleeding on probing (BOP), plaque assessment, and visual detection of untreated decay. Chi-squares and one-way ANOVAs with Tukey’s Studentized Range Test of planned comparisons were conducted to examine bivariable relationships between both sociodemographic and behavioral characteristics to OH status. Multivariable logistic regression analyses tested whether the effects of sociodemographic variables on OH status might be mediated by behaviors, including self-reported oral hygiene and recent dental visits. Results Forty-five percent of the sample had untreated decay and the mean percentage of sites with BOP=18%. Bivariable analyses of sociodemographic factors indicated that compared to Whites, Hispanic women had greater % of sites with: BOP, PD ≥5mm plus BOP, and Plaque Index (PI) scores of ≥2, all p=0.05; and greater untreated decay (Chi-square 13.3, p<0.001). Lower income was related to greater untreated decay (Chi-square 7.6, p<0.01). Compared to the highest education level, the lowest level group had higher % BOP, p<0.05. Public dental insurance (versus private) was associated with greater % BOP, PD ≥5mm plus BOP, both p<0

  20. Altered Preconception Fatty Acid Intake Is Associated with Improved Pregnancy Rates in Overweight and Obese Women Undertaking in Vitro Fertilisation

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    Lisa J. Moran

    2016-01-01

    Full Text Available Maternal preconception diet is proposed to affect fertility. Prior research assessing the effect of altering the fatty acid profile on female fertility is conflicting. The aim of this study was to assess the effect of preconception maternal diet, specifically fatty acid profile, on pregnancies and live births following in vitro fertilisation (IVF. Forty-six overweight and obese women undergoing IVF were randomised to a diet and physical activity intervention (intervention or standard care (control. Outcome measures included pregnancy, live birth and pre-study dietary intake from food frequency questionnaire. Twenty pregnancies (n = 12/18 vs. n = 8/20, p = 0.12 and 12 live births (n = 7/18 vs. n = 5/20, p = 0.48 occurred following the intervention with no differences between the treatment groups. On analysis adjusted for BMI and smoking status, women who became pregnant had higher levels of polyunsaturated fatty acid (PUFA intake (p = 0.03, specifically omega-6 PUFA and linoleic acid (LA (p = 0.045 with a trend for an elevated intake of omega-3 PUFA (p = 0.06. There were no dietary differences for women who did or did not have a live birth. Maternal preconception PUFA, and specifically omega-6 and LA intake, are associated with improved pregnancy rates in overweight and obese women undergoing IVF. This has implications for optimising fertility through preconception nutrition.

  1. Evaluation of the enzyme test for the detection of clinically significant red blood cell antibodies during pregnancy.

    Science.gov (United States)

    Hundrić-Haspl, Z; Juraković-Loncar, N; Grgicević, D

    1999-01-01

    In the Croatian transfusion medicine, no general agreement has yet been achieved whether red blood cell (RBC) Rhesus (Rh) antibodies detected during pregnancy only by enzyme tests can cause hemolytic disease of the newborn (HDN). Results of the detection of clinically significant RBC antibodies by low-ionic-strength additive solution antiglobulin test (LISS-IAT) and trypsin enzyme test in 22,947 pregnant women are presented. All pregnant women in whom clinically significant RBC antibodies (RBC-CSA) were detected by LISS-IAT and/or enzyme tests were followed and observed during pregnancy. The women who had enzyme-only anti-D antibodies in their serum were followed up during subsequent pregnancies. Out of 302 positive results obtained by both techniques, irregular clinically significant enzyme-only antibodies (anti-RhD and anti-RhE specificity) were detected in 14 (4.6%) pregnant women. None of 11 RhD positive newborns whose mothers had enzyme-only anti-D antibodies, had signs of HDN after delivery. In these 11 women, anti-D antibodies were detected by LISS-IAT in the first trimenon of subsequent pregnancy. Nine infants born from subsequent pregnancies to women who had previously had enzyme-only anti-D, had clinical signs of HDN. The authors concluded that there is no need for enzyme tests in prenatal testing because enzyme tests are not reliable in the prediction of HDN.

  2. A clinical decision support system for prediction of pregnancy outcome in pregnant women with systemic lupus erythematosus.

    Science.gov (United States)

    Paydar, Khadijeh; Niakan Kalhori, Sharareh R; Akbarian, Mahmoud; Sheikhtaheri, Abbas

    2017-01-01

    Pregnancy among systemic lupus erythematosus (SLE)-affected women is highly associated with poor obstetric outcomes. Predicting the risk of foetal outcome is essential for maximizing the success of pregnancy. This study aimed to develop a clinical decision support system (CDSS) to predict pregnancy outcomes among SLE-affected pregnant women. We performed a retrospective analysis of 149 pregnant women with SLE, who were followed at Shariati Hospital (104 pregnancies) and a specialized clinic (45 pregnancies) from 1982 to 2014. We selected significant features (ppregnancy outcome. In order to evaluate and select the most effective network, we used the confusion matrix and the receiver operating characteristic (ROC) curve. We finally developed a CDSS based on the most accurate network. MATLAB 2013b software was applied to design the neural networks and develop the CDSS. Initially, 45 potential variables were analysed by the binary logistic regression and 16 effective features were selected as the inputs of neural networks (P-valuepregnancy outcome. The developed CDSS based on the MLP network can help physicians to predict pregnancy outcomes in women with SLE. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Relaxation Therapy on Fetal Outcomes in Complicated Pregnancies Suffering Sleep Disorders: A Randomized Clinical Trial

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    azar nematollahi

    2016-10-01

    Full Text Available Background: Sleep disorders like snoring, mouth breathing, and insomnia are frequent in pregnancy and studies have shown that poor sleep is linked to obstetric complications. Muscle relaxation technique is an effective method used for improving sleep quality. The purpose of this study was to determine the effect of muscle relaxation technique on fetal outcomes in complicated pregnancies with sleep disorders. Methods: This study was performed as a clinical trial on 160 pregnant women who suffered from preeclampsia and gestational diabetes. The participants filled the Pittsburgh Sleep Quality Index (PSQI in order to measure the quality and patterns of their sleep. The participants with the total score of 5 or more were included in the present study. Intervention group were asked to use muscle relaxation technique twice a week at home for 8 weeks alongside the routine care. Study variables included sleep quality, Apgar scores, birth weight, levels of Interleukin- 6 (IL- 6, as well as umbilical cord PH and PO2. Results: The mean score of PSQI before the intervention was 9.28±4.16 and 9.18±3.06 in the intervention and control groups without a significant difference (P=0.6, respectively. However, PSQI global score of the experimental group was smaller than the control group at the end of the study (P<0.001. Also, birth weight (P=0.04, Apgar score (P=0.01, and umbilical cord blood po2 (P=0.03 and PH (P=0.01 were higher, and IL-6 (P=0.04 was smaller in the experimental group compared to the control group. Conclusion: The results of this study showed that muscle relaxation, as a simple, inexpensive and safe method, can improve the fetal outcomes such as birth weight, Apgar score, cord blood po2, and cord blood PH, and also it leads to lower IL-6 in complicated pregnancies.

  4. IUD insertion following termination of pregnancy: a clinical trial of the TCu 220C, Lippes loop D, and copper 7.

    Science.gov (United States)

    1983-04-01

    A randomized multicenter trial was performed of the TCu 220C, Lippes Loop D, and Copper 7 involving 2340 insertions immediately following legal termination of pregnancy. The TCu 220C was shown to be superior to the other 2 devices, with lower pregnancy, expulsion, and medical removal rates at 750 days of use. The removal rates for pelvic inflammatory disease were low for all 3 devices. The expulsion rates following 2nd trimester termination for all devices were much higher than following early 1st trimester termination, particularly for the Lippes Loop. IUD insertion following 2nd trimester abortion is not to be recommended using the conventional insertion techniques.

  5. Pregnancy rate after vasectomy reversal in a contemporary series: influence of smoking, semen quality and post-surgical use of assisted reproductive techniques.

    Science.gov (United States)

    van Dongen, Joyce; Tekle, Fetene B; van Roijen, J Herman

    2012-08-01

    Study Type - Outcomes (cohort series). Level of Evidence 2b What's known on the subject? and What does the study add? Microsurgical vasectomy reversal is an effective and cost-effective method of reinstating fertility in a man who has previously had a vasectomy. The current literature indicates that the success rate (i.e. potency and pregnancy rates) are dependent primarily on the time elapsed since vasectomy and the age of the female partner. Using a multivariate Cox regression model, evaluation of the influence of preoperative data (including smoking) and semen parameters indicates a significant influence of post-surgical sperm motility only, on time to first pregnancy. The use of assisted reproductive techniques, when natural pregnancy failed, was successful in ≈50% of couples who attempted this procedure and accounted for an absolute increase in pregnancy rate of 14%. • To determine the influence of smoking, postoperative semen characteristics and the use of an assisted reproductive technique (ART) on pregnancy rate in a contemporary series of men undergoing vasectomy reversal. • Between January 2002 and January 2009, 186 vasectomy reversals were performed. Of the 171 patients who could be contacted for follow-up, 162 attempted pregnancy and constitute the study group. • Semen analysis was performed 3 months after the procedure and at subsequent 3-monthly intervals. • Patient characteristics and surgical information were obtained from a computerized database, and follow-up data were collected by telephone interview. • A multivariate Cox regression model was used to discern possible prognosticators with respect to pregnancy outcome. • The overall patency rate was 91.4%, with a natural pregnancy rate of 44.4% and a subsequent 14.2% of patients conceiving using a ARTs resulting in a total pregnancy rate of 58.6%. Multiple pregnancies were obtained by 20.4% of couples. • Smoking of the male or female partner did not influence the probability of

  6. Anti-N-Methyl-d-Aspartate receptor (NMDAR) encephalitis during pregnancy: Clinical analysis of reported cases.

    Science.gov (United States)

    Shi, Yan-Chao; Chen, Xiu-Ju; Zhang, Hong-Mei; Wang, Zhen; Du, Da-Yong

    2017-06-01

    To analyze the clinical features of 13 pregnant patients with anti-N-Methyl-d-Aspartate receptor (NMDAR) encephalitis. Retrospective review of thirteen reported cases was conducted for anti-NMDAR encephalitis patients during pregnancy. The clinical data were collected from papers published in PubMed prior to 16 February 2016. Statistical analysis of the data was performed, which encompasses the patients' age, past medical history, onset of symptoms, concomitant with ovarian teratomas, immunotherapy, outcomes of mothers and newborns. Thirteen cases were reported in 11 articles with a median age of 23 (interquartile range, 19-27) years old. There were eight cases in which the onset periods of gestation happened in the first trimester and five cases in the second trimester. Among 13 cases, five patients had a past medical history, one concomitant with autoimmune Graves' hyperthyroidism, one with bilateral ovarian teratomas removed history, one with anti-NMDAR encephalitis five years before pregnancy and two with psychiatric symptoms. Five patients were found with ovarian teratomas. Seven patients responded to first-line immunotherapy whereas all of two patients responded to second-line immunotherapy when the first-line immunotherapy failed. Following up all the 13 patients, most experienced a substantial recovery, except one had spasticity and dystonia in one hand, and one died of a superimposed infection. Three fetuses were miscarried or aborted in total. Most newborns were healthy, except two cases (2/10) with abnormal neurologic signs. Clinical analysis of the data indicates that most patients respond to first-line immunotherapy. A second-line immunotherapy is effective when first-line immunotherapy fails. It has also been found that most mothers and newborns can have good outcomes. Copyright © 2017. Published by Elsevier B.V.

  7. Has Roe v. Wade Reduced U.S. Crime Rates?: Examining the Link between Mothers' Pregnancy Intentions and Children's Later Involvement in Law-Violating Behavior

    Science.gov (United States)

    Hay, Carter; Evans, Michelle M.

    2006-01-01

    Rates of serious crime in the United States dropped greatly throughout the 1990s for virtually all offenses. John Donohue and Steven Levitt have argued that this reduction relates strongly to the 1973 "Roe v. Wade" decision that legalized the abortion of unwanted pregnancies. If such pregnancies result in children with higher lifetime risks of…

  8. The effect of DASH diet on pregnancy outcomes in gestational diabetes: a randomized controlled clinical trial.

    Science.gov (United States)

    Asemi, Z; Samimi, M; Tabassi, Z; Esmaillzadeh, A

    2014-04-01

    The current study was performed to investigate the effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM). This randomized controlled clinical trial was performed among 52 women diagnosed with GDM. Participants were randomly assigned to consume either the control (n=26) or the DASH diet (n=26) for 4 weeks. The control diet was designed to contain 45-55% carbohydrates, 15-20% protein and 25-30% total fat. The DASH diet was rich in fruits, vegetables, whole grains and low-fat dairy products, and contained lower amounts of saturated fats, cholesterol and refined grains with a total of 2400 mg/day sodium. The numbers of women who commenced insulin therapy after dietary intervention, the mode of delivery and prevalence of polyhydramnios were assessed. The length, weight and head circumference of infants were measured during the first 24 h after birth. Whereas 46.2% of women in the DASH diet needed to have a cesarean section, this percentage for the control group was 80.8% (P=0.01). The percentage of those who needed to commence insulin therapy after intervention was also significantly different between the two groups (23% for DASH vs 73% for control group, PDASH diet had significantly lower weight (3222.7 vs 3818.8 g, Pdiet. In conclusion, consumption of DASH diet for 4 weeks among pregnant women with GDM resulted in improved pregnancy outcomes.

  9. Diagnosis and treatment of 163 patients with ectopic pregnancy in exceptional site

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    Jie ZOU

    2013-05-01

    Full Text Available Objective  To explore the clinical characteristics, reasons for misdiagnosis and treatment of ectopic pregnancies in exceptional sites. Methods  A retrospective analysis was performed based on the clinical data of 163 patients with ectopic pregnancy in exceptional site concerning clinical characteristics, type of ectopic pregnancy, preoperative diagnosis and misdiagnosis rate, and treatment and outcomes in our hospital from Jan. 2007 to Jun. 2012. Results  The incidence of exceptional site ectopic pregnancy accounted for 14.82% (163/1100 of the total number of ectopic pregnancy occurring during the same period, and the preoperative diagnosis rate was 49.7%, the misdiagnosis rate was 50.3%. Of the exceptional site ectopic pregnancy, 8 cases were cervical pregnancy, 3 were abdominal pregnancy, 37 cesarean section scar pregnancy, 44 uterine horn pregnancy, 54 interstitial part of Fallopian tube pregnancy, 1 retroperitoneal pregnancy, 15 ovarian pregnancy and 1 uterine intramural pregnancy. Conclusion  Ectopic pregnancy in exceptional sites is usually accompanied by atypical clinical features, so it is hard to diagnose exactly. It is necessary to raise our ability to recognize the characteristic of ectopic pregnancy in an exceptional site, so as to make a right diagnosis and treatment, and reduce misdiagnosis and serious consequences.

  10. [Clinical analysis of acute hyperlipidemic pancreatitis during pregnancy and postpartum period].

    Science.gov (United States)

    Li, Hong-liang; Jiang, Yuan-hui; Wei, Yuan; Zhao, Yang-yu; Zhu, Xi; Yao, Gai-qi

    2014-02-18

    To describe the characteristics of acute pancreatitis during pregnancy and postpartum. From 1994 to 2012, 18 cases of gravida and postpartum women complicated with acute pancreatitis were treated at Peking University Third Hospital and retrospective analysis was performed. The admission rate due to acute pancreatitis was 41.24 per 100 000 admission. The median age was 32.0 (28.0, 34.7) years, with the onset of acute pancreatitis on 35.0 (23.5, 37.0) weeks'gestation. Of all the cases, 13 (72.2%) were interstitial edematous acute pancreatitis, and 5 (27.8%) were necrotizing. Nine (50.0%) were caused by hyperlipidemia, of which 7 (38.9%) were caused by gallstones, and 2 (1.1%) were idiopathic. Stratified by severity, 6 (33.3%) were mild, 7 (38.9%) were moderately severe and 5 (27.8%) were severe, of which 8 were transferred to Intensive Care Unit. Compared with non-hyperlipidemic acute pancreatitis, cases caused by hyperlipidemia were more severe, however, the prognoses of mothers and infants were good. The incidence of acute pancreatitis during pregnancy and postpartum was similar to that of the regular population, and mostly caused by gallstones and hyperlipidemia. Although acute hyperlipidemic pancreatitis is more severe, the morbidity and mortality of maternal and perinatal could be decreased by aggressive therapy.

  11. First trimester sonography: effective in reducing of post term pregnancy rate

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    Behdani R

    2008-06-01

    Full Text Available Background: Approximately 10 percent of all pregnancies continue to 42 weeks'gestation. The true prevalence of pregnancies lasting longer than 41 or 42 weeks'gestation has been difficult to establish because many such diagnoses occur as a result of an inability to accurately establish time of conception. Several studies indicate that menstrual dating is often inaccurate and can lead to induction of labor for a presumed but inaccurate diagnosis of postterm pregnancy. It is now widely accepted that a more precise method of determining gestational age is the first trimester measurement of crown-rump length of the fetus.Methods: We carried out a cross- sectional study on patients who were referred for a prenatal care to Arash hospital, Medical Sciences/University of Tehran. Women in the first trimester of pregnancy who presented to the center during the study period with precise  date of last menstrual period were eligible to enroll. They underwent an ultrasound dating scan between 8 and 12 weeks, measuring crown-rump length. The estimated date of delivery (EDD was changed if there was a discrepancy of more than 5 days from the gestation, calculated from the last menstrual period (LMP. For the remaining women (no-scan group, gestation was determined using the LMP. Data were analyzed using SPSS, 11. Statistical significance was assessed with Chi-square, student t-test and Anova, using a significance threshold of < 0.05.Results: Of 217 women who were enrolled, 10.6% of the patients who underwent an ultrasound dating scan were postdate versus 3.7% of the patients whose gestational age calculated from LMP (p=0.005.Conclusions: The application of first trimester sonographic measurement of crown-rump length of the fetus results in a significant reduction of the diagnosis of postterm pregnancies.

  12. Safety aspects of Chinese herbal medicine in pregnancy-re-evaluation of experimental data of two animal studies and the clinical experience.

    Science.gov (United States)

    Wiebrecht, Axel; Gaus, Wilhelm; Becker, Simon; Hummelsberger, Josef; Kuhlmann, Kirsten

    2014-10-01

    Chinese herbal medicine is an increasingly popular worldwide medical therapy which also has an impact in pregnancy. However, the question of its drug safety during pregnancy remains unresolved. Potential problems include teratogenicity, abortion, perinatal toxicity, pre- and postnatal developmental abnormalities, and eventually an increased risk for carcinomas in the offspring. Standard Materia Medica textbooks contain unreliable information when it comes to risks during pregnancy. Wang and co-workers conducted an experimental study (WS) on mice in which they investigated the effects of 17 Chinese medicinals regarding embryotoxicity and fetotoxicity. All these drugs seemed to exhibit multiple significant toxic effects. Another study by Li and co-workers (LS) investigated the reproductive toxicity of Atractylodis macrocephalae Rhizoma in mice, rats and rabbits. They described an increased pre- and postnatal mortality and, at high doses, congenital malformations. In an attempt to identify the risks of the tested medicinals during pregnancy, we analysed these two experimental studies and compared their results with possible safety data for humans from two reviews of clinical studies on threatened miscarriage (AR and CR). We re-evaluated WS and LS in relation to accordance with internationally accepted rules, equivalence to human dose, biometric accuracy, plausibility, and coherence. Eligible studies of the two reviews on threatened miscarriage were evaluated for specific pregnancy risks concerning the 17 medicinals tested in WS and LS. We found that WS does not conform to international ICH guidelines and includes many inconsistencies, implausibilities and several severe biometrical flaws. It reported a total of 364 significant events out of which 145 false significant results are expected. The data-handling pointed to irregularities. Analysis of LS exhibited also many inconsistencies. The results regarding congenital malformations were statistically insignificant and

  13. Congenital cytomegalovirus infection in pregnancy: a review of prevalence, clinical features, diagnosis and prevention.

    Science.gov (United States)

    Naing, Zin W; Scott, Gillian M; Shand, Antonia; Hamilton, Stuart T; van Zuylen, Wendy J; Basha, James; Hall, Beverly; Craig, Maria E; Rawlinson, William D

    2016-02-01

    Human cytomegalovirus (CMV) is under-recognised, despite being the leading infectious cause of congenital malformation, affecting ~0.3% of Australian live births. Approximately 11% of infants born with congenital CMV infection are symptomatic, resulting in clinical manifestations, including jaundice, hepatosplenomegaly, petechiae, microcephaly, intrauterine growth restriction and death. Congenital CMV infection may cause severe long-term sequelae, including progressive sensorineural hearing loss and developmental delay in 40-58% of symptomatic neonates, and ~14% of initially asymptomatic infected neonates. Up to 50% of maternal CMV infections have nonspecific clinical manifestations, and most remain undetected unless specific serological testing is undertaken. The combination of serology tests for CMV-specific IgM, IgG and IgG avidity provide improved distinction between primary and secondary maternal infections. In pregnancies with confirmed primary maternal CMV infection, amniocentesis with CMV-PCR performed on amniotic fluid, undertaken after 21-22 weeks gestation, may determine whether maternofetal virus transmission has occurred. Ultrasound and, to a lesser extent, magnetic resonance imaging are valuable tools to assess fetal structural and growth abnormalities, although the absence of fetal abnormalities does not exclude fetal damage. Diagnosis of congenital CMV infection at birth or in the first 3 weeks of an infant's life is crucial, as this should prompt interventions for prevention of delayed-onset hearing loss and neurodevelopmental delay in affected infants. Prevention strategies should also target mothers because increased awareness and hygiene measures may reduce maternal infection. Recognition of the importance of CMV in pregnancy and in neonates is increasingly needed, particularly as therapeutic and preventive interventions expand for this serious problem. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  14. Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices.

    Science.gov (United States)

    Sivin, I; Stern, J; Diaz, S; Pavéz, M; Alvarez, F; Brache, V; Mishell, D R; Lacarra, M; McCarthy, T; Holma, P

    1992-04-01

    The objectives were to measure rates of planned pregnancy and factors affecting these rates after use of very-long-acting contraceptive methods (Norplant or Norplant II implants, a levonorgestrel-releasing intrauterine contraceptive device, or the copper T (model TCu 380Ag) intrauterine contraceptive device. The design was a concurrent, multicenter prospective study of 372 women who stopped contraception for planned pregnancy. Analysis was by life-table, log-rank, and standard chi 2 methods. Pregnancy rates 12 and 24 months after cessation of contraceptive use were 82 and 89 per 100, respectively. Age at removal and family planning intentions at initiation of contraception were both significantly correlated with pregnancy rates (p less than 0.05), but former contraceptive regimen and duration of contraceptive use were not. Pregnancy outcomes did not deviate from normal limits and did not differ by contraceptive formerly used. Contraceptive implants releasing 30 micrograms/day of levonorgestrel or intrauterine contraceptive devices releasing 20 micrograms/day of levonorgestrel or having copper surface areas of 380 mm2 are associated with normal fertility after use for women seeking pregnancy at termination. Durations of use do not affect pregnancy rates.

  15. Meningiomas in pregnancy: timing of surgery and clinical outcomes as observed in 104 cases and establishment of a best management strategy.

    Science.gov (United States)

    Laviv, Yosef; Bayoumi, Ahmed; Mahadevan, Anand; Young, Brett; Boone, Myles; Kasper, Ekkehard M

    2017-03-22

    There is a strong correlation between the level of circulating female sex hormones and the parturient growth of meningiomas. As a result, rapid changes in meningioma size occur during pregnancy, putting both the mother and fetus at risk. Large, symptomatic meningiomas require surgical resection, regardless of the status of pregnancy. However, the preferred timing of such complex intervention is a matter of debate. The rarity of this clinical scenario and the absence of prospective trials make it difficult to reach evidence-based conclusions. The aim of this study was to create evidence-based management guidelines for timing of surgery for pregnancy-related intracranial meningiomas. The English literature from 1990 to 2016 was systematically reviewed according to PRISMA guidelines for all surgical cases of pregnancy-related intracranial meningiomas. Cases were divided into two groups: patients who have had surgery during pregnancy and delivered thereafter (group A) and patients who delivered first (group B). Groups were compared for demographic, clinical and radiological features, as well as for neurosurgical, obstetrical and neonatological outcomes. Statistical analysis was performed to assess differences. A total of 104 surgical cases were identified and reviewed, of which 86 were suitable for comparison and statistical analysis. Thirty-five patients (40%) underwent craniotomy for resection during pregnancy or at delivery (group A) and 51 patients (60%) underwent surgery after delivery (group B). Groups showed no significant differences in characteristics such as age at diagnosis, number of gestations, presenting symptoms, tumor site and tumor size. Despite a comparable distribution over the gestational trimesters, group A had significantly more patients diagnosed prior to the 27th gestational week (46 vs 17.5%, p = 0.0075). Group A was also associated with a significantly higher rate of both emergent craniotomies (40 vs 19.6%, p = 0.0048) and emergent

  16. Incidence rate of clinical bovine mastitis in selected smallholder ...

    African Journals Online (AJOL)

    A study was conducted in Gondar town in six selected smallholder farms from. August 2005 to January 2006 for six months to measure incidence rate of clinical bovine mastitis. Monitoring was performed by animal attendants of each farm after training and supervision of the monitoring activities and collection of data.

  17. Clinical Rating Project Interim Report Number 3: Background and Status.

    Science.gov (United States)

    Cason, Gerald J.

    A substantial and indispensable portion of the training of health professionals must be conducted in clinical settings and is performance oriented rather than cognitively oriented. Evaluation methods usually require reliance upon check lists and rating scales and capture a large volume of information in order to accurately reflect the complexity…

  18. Effectiveness of respiratory rates in determining clinical deterioration

    DEFF Research Database (Denmark)

    Mølgaard, Rikke Rishøj; Larsen, Palle; Håkonsen, Sasa Jul

    2016-01-01

    Review question/objective: The objective of this systematic review is to identify, appraise and synthesize the best available evidence on the effectiveness of manually measuring respiratory rates for 60 s or less in detecting clinical deterioration of inpatients. More specifically, the review...

  19. Incidence rate of clinical bovine mastitis in selected smallholder ...

    African Journals Online (AJOL)

    A study was conducted in Gondar town in six selected smallholder farms from August 2005 to January 2006 for six months to measure incidence rate of clinical bovine mastitis. Monitoring was performed by animal attendants of each farm after training and supervision of the monitoring activities and collection of data was ...

  20. Can risk factors, clinical history and symptoms be used to predict risk of ectopic pregnancy in women attending an early pregnancy assessment unit?

    Science.gov (United States)

    Ayim, F; Tapp, S; Guha, S; Ameye, L; Al-Memar, M; Sayasneh, A; Bottomley, C; Gould, D; Stalder, C; Timmerman, D; Bourne, T

    2016-11-01

    To examine whether risk factors and symptoms may be used to predict the likelihood of ectopic pregnancy (EP) in women attending early pregnancy assessment units in the UK. This was an observational cohort study of pregnant women under 12 weeks' gestation who were recruited from three London university hospitals between August 2012 and April 2013. One hospital continued recruitment between January and June 2015. A standardized information sheet incorporating patient demographics, medical history and symptoms was completed by patients and confirmed by examining clinicians. The outcome measure was final pregnancy location. There were 1320 eligible patients included in the analysis, with a total of 72 EPs (rate of 6%). Pelvic pain and diarrhea > three times in the previous 24 h were independent symptoms that increased the risk of EP, with relative risks of 2.4 (95% CI, 1.4-4.0; P = 0.002) and 2.2 (95% CI, 1.08-4.5; P = 0.03), respectively. The only other independent marker of risk of EP was duration of vaginal bleeding; the risk of EP increased by 20% (95% CI, 14%-27%) for every 1-day increment in duration (P three times in the previous 24 h was reported and 9% (9/103) when there was only vaginal bleeding with a duration > 3 days. Women with pelvic pain and vaginal bleeding of any severity for > 3 days had a high EP rate of 16% (23/146). In the nine women who also reported diarrhea > three times in the previous 24 h, two had EP. Only the presence of pelvic pain, diarrhea > three times in the previous 24 h and duration of bleeding were symptoms that significantly increased the risk for EP in women attending early pregnancy assessment units. Risk factors and symptoms alone could not be used to predict reliably an EP. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

  1. Multivariate analysis of factors affecting probability of pregnancy and live birth with in vitro fertilization: an analysis of the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System.

    Science.gov (United States)

    Baker, Valerie L; Luke, Barbara; Brown, Morton B; Alvero, Ruben; Frattarelli, John L; Usadi, Rebecca; Grainger, David A; Armstrong, Alicia Y

    2010-09-01

    To evaluate factors predictive of clinical pregnancy and of pregnancy loss from assisted reproductive technology (ART) using data from the Society for Assisted Reproductive Technology database for 2004-2006. Retrospective cohort. Clinic-based data. The study population included 225,889 fresh embryo transfer cycles using autologous oocytes and partner semen. None. Clinical intrauterine gestation (presence of gestational sac) and live birth (>or=22 weeks gestation and >or=300 g birth weight). Increasing maternal age was significantly associated with a reduced odds of conception and increased fetal loss until 19 weeks gestation, but not with later pregnancy loss. Intracytoplasmic sperm injection (ICSI), assisted hatching, and increasing number of embryos transferred had significant positive effects on the odds of conception and pregnancy continuation through the first trimester, but did not affect the risk of later loss. Blacks, Asians, and Hispanics had significantly lower odds of clinical pregnancy compared with whites. Also compared with whites, Hispanics and Asians had a significantly greater risk of pregnancy loss in the second and third trimesters, and blacks had a significantly greater risk of pregnancy loss in all trimesters. Certain demographic and ART treatment parameters influenced chance of conception and early pregnancy loss, whereas black race and Hispanic ethnicity were also significantly associated with late pregnancy loss in ART-conceived pregnancies. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  2. Pelvic endometriosis with peritoneal fluid reduces pregnancy rates in women undergoing intrauterine insemination

    OpenAIRE

    Wu, Hong-Ming; Tzeng, Chii-Ruey; Chen, Chi-Hung; Chen, Pi-Hua

    2013-01-01

    Objective: This study investigated the occurrence of peritoneal fluid in women undergoing intrauterine insemination (IUI) and its correlation with the stage of pelvic endometriosis and its influence on pregnancy outcomes. Materials and Methods: A retrospective case–control design was used to recruit 272 infertile women with pelvic endometriosis. The treatment protocol consisted of controlled ovarian hyperstimulation with downregulation and gonadotropin for IUI treatment following ultrasoun...

  3. Thyroid hormone availability during pregnancy and early life: determinants, interpretation and consequences : Translating thyroid physiology into clinical epidemiology studies

    NARCIS (Netherlands)

    T.I.M. Korevaar (Tim)

    2017-01-01

    markdownabstractThis thesis contains studies that investigates determinants of thyroid function during pregnancy and early life. We identified novel determinants such as angiogenic factors, known factors such as hCG and also clinical factors that were incorporated into a prediction model. We also

  4. Methylenetetrahydrofolate reductase C677T and A1298C variants do not affect ongoing pregnancy rates following IVF.

    Science.gov (United States)

    Dobson, A T; Davis, R M; Rosen, M P; Shen, S; Rinaudo, P F; Chan, J; Cedars, M I

    2007-02-01

    There is concern that IVF could compromise normal imprinting and methylation of DNA. Methylenetetrahydrofolate reductase (MTHFR) regulates the flow of folic acid-derived, one-carbon moieties for methylation and is critical to early embryonic development. Therefore, we hypothesized that common polymorphisms in MTHFR could associate with IVF outcome. MTHFR C677T and A1298C polymorphism genotyping was performed on 374 subjects for this study, representing 197 couples undergoing IVF in a university setting from July 2005 to January 2006. Analysis of variance (ANOVA), chi-square and/or multivariate analyses were used to assess whether these polymorphisms are associated with embryo quality or with ongoing pregnancy or spontaneous abortion rates. Allele frequencies for C677T ( p=0.67, q=0.33) and A1298C ( p=0.71, q=0.29) were in Hardy-Weinberg equilibrium. The C677T and A1298C variants, either alone or in combination, did not associate with embryo quality or short-term pregnancy outcome. The common polymorphisms in MTHFR are not associated with embryo quality, as defined by cell number or fragmentation score, or with short-term pregnancy outcomes. Therefore, in our population in which women receive adequate folic acid, MTHFR genotypes are not informative in explaining IVF failure. Further studies, however, examining birth outcomes and the other enzymes in the folic acid pathway are warranted.

  5. Clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus in pregnancy.

    Science.gov (United States)

    Laibl, Vanessa R; Sheffield, Jeanne S; Roberts, Scott; McIntire, Donald D; Trevino, Sylvia; Wendel, George D

    2005-09-01

    The objective of this study was to review the presentation and management of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) in pregnant women. This was a chart review of pregnant patients who were diagnosed with MRSA between January 1, 2000, and July 30, 2004. Data collected included demographic characteristics, clinical presentation, culture results, and pathogen susceptibilities. Patients' pregnancy outcomes were compared with the general obstetric population during the study period. Fifty-seven charts were available for review. There were 2 cases in 2000, 4 in 2001, 11 in 2002, 23 in 2003, and 17 through July of 2004. Comorbid conditions included human immunodeficiency virus and acquired immunodeficiency syndrome (13%), asthma (11%), and diabetes (9%). Diagnostic culture was most commonly obtained in the second trimester (46%); however 18% of cases occurred in the postpartum period. Skin and soft tissue infections accounted for 96% of cases. The most common site for a lesion was the extremities (44%), followed by the buttocks (25%), and breast (mastitis) (23%). Fifty-eight percent of patients had recurrent episodes. Sixty-three percent of patients required inpatient treatment. All MRSA isolates were sensitive to trimethoprim-sulfamethoxazole, vancomycin, and rifampin. Other antibiotics to which the isolates were susceptible included gentamicin (98%) and levofloxacin (84%). In comparison with the general obstetric population, patients with MRSA were more likely to be multiparous and to have had a cesarean delivery. Community-acquired MRSA is an emerging problem in our obstetric population. Most commonly, it presents as a skin or soft tissue infection that involves multiple sites. Recurrent skin abscesses during pregnancy should raise prompt investigation for MRSA. II-3.

  6. The Obesity-Fertility Protocol: a randomized controlled trial assessing clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention, before and during pregnancy, in obese infertile women.

    Science.gov (United States)

    Duval, Karine; Langlois, Marie-France; Carranza-Mamane, Belina; Pesant, Marie-Hélène; Hivert, Marie-France; Poder, Thomas G; Lavoie, Hélène B; Ainmelk, Youssef; St-Cyr Tribble, Denise; Laredo, Sheila; Greenblatt, Ellen; Sagle, Margaret; Waddell, Guy; Belisle, Serge; Riverin, Daniel; Jean-Denis, Farrah; Belan, Matea; Baillargeon, Jean-Patrice

    2015-01-01

    Obesity in infertile women increases the costs of fertility treatments, reduces their effectiveness and increases significantly the risks of many complications of pregnancy and for the newborn. Studies suggest that even a modest loss of 5-10 % of body weight can restore ovulation. However, there are gaps in knowledge regarding the benefits and cost-effectiveness of a lifestyle modification program targeting obese infertile women and integrated into the fertility clinics. This study will evaluate clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention, before and during pregnancy, in obese infertile women. We hypothesize that the intervention will: 1) improve fertility, efficacy of fertility treatments, and health of mothers and their children; and 2) reduce the cost per live birth, including costs of fertility treatments and pregnancy outcomes. Obese infertile women (age: 18-40 years; BMI ≥30 kg/m(2) or ≥27 kg/m(2) with polycystic ovary syndrome) will be randomised to either a lifestyle intervention followed by standard fertility treatments after 6 months if no conception has been achieved (intervention group) or standard fertility treatments only (control group). The intervention and/or follow-up will last for a maximum of 18 months or up to the end of pregnancy. Evaluation visits will be planned every 6 months where different outcome measures will be assessed. The primary outcome will be live-birth rates at 18 months. The secondary outcomes will be sub-divided into four categories: lifestyle and anthropometric, fertility, pregnancy complications, and neonatal outcomes. Outcomes and costs will be also compared to similar women seen in three fertility clinics across Canada. Qualitative data will also be collected from both professionals and obese infertile women. This study will generate new knowledge about the implementation, impacts and costs of a lifestyle management program in obese infertile women. This information

  7. A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.

    Science.gov (United States)

    Wang, Chen; Wei, Yumei; Zhang, Xiaoming; Zhang, Yue; Xu, Qianqian; Sun, Yiying; Su, Shiping; Zhang, Li; Liu, Chunhong; Feng, Yaru; Shou, Chong; Guelfi, Kym J; Newnham, John P; Yang, Huixia

    2017-04-01

    Obesity and being overweight are becoming epidemic, and indeed, the proportion of such women of reproductive age has increased in recent times. Being overweight or obese prior to pregnancy is a risk factor for gestational diabetes mellitus, and increases the risk of adverse pregnancy outcome for both mothers and their offspring. Furthermore, the combination of gestational diabetes mellitus with obesity/overweight status may increase the risk of adverse pregnancy outcome attributable to either factor alone. Regular exercise has the potential to reduce the risk of developing gestational diabetes mellitus and can be used during pregnancy; however, its efficacy remain controversial. At present, most exercise training interventions are implemented on Caucasian women and in the second trimester, and there is a paucity of studies focusing on overweight/obese pregnant women. We sought to test the efficacy of regular exercise in early pregnancy to prevent gestational diabetes mellitus in Chinese overweight/obese pregnant women. This was a prospective randomized clinical trial in which nonsmoking women age >18 years with a singleton pregnancy who met the criteria for overweight/obese status (body mass index 24≤28 kg/m 2 ) and had an uncomplicated pregnancy at exercise or a control group. Patients did not have contraindications to physical activity. Patients allocated to the exercise group were assigned to exercise 3 times per week (at least 30 min/session with a rating of perceived exertion between 12-14) via a cycling program begun within 3 days of randomization until 37 weeks of gestation. Those in the control group continued their usual daily activities. Both groups received standard prenatal care, albeit without special dietary recommendations. The primary outcome was incidence of gestational diabetes mellitus. From December 2014 through July 2016, 300 singleton women at 10 weeks' gestational age and with a mean prepregnancy body mass index of 26.78 ± 2.75 kg/m 2 were

  8. The association between coenzyme Q10 concentrations in follicular fluid with embryo morphokinetics and pregnancy rate in assisted reproductive techniques.

    Science.gov (United States)

    Akarsu, Süleyman; Gode, Funda; Isik, Ahmet Zeki; Dikmen, Zeliha Günnur; Tekindal, Mustafa Agah

    2017-05-01

    This study seeks to evaluate the association between follicular fluid (FF) coenzyme Q10 (CoQ10) levels, embryo morphokinetics, and pregnancy rate. Sixty infertile patients who underwent intracytoplasmic sperm injection (ICSI) cycles were included in the study. For each patient, CoQ10 level of the follicular fluid was measured by high-performance liquid chromatography system. After the ICSI of each oocyte, the relationship between the level of CoQ10 content of each follicular fluid, the subsequent embryo quality, and embryo morphokinetics was investigated. The relationship between the level of CoQ10 content of each follicle and optimal time-lapse parameters for the embryos of these follicles including t5, s2, and cc2 was also analyzed. The embryos were further classified into four categories, namely, grades A, B, C, and D, according to morphokinetic parameters using t5-t2 and t5-t3 (cc3). Each follicular fluid analysis was performed for a single oocyte of a single embryo which was transferred to the patients. Additionally, follicular fluid CoQ10 levels and pregnancy rates were evaluated. Follicular fluid CoQ10 levels were significantly higher in grades A and B than grades C and D embryos (p < 0.05). The concentration of CoQ10 levels was significantly higher in the pregnant group (p < 0.05). There was no significant correlation between optimal t5 and s2 morphokinetic parameters and CoQ10 levels. However, CoQ10 levels were significantly higher in follicular fluid of embryos which had optimal cc2 (p < 0.05). High follicular fluid CoQ10 level is associated with optimal embryo morphokinetic parameters and higher pregnancy rates.

  9. Cesarean section and rate of subsequent stillbirth, miscarriage, and ectopic pregnancy: a Danish register-based cohort study.

    Directory of Open Access Journals (Sweden)

    Sinéad M O'Neill

    2014-07-01

    Full Text Available BACKGROUND: With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. METHODS AND FINDINGS: We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n = 832,996, with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28 was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI of 0.03% for stillbirth, and a number needed to harm (NNH of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31 and elective cesarean (HR 1.11, 95% CI 0.91, 1.35, although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15 and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21, yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85. Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment

  10. Cesarean Section and Rate of Subsequent Stillbirth, Miscarriage, and Ectopic Pregnancy: A Danish Register-Based Cohort Study

    Science.gov (United States)

    O'Neill, Sinéad M.; Agerbo, Esben; Kenny, Louise C.; Henriksen, Tine B.; Kearney, Patricia M.; Greene, Richard A.; Mortensen, Preben Bo; Khashan, Ali S.

    2014-01-01

    Background With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. Methods and Findings We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n = 832,996), with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy) or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28) was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI) of 0.03% for stillbirth, and a number needed to harm (NNH) of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31) and elective cesarean (HR 1.11, 95% CI 0.91, 1.35), although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15) and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21), yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85). Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment, causes of

  11. Clinical guidelines for management of thyroid nodule and cancer during pregnancy.

    Science.gov (United States)

    Galofré, Juan Carlos; Riesco-Eizaguirre, Garcilaso; Alvarez-Escolá, Cristina

    2014-03-01

    Special considerations are warranted in management of thyroid nodule and thyroid cancer during pregnancy. The diagnostic and therapeutic approach of thyroid nodules follows the standard practice in non-pregnant women. On the other hand, differentiated thyroid cancer management during pregnancy poses a number of challenges for the mother and fetus. The available data show that pregnancy is not a risk factor for thyroid cancer development or recurrence, although flare-ups cannot be completely ruled out in women with active disease. If surgery is needed, it should be performed during the second term or, preferably, after delivery. A majority of pregnant patients with low-risk disease only need adjustment in levothyroxine therapy. However, women with increased serum thyroglobulin levels before pregnancy or structural disease require regular thyroglobulin measurements and neck ultrasound throughout pregnancy. Pregnancy is an absolute contraindication for radioactive iodine administration. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  12. Pregnancy - associated human listeriosis: Virulence and genotypic analysis of Listeria monocytogenes from clinical samples.

    Science.gov (United States)

    Soni, Dharmendra Kumar; Singh, Durg Vijai; Dubey, Suresh Kumar

    2015-09-01

    Listeria monocytogenes, a life-threatening pathogen, poses severe risk during pregnancy, may cause abortion, fetal death or neonatal morbidity in terms of septicemia and meningitis. The present study aimed at characterizing L. monocytogenes isolated from pregnant women based on serotyping, antibiotic susceptibility, virulence genes, in vivo pathogenicity test and ERIC- and REP-PCR fingerprint analyses. The results revealed that out of 3700 human clinical samples, a total of 30 (0.81%) isolates [12 (0.80%) from placental bit (1500), 18 (0.81%) from vaginal swab (2200)] were positive for L. monocytogenes. All the isolates belonged to serogroup 4b, and were + ve for virulence genes tested i.e. inlA, inlC, inlJ, plcA, prfA, actA, hlyA, and iap. Based on the mice inoculation tests, 20 isolates showed 100% and 4 isolates 60% relative virulence while 6 isolates were non-pathogenic. Moreover, 2 and 10 isolates were resistant to ciprofloxacin and cefoxitin, respectively, while the rest susceptible to other antibiotics used in this study. ERIC- and REP-PCR collectively depicted that the isolates from placental bit and vaginal swab had distinct PCR fingerprints except a few isolates with identical patterns. This study demonstrates prevalence of pathogenic strains mostly resistant to cefoxitin and/or ciprofloxacin. The results indicate the importance of isolating and characterizing the pathogen from human clinical samples as the pre-requisite for accurate epidemiological investigations.

  13. Risks to the fetus from diagnostic imaging during pregnancy: review and proposal of a clinical protocol

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, Mafalda; Matias, Alexandra [University of Porto, Faculty of Medicine, Porto (Portugal); Macedo, Filipe [SMIC, Porto (Portugal)

    2015-12-15

    Every day, medical practitioners face the dilemma of exposing pregnant or possibly pregnant patients to radiation from diagnostic examinations. Both doctors and patients often have questions about the risks of radiation. The most vulnerable period is between the 8th and 15th weeks of gestation. Deterministic effects like pregnancy loss, congenital malformations, growth retardation and neurobehavioral abnormalities have threshold doses above 100-200 mGy. The risk is considered negligible at 50 mGy and in reality no diagnostic examination exceeds this limit. The risk of carcinogenesis is slightly higher than in the general population. Intravenous iodinated contrast is discouraged, except in highly selected patients. Considering all the possible noxious effects of radiation exposure, measures to diminish radiation are essential and affect the fetal outcome. Nonionizing procedures should be considered whenever possible and every radiology center should have its own data analysis on fetal radiation exposure. In this review, we analyze existing literature on fetal risks due to radiation exposure, producing a clinical protocol to guide safe radiation use in a clinical setting. (orig.)

  14. Do clinical and laboratory parameters effect maternal and fetal outcomes in pregnancies complicated with hemolysis, elevated liver enzymes, and low platelet count syndrome?

    Science.gov (United States)

    Bezircioğlu, Incim; Baloğlu, Ali; Cetinkaya, Burcu; Pirim, Betül

    2012-01-01

    The aim of the study was to investigate whether the clinical features and laboratory parameters affect maternal and fetal outcomes in pregnancies complicated with HELLP syndrome. The medical records of pregnant patients complicated with HELLP syndrome were analyzed retrospectively between June 01, 2003 and June 01, 2010. The demographic data, medical history, admission symptoms, clinical and laboratory findings and recovery time were evaluated. The adverse maternal outcomes including eclampsia, placental abruption, disseminated intravascular coagulation, postpartum hemorrhage, pulmonary complications, cerebral edema and visual loss were recorded. Fetal growth restriction, necessity for neonatal intensive care unit admission and perinatal mortality were recorded as an adverse fetal outcome. The incidence of HELLP syndrome was 0.52%. The mean age of the patients was 28.93±7.90 (range 17-45). HELLP syndrome was diagnosed on average in the 33.68±4.41(th) (ranged 24-40) week of gestation. Eighteen cases (40.9%) were nullipara and twenty-six cases (59.1%) multipara. The most common complications were eclampsia (40.9%) and abruption placenta (15.9%). Pregnancy was terminated within 48 hours in all patients. The rate of cesarean section was 90.9%. Perinatal mortality rate in HELLP syndrome was 31.8%. There was no maternal mortality. Neither clinical characteristics nor laboratory parameters was found effective for prediction of adverse maternal and fetal outcomes.

  15. Possible factors affecting pregnancy rate of cows in the Amazon Ecuatorian

    Directory of Open Access Journals (Sweden)

    Yánez D

    2016-12-01

    Full Text Available The objective of this work was to assess how the cow pregnancy depends on the type of service as, race and follicular development in cattle with dual purpose in the Ecuadorian Amazon. The 341 records of the individual services were evaluated from January 2015 to December 2015 that corresponds to cows of different genotypes and cross: Brown Swiss (BS n = 135, Charolais (Ch n = 24, Holstein Friesian (HF n = 104, Jersey (J n = 12, Normando (N n = 21, x Brown Swiss Holstein Friesian (HFxBS n = 35 and Holstein Friesian x Normando (HFxN n = 10. The work was conducted in the Cantons and Santa Clara which is located in the Pastaza Province (Ecuador. The Two insemination techniques were performed: a estrus detected (natural 136 cows and a Insemination Time (TAI. The independent variables are "Race" (BS, CH, HF, J, HFxBS and HFxN, the "Technical Service" (N and IATF and "Follicular Development" (DF. An additive model was adjusted and it was not significant for the interactions between independent variables and the result of the model. It was found that the variable DF is the only that contributes significantly to the model. That is, pregnancy is significantly affected by follicular development (p-value <0.0001, but is not related to the technical service and race. Maximum Credible estimates the coefficients model and calculated odds ratios. For every unit increase in the value of follicular development, the chance of "pregnant" is 14 times higher than "empty". Keeping fixed the categories for race and service. To conclude that there was no difference between races and insemination technique that was used, even if a relationship between follicular development in proestrus and pregnancy in the Ecuadorian Amazon.

  16. Comparison of pregnancy rate between fresh embryo transfers and frozen-thawed embryo transfers following ICSI treatment

    Directory of Open Access Journals (Sweden)

    Zahra Basirat

    2016-01-01

    Full Text Available Background: The use of assisted reproductive technology (ART is increasing in the world. The rate, efficacy and safety of ART are very different among countries. There is an increase in the use of intra cytoplasmic sperm injection (ICSI, single fresh embryo transfer (ET and frozen-thawed embryo transfer (FET. Objective: The objective of this study was to compare pregnancy rate in fresh ET and FET. Materials and Methods: In this retrospective cross-sectional study 1014 ICSI-ET cycles (426 fresh ET and 588 FET from 753 women undergoing ICSI treatment referred to Fatemezahra Infertility and Reproductive Health Research Center in Babol, Iran from 2008 to 2013 were reviewed. Results: There were no significant differences between biochemical pregnancy rate (23% versus 18.8%, OR 1.301; 95% CI .95-1.774, gestational sac (95.6% versus 100% in FET, OR 0.60; 95% CI 0.54-0.67, and fetal heart activity (87.2% versus 93.6% OR .46; 95% CI .16-1.32 in fresh ET and FET cycles, respectively. P< 0.05 was considered statistically significant for all measures. Conclusion: Although, the result showed no significantly difference between the fresh ET and the FET cycles, however the embryos are able to be stored for subsequent ART. Therefore, we recommend FET cycles as an option alongside the fresh ET.

  17. Descriptive study of current therapeutic practices, clinical reproductive findings and incidence of pregnancy loss in intensively managed thoroughbred mares.

    Science.gov (United States)

    Rose, B V; Firth, M; Morris, B; Roach, J M; Wathes, D C; Verheyen, K L P; de Mestre, A M

    2018-01-01

    Therapeutic practices in equine reproductive medicine have dramatically evolved over the last 20 years but current usage is not described. The aims of this study were to provide a description of medication use and clinical findings of reproductive examinations alongside measures of reproductive efficiency in thoroughbreds. A prospective cohort study was conducted in the 2013 and 2014 breeding seasons. Mare and stallion details, information on veterinary interventions and findings of reproductive ultrasound scans were collected using questionnaires and entered into a custom-designed Microsoft Access database. Descriptive summary statistics were derived directly from the database and using Microsoft Excel. Information was collected from 2246 pregnancies in 1754 mares from 29 stud farms. Ovulatory induction agents were used in 91.8% of cases, oestrus induction agents in 38.4% and covering therapies in 62.7%. Intrauterine antimicrobials were used in 49.6% of mares. Single pregnancies accounted for 83.9% of pregnancies, twins for 15.3% and triplets for 0.7%. The overall incidence of pregnancy loss between days 15-42 was 6.4% (95% CI 5.4%, 7.4%) and 1.6% (95% CI 1.1%, 2.1%) between days 43-65. A further 1.3% of pregnancies were lost by October and 4.5% by birth (including stillbirths). Eighty-three percent of all pregnancies resulted in a live foal. In conclusion, there has been a considerable increase in the use of reproductive therapeutics over the last 12 years. Nonetheless, incidence of pregnancy loss and live foal percentages remain essentially unchanged. Risk factor studies are required to determine if the substantial increase in therapeutic usage is conferring positive benefits. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Diabetes in pregnancy

    DEFF Research Database (Denmark)

    Feig, Denice S; Corcoy, Rosa; Jensen, Dorte Møller

    2015-01-01

    BACKGROUND: Rising rates of diabetes in pregnancy have led to an escalation in research in this area. As in any area of clinical research, outcome definitions vary from study to study, making it difficult to compare research findings and draw conclusions. Our aim was to compile and create...... a repository of definitions, which could then be used universally. METHODS: A systematic review of the literature was performed of published and ongoing randomized controlled trials (RCTs) in the area of diabetes in pregnancy between Jan 1, 2000 and June 1, 2012. Other sources included the World Health...... Organization and Academic Society Statements. The advice of experts was sought when appropriate definitions were lacking. RESULTS: Among the published RCTs on diabetes and pregnancy, 171 abstracts were retrieved, 64 full texts were reviewed, and 53 were included. Among the ongoing RCTs published in Clinical...

  19. Pregnancy outcome of “delayed start” GnRH antagonist protocol versus GnRH antagonist protocol in poor responders: A clinical trial study

    Directory of Open Access Journals (Sweden)

    Abbas Aflatoonian

    2017-08-01

    Full Text Available Background: Management of poor-responding patients is still major challenge in assisted reproductive techniques (ART. Delayed-start GnRH antagonist protocol is recommended to these patients, but little is known in this regards. Objective: The goal of this study was assessment of delayed-start GnRH antagonist protocol in poor responders, and in vitro fertilization (IVF outcomes. Materials and Methods: This randomized clinical trial included sixty infertile women with Bologna criteria for ovarian poor responders who were candidate for IVF. In case group (n=30, delayed-start GnRH antagonist protocol administered estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation with gonadotropin. Control group (n=30 treated with estrogen priming antagonist protocol. Finally, endometrial thickness, the rates of oocytes maturation, , embryo formation, and pregnancy were compared between two groups. Results: Rates of implantation, chemical, clinical, and ongoing pregnancy in delayed-start cycles were higher although was not statistically significant. Endometrial thickness was significantly higher in case group. There were no statistically significant differences in the rates of oocyte maturation, embryo formation, and IVF outcomes between two groups. Conclusion: There is no significant difference between delayed-start GnRH antagonist protocol versus GnRH antagonist protocol.

  20. Optimising the diagnosis of ectopic pregnancy.

    Science.gov (United States)

    Berry, Janet; Davey, Mark; Hon, Mei-See; Behrens, Renée

    2016-05-01

    This retrospective cohort study reviewed the diagnosis of all ectopic pregnancies within a district general hospital over a 5-year period after the establishment of a dedicated Early Pregnancy Assessment Unit (EPAU). Of 215 ectopic pregnancies identified, notes were available for 208 (97%). Two-hundred and two cases were determined to have been diagnosed and managed as ectopic pregnancies. Six cases were excluded as they were pregnancies of unknown location managed as such. Overall, 91% were diagnosed by ultrasound scan, 5% were diagnosed clinically and 3% were diagnosed on serial human chorionic gonadotrophin (hCG) levels. This study found that the introduction of a dedicated, multi-professional, EPAU with a stable workforce improved ultrasound visualisation of ectopic pregnancies at first ultrasound scan from 22% prior to its commencement, to 61% over this period. The improvement in positive scan diagnosis of ectopic pregnancy was associated with a reduction in negative laparoscopy rate from 13% to 6%.

  1. Achieving low anastomotic leak rates utilizing clinical perfusion assessment.

    Science.gov (United States)

    Kream, Jacob; Ludwig, Kirk A; Ridolfi, Timothy J; Peterson, Carrie Y

    2016-10-01

    Anastomotic leak after colorectal resection increases morbidity, mortality, and in the setting of cancer, increases recurrences rates and reduces survival odds. Recent reports suggest that fluorescence evaluation of perfusion after colorectal anastomosis creation is associated with low anastomotic leak rates (1.4%). The purpose of this work was to evaluate whether a similar low anastomotic leak rate after left-sided colorectal resections could be achieved using standard assessment of blood flow to the bowel ends. We performed a retrospective chart review at an academic tertiary referral center, evaluating 317 consecutive patients who underwent a pelvic anastomosis after sigmoid colectomy, left colectomy, or low anterior resection. All operations were performed by a single surgeon from March 2008 to January 2015 with only standard clinical measures used to assess perfusion to the bowel ends. The primary outcome measure was the anastomotic leak rate as diagnosed by clinical symptoms, exam, or routine imaging. The average patient age was 59.7 years with an average body mass index of 28.8 kg/m(2). Rectal cancer (128, 40.4%) was the most common indication for operation while hypertension (134, 42.3%) was the most common comorbidity. In total, 177 operations were laparoscopic (55.8%), 13 were reoperative resections (4.1%), and 108 were protected with a loop ileostomy (34.1%). Preoperative chemotherapy was administered to 25 patients (7.9%) while preoperative chemo/radiation was administered to 64 patients (20.2%). The anastomotic leak rate was 1.6% (5/317). Our data suggests that standard, careful evaluation of adequate blood flow via inspection and confirmation of pulsatile blood flow to the bowel ends and meticulous construction of the colorectal or coloanal anastomoses can result in very low leak rates, similar to the rate reported when intraoperative imaging is used to assess perfusion. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Comparison of methionine chelated versus sulfate trace minerals on rate and efficiency of gain and pregnancy rates in beef heifers

    Science.gov (United States)

    Objectives of this experiment were to compare rate and efficiency of gain, and conception rates of yearling heifers supplemented with Cu, Zn, and Mn as either metal methionine hydroxy analogue chelated trace minerals (CTM; provided as MINTREX) or the same trace minerals in SO4 form. The experimental...

  3. Comparison of organic versus inorganic trace minerals on rate and efficiency of gain and pregnancy rates in beef heifers

    Science.gov (United States)

    Objectives of this experiment were to compare rate and efficiency of gain, and conception rates of yearling heifers supplemented with Cu, Zn and Mn in either a methionine chelated form (ORG) or the same trace minerals in a SO4 form. The experimental design utilized 3 ranches, each having 2 replicati...

  4. Pregnancy Outcomes Among Patients With Vasculitis

    Science.gov (United States)

    Clowse, Megan E. B.; Richeson, Rachel L.; Pieper, Carl; Merkel, Peter A.

    2015-01-01

    Objective Pregnancy outcomes of patients with vasculitis are unknown, but are of great concern to patients and physicians. Through an online survey, this study assessed pregnancy outcomes among patients with vasculitis. Methods Participants in the Vasculitis Clinical Research Consortium Patient Contact Registry were invited to respond to an anonymous, internet-based survey that included questions about pregnancy outcomes, the timing of pregnancy relative to a diagnosis of vasculitis, and medication use. Results A total of 350 women and 113 men completed the survey. After a diagnosis of vasculitis, 74 pregnancies were reported by women and 18 conceptions were reported by men. The rate of pregnancy loss was higher among women who conceived after a diagnosis of vasculitis compared to those who conceived prior to diagnosis (33.8% versus 22.4%; P = 0.04). Among women, the rate of preterm births increased significantly for pregnancies conceived after a diagnosis of vasculitis relative to those conceived before diagnosis (23.3% versus 11.4%; P = 0.03). Only 18% of women reported worsening of vasculitis during pregnancy, but those who experienced increased vasculitis activity were more likely to deliver preterm. Exposure to cyclophosphamide or prednisone did not appear to impact pregnancy outcomes; however, the number of pregnancies among women taking these medications was small. Among the pregnancies conceived by men with vasculitis, the timing of diagnosis had no significant effect on the rate of pregnancy loss. Conclusion Women who conceived after a diagnosis of vasculitis had a higher rate of pregnancy loss than those who conceived prior to diagnosis. Vasculitis did not worsen during the majority of pregnancies conceived after diagnosis. PMID:23401494

  5. Updated Estimates of Ectopic Pregnancy among Commercially and Medicaid-Insured Women in the United States, 2002-2013.

    Science.gov (United States)

    Tao, Guoyu; Patel, Chirag; Hoover, Karen W

    2017-01-01

    To update trends in the rates of ectopic pregnancy, to compare rates of ectopic pregnancy between commercially insured and Medicaid-insured women, and to assess the differences in rates of ectopic pregnancy by different measures of ectopic pregnancy. We analyzed data from 2002 to 2013 using the Truven Health MarketScan Commercial and Medicaid Claims Database. We limited the study population to women aged 15 to 44 years with any pregnancy in each year. Pregnancy and ectopic pregnancy were identified by clinical services with diagnostic or procedural codes. Ectopic pregnancy was measured in two ways: diagnosed and treated compared with diagnosed only; pregnancy was measured in two ways: any pregnancy compared with pregnancy with delivery. We did not observe a substantial trend in the rate of ectopic pregnancy from 2002 to 2013. The rate of diagnosed and treated ectopic pregnancy substantially increased by age: 0.29% in women aged 15 to 19 years and 0.89% in women aged 40 to 44 years among the commercially insured population and 0.23% and 0.85% among the Medicaid-insured population, respectively. The rate of ectopic pregnancy also varied by the different methodologies used to estimate rates. The rate of ectopic pregnancy is relatively low and stable for women of reproductive age in the United States. Our findings highlight that it is important to clearly define the numerator and denominator in the measure of ectopic pregnancy rates.

  6. Complete molar pregnancy in adolescents from North and South America: Clinical presentation and risk of gestational trophoblastic neoplasia.

    Science.gov (United States)

    Soares, Renan Rocha; Maestá, Izildinha; Colón, José; Braga, Antonio; Salazar, Aleydah; Charry, Rafael Cortés; Sun, Sue Yazaki; Goldstein, Donald P; Berkowitz, Ross S

    2016-09-01

    To compare complete hydatidiform mole (CHM) clinical presentation and risk factors associated with GTN development between North American and South American adolescents. This non-concurrent cohort study was undertaken including adolescents with CHM referred to centers in North America (New England Trophoblastic Disease Center, Harvard University, USA), and South America (Botucatu Trophoblastic Disease Center-São Paulo State University, Brazil; Trophoblastic Unit of Central University of Venezuela and Maternidad Concepcion Palacios of Caracas, Venezuela) between 1990 and 2012. Data were obtained from medical records and pathology reports. Study participants were allocated into 2 groups: North America (NA) and South America (SA). In NA and SA, 13.1% and 30.9% of patients with hydatidiform mole were adolescents, respectively. Of these, 77.6% in NA and 86.1% in SA had pathologic diagnosis of CHM (p=0.121). Vaginal bleeding (SA=69% vs NA=51%; p=0.020), anemia (SA=48% vs NA=18%; p<0.001), and elevated serum hCG (SA=232,860mIU/mL vs NA=136,412mIU/mL; p=0.039) were more frequent in SA than in NA. Median gestational age at diagnosis (SA=12weeks, NA=11weeks; p=0.030) differed whereas GTN development rate (SA=20%, NA=27%; p=0.282) showed no significant difference between groups. Compared to NA, medical complications and clinical factors associated with post-molar GTN were more frequent among SA adolescents. Medical complications and clinical factors associated with GTN development were more frequent in SA than in NA adolescents with CHM, suggesting that, in South America, awareness about the importance of diagnosing molar pregnancy early and considering CHM in the differential diagnosis in adolescents suspected to be pregnant should be raised. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Pregnancy incidence and correlates in a clinical trial preparedness study, North West Province South Africa.

    Directory of Open Access Journals (Sweden)

    Candice M Chetty-Makkan

    Full Text Available Women in HIV prevention trials often must typically agree to avoid pregnancy. Regardless, some become pregnant. Screening tools predicting pregnancy risk could maximize trial safety and efficiency.We assessed incidence and correlates of pregnancy among women at high HIV risk.We enrolled sexually-active, HIV-negative women into an observational cohort (2008-2011. At enrollment demographic, contraceptive, reproductive, pregnancy intention and behavioural data were collected. Women reported if one or both partners wanted or intended for the couple to become pregnant. We measured gender role beliefs using a locally validated eight-point index. We tested HIV and pregnancy, and inquired about sexually transmitted infection symptoms (STIs at enrollment and monthly. HIV testing included behavioural counselling and condom provision, but did not specifically counsel women to avoid pregnancy. Cox proportional hazard modelling evaluated the associations with pregnancy. The multivariate model included the following variables "Recent pregnancy attempts", "Gender Roles Beliefs", "Self-reported STIs" and "Age".We screened 1068 women and excluded (24.6%, 263/1068 who did not report risk behaviour. Non-pregnant, non-sterilized women aged 18-35 (median = 21 years enrolled (n = 438. Most women reported one partner (74.7% and a prior live birth (84.6%. Median follow-up time was 6 months (range 0.7-15.5. Pregnancy incidence was 25.1 per 100 women-years (n = 57 pregnancies. Conservative beliefs on gender roles (Adjusted Hazard Ratio (aHR 1.8; 95% confidence interval [CI] 1.1-2.9, recent pregnancy attempts (aHR 1.9; 95% CI 1.1-3.4 and baseline self-reported STI (aHR 2.5; 95% CI 1.4-4.4 were associated with increased incident pregnancy. Report of no pregnancy intention was associated with lowered pregnancy risk (aHR 0.3; 95% CI 0.1-0.7.We identified new and confirmed existing factors that can facilitate screening for pregnancy risk.

  8. Clinical utility of non-invasive prenatal testing in pregnancies with ultrasound anomalies

    NARCIS (Netherlands)

    Beulen, L.; Faas, B.H.W.; Feenstra, I.; Vugt, J.M.G. van; Bekker, M.N.

    2017-01-01

    OBJECTIVE: To evaluate the application of non-invasive prenatal testing (NIPT) as an alternative to invasive diagnostic prenatal testing in pregnancies with abnormal ultrasound findings. METHODS: This was a retrospective analysis of 251 singleton and multiple pregnancies at high risk for fetal

  9. The clinical utility of non-invasive prenatal testing in pregnancies with ultrasound anomalies

    NARCIS (Netherlands)

    Beulen, L; Faas, B; Feenstra, I; van Vugt, J M; Bekker, M N

    ObjectivesThis study aims to evaluate the application of non-invasive prenatal testing (NIPT) as an alternative to invasive diagnostic testing in pregnancies with abnormal ultrasound findings.MethodsA retrospective analysis was performed of 251 single and multiple pregnancies at high risk for fetal

  10. The clinical utility of non-invasive prenatal testing in pregnancies with ultrasound anomalies

    NARCIS (Netherlands)

    Beulen, Lean; Faas, Brigitte H W; Feenstra, Ilse; van Vugt, John M G; Bekker, Mireille N

    OBJECTIVE: This study aims to evaluate the application of non-invasive prenatal testing (NIPT) as an alternative to invasive diagnostic prenatal testing for pregnancies with abnormal ultrasound findings. METHOD: A retrospective analysis was performed of 251 single and multiple pregnancies at high

  11. Fecal Calprotectin Is Not Affected by Pregnancy: Clinical Implications for the Management of Pregnant Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Julsgaard, Mette; Hvas, Christian L; Gearry, Richard B; Vestergaard, Thea; Fallingborg, Jan; Svenningsen, Lise; Kjeldsen, Jens; Sparrow, Miles P; Wildt, Signe; Kelsen, Jens; Bell, Sally J

    2017-07-01

    Noninvasive biomarkers of inflammation for monitoring inflammatory bowel disease (IBD) are important in pregnancy. Clinical and laboratory markers are often affected by the physiological adaption that occurs during pregnancy, although, few, if any, data exist on fecal calprotectin (FC). We investigated FC concentrations in pregnant controls and IBD women, and whether FC correlated with physician global assessment (PGA), C-reactive protein (CRP), and Harvey-Bradshaw Index (HBI)/Simple Clinical Colitis Activity Index (SCCAI) before and after pregnancy, as well as during each trimester. The study is a prospective multicenter study of 46 pregnant women with and 21 without IBD in Denmark, Australia, and New Zealand. Demographics, clinical parameters, and HBI/SCCAI were recorded. Stool and blood samples were obtained to determine FC and CRP concentrations. From pregnant IBD women and pregnant controls, 174 and 21 fecal samples were collected, respectively. The median FC concentration in pregnant IBD women was 131 μg/g (range 0-3600) and in controls 0 μg/g (range 0-84) (P 0.05). An FC cutoff concentration of 250 μg/g significantly correlated with active disease according to PGA in all 5 periods (P ≤ 0.0002). CRP only significantly correlated with FC (P = 0.0007) and PGA in the second trimester (P = 0.0003). No significant correlation was found between CRP and HBI/SCCAI at any timepoint (P > 0.05). The physiological changes that occur during pregnancy do not affect FC, in contrast to CRP and HBI/SCCAI. The combined use of FC and PGA seems optimal to assess disease activity in IBD during pregnancy.

  12. Promoting Tdap immunization in pregnancy: Associations between maternal perceptions and vaccination rates.

    Science.gov (United States)

    Payakachat, Nalin; Hadden, Kristie B; Ragland, Denise

    2016-01-02

    Tdap vaccine uptake among US pregnant women is low despite current recommendations. This study evaluated if a Tdap vaccine information statement (VIS) affected overall perception, vaccination intention, and components of a health behavior model associated with Tdap vaccination rates. A randomized, prospective study was conducted among pregnant women receiving care at two women's clinics in May-August 2014. Verbally consented participants were randomized to receive either the standard CDC Tdap VIS (sVIS) or a modified version (mVIS) before completing the first multi-part survey (T1). After T1, participants read their assigned VIS then completed the second part (T2). A 2015 chart review identified vaccinated participants. A health behavior model was hypothesized using the Reasoned Action Approach and Health Belief Model. Logistic regression, path analysis, and chi-square tests were used in the analysis. 279 surveys were analyzed. Average age of the participants was 26.4 years (SD=5.7) with average gestational age of 25.9 weeks (SD=9.2). 13% self-reported receiving Tdap vaccine prior to the survey. Overall perception scores significantly increased (3.1-3.4, pvaccine post study. There was no significant difference in vaccination rates between the sVIS and mVIS groups (45% vs. 49%). Perceived benefits (B=0.315) and self-efficacy (B=0.197) were positively associated with the overall perception (T1), while perceived barriers (B=-0.191) were negatively associated with the overall perception (T1). Social norms (B=0.230), self-efficacy (B=0.213), and perceived benefits (B=0.117) were positively associated with vaccination intention (T1). The vaccination intention (T2) was positively associated with participants' decision to receive Tdap vaccine (B=0.223). A VIS improved overall perception of the Tdap vaccine. Vaccination intention was a predictor of Tdap vaccination. It is crucial to provide information about immunization benefits to promote maternal Tdap vaccination

  13. Impact of clinical audits on cesarean section rate.

    Science.gov (United States)

    Peng, Fu-Shiang; Lin, Hsien-Ming; Lin, Ho-Hsiung; Tu, Fung-Chao; Hsiao, Chin-Fen; Hsiao, Sheng-Mou

    2016-08-01

    Many countries have noted a substantial increase in the cesarean section rate (CSR). Several methods for lowering the CSR have been described. Understanding the impact of clinical audits on the CSR may aid in lowering CSR. Thus, our aim is to elucidate the effect of clinical audits on the CSR. We retrospectively analyzed 3781 pregnant women who gave birth in a medical center between January 2008 and January 2011. Pregnant women who delivered between January 2008 and July 2009 were enrolled as the pre-audit group (n = 1592). After August 2009, all cesarean section cases that were audited were enrolled in the audit group (n = 2189). The CSR was compared between groups. The overall CSR (34.5% vs. 31.1%, adjusted odds ratio [OR] = 0.83, p = 0.008) and the cesarean section rate due to dystocia (9.6% vs. 6.2%, p cesarean section was achieved in 16 (8.2%) of 195 audit cases in the monthly audit conference. In nulliparous pregnant women (n = 2148), multivariate analysis revealed that clinical audit (OR = 0.78), maternal age (OR = 1.10), gestational age at delivery (OR = 0.80), and fetal body weight at birth (OR = 1.0005) were independent predictors of cesarean section (all p cesarean section to reduce the CSR. Copyright © 2016. Published by Elsevier B.V.

  14. Prolonged gonadotropin stimulation for assisted reproductive technology cycles is associated with decreased pregnancy rates for all women except for women with polycystic ovary syndrome.

    Science.gov (United States)

    Ryan, Amanda; Wang, Shunping; Alvero, Ruben; Polotsky, Alex J

    2014-07-01

    To determine if etiology of infertility modifies the relationship between the duration of ovarian stimulation and success during assisted reproductive technology (ART) cycles. A prospectively collected database was analyzed in an academic infertility practice. Eight hundred and twelve infertile women undergoing their initial fresh embryo, non-donor in vitro fertilization (IVF) or Intracytoplasmic Sperm Injection ICSI) cycle between January 1999 and December 2010 were evaluated. Clinical pregnancy was the main outcome measured. Out of 663 cycles resulting in oocyte retrieval, 299 produced a clinical pregnancy (45.1%). Women who achieved a clinical pregnancy had a significantly shorter stimulation length (11.9 vs. 12.1 days, p = 0.047). Polycystic ovary syndrome (PCOS) was the only etiology of infertility that was significantly associated with a higher chance for clinical pregnancy and was a significant confounder for the association of duration and success of treatment. Women with 13 days or longer of stimulation had a 34 % lower chance of clinical pregnancy as compared to those who had a shorter cycle (OR 0.66, 95% CI:0.46-0.95) after adjustment for age, ovarian reserve, number of oocytes retrieved, embryos transferred and PCOS diagnosis. Prolonged duration of stimulation is associated with decreased ART success for all couples, except for women with PCOS.

  15. Presumed Cases of Mumps in Pregnancy: Clinical and Infection Control Implications

    Directory of Open Access Journals (Sweden)

    Svjetlana Lozo

    2012-01-01

    Full Text Available Recently, a mumps outbreak in New York and New Jersey was reported by the Centers for Disease Control and Prevention (CDC. Subsequently, the dissemination of the disease was rapid, and, from June 28th 2009 through January 29th 2010, a total of 1,521 cases of mumps were reported in New York and New Jersey. Seven presumed cases occurred in pregnant women cared for at our institution. Mumps diagnosis as per the NYC Department of Health and Mental Hygiene was based on clinical manifestations, particularly parotitis. Prior immunizations with mumps vaccine and negative IgM were not adequate to rule out mumps infections. All of our seven patients had exposure to mumps in either their household or their community, and some of the them had symptoms of mumps. Due to the difficulties in interpreting serologies of these patients, their cases led to a presumed diagnosis of mumps. The diagnosis of mumps lead to the isolation of patients and health care personnel that were in contact with them. In this paper, we detail the presenting findings, diagnostic dilemmas and infection control challenges associated with presumed cases of mumps in pregnancy.

  16. Clinical use of MRI for the evaluation of acute appendicitis during pregnancy.

    Science.gov (United States)

    Patel, Darshan; Fingard, Jordan; Winters, Sean; Low, Gavin

    2017-07-01

    The purpose of this study was to determine the diagnostic accuracy of MRI for detecting acute appendicitis in pregnancy in a multi-institution study involving general body MR readers with no specific expertise in MR imaging of the pregnant patient. Retrospective review of MRI examinations on PACS in 42 pregnant patients was evaluated for acute right lower quadrant pain. Three fellowship-trained general body radiologists analyzed the MRI examinations in consensus and attempted to localize the appendix, assess for features of appendicitis, and exclude alternative etiologies for the right lower quadrant pain. Of the 42 MRI examinations, the readers noted 6 cases of acute appendicitis, 16 cases of a normal appendix, and 20 cases involving non-visualization of the appendix but where there were no secondary features of acute appendicitis. Based on the surgical data and clinical follow-up, there were 3 true-positive cases, 3 false-positive cases, 34 true-negative cases, and 2 false-negative cases of acute appendicitis on MRI. This yielded an accuracy of 88.1%, sensitivity of 60%, specificity of 91.9%, positive predictive value of 50%, and negative predictive value of 94.4% for the detection of acute appendicitis in the pregnant patient on MRI. Alternative etiologies for the right lower quadrant pain on MRI included torsion of an ovarian dermoid in 1 case and pyelonephritis in 1 case. MRI is an excellent modality for excluding acute appendicitis in pregnant patients presenting with right lower quadrant pain.

  17. [Irregular antibody testing during pregnancy in Tunisia: clinical study of 5369 women].

    Science.gov (United States)

    Rekik, T; Ben Amor, I; Louati, N; Rekik, H; Menif, H; Gargouri, J

    2012-04-01

    To evaluate the prevalence of alloimmunization in women followed in an obstetrical environment in Tunisia, to identify the specificities of antibodies found and to determine factors that could influence the appearance of this immunization. We proceeded to a retrospective analysis of search for irregular antibodies in women followed up in obstetrical environment over nine consecutive years (2000-2008). The panel was officially defined and produced by the Regional Centre for Blood Transfusion in Sfax (Tunisia). Overall 5369 women benefited from 6575 antibody testing (average: 1.22; extremes: 1-14). The results were positive for 278 women (5.17 %), allowing to identify 216 antibodies or associations of antibodies. Among identified antibodies, those immune were found in 198 women. The rate of alloimmunization was 3.68 % (198/5369). The majority of the antibodies found was anti-Rh1, isolated or associated with another antibody, in 84.3 % of the total immunized women. The immunization of women according to the number of gestations showed a significant increasing rate ranging from 2.34 % for a first gestation to 5.27 % for four gestations or more. In addition, a significant difference was also noted between the rate of immunization in women who had received anti-Rh1 immunoglobulin and those who had not. Anti-Rh1 immunization is the most frequent in the population of studied women. This could denote of an insufficiency in pregnancies follow-up and immunoprophylaxis protocols. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  18. PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian hyperstimulation syndrome.

    Science.gov (United States)

    Yovich, John L; Alsbjerg, Birgit; Conceicao, Jason L; Hinchliffe, Peter M; Keane, Kevin N

    2016-01-01

    The first PIVET algorithm for individualized recombinant follicle stimulating hormone (rFSH) dosing in in vitro fertilization, reported in 2012, was based on age and antral follicle count grading with adjustments for anti-Müllerian hormone level, body mass index, day-2 FSH, and smoking history. In 2007, it was enabled by the introduction of a metered rFSH pen allowing small dosage increments of ~8.3 IU per click. In 2011, a second rFSH pen was introduced allowing more precise dosages of 12.5 IU per click, and both pens with their individual algorithms have been applied continuously at our clinic. The objective of this observational study was to validate the PIVET algorithms pertaining to the two rFSH pens with the aim of collecting ≤15 oocytes and minimizing the risk of ovarian hyperstimulation syndrome. The data set included 2,822 in vitro fertilization stimulations over a 6-year period until April 2014 applying either of the two individualized dosing algorithms and corresponding pens. The main outcome measures were mean oocytes retrieved and resultant embryos designated for transfer or cryopreservation permitted calculation of oocyte and embryo utilization rates. Ensuing pregnancies were tracked until live births, and live birth productivity rates embracing fresh and frozen transfers were calculated. Overall, the results showed that mean oocyte numbers were 10.0 for all women algorithms in our clinic meant that the starting dose was not altered for 79.1% of patients and for 30.1% of those receiving the very lowest rFSH dosages (≤75 IU). Only 0.3% patients were diagnosed with severe ovarian hyperstimulation syndrome, all deemed avoidable due to definable breaches from the protocols. The live birth productivity rates exceeded 50% for women algorithms led to only 11.6% of women generating >15 oocytes, significantly lower than recently published data applying conventional dosages (38.2%; Palgorithms to each other, the outcomes were mainly comparable for

  19. Ectopic pregnancy.

    Science.gov (United States)

    Randall, S

    1986-12-01

    This discussion of ectopic pregnancy covers mortality, definition, etiology, diagnosis and management, and contraception. In the 1979-81 "Report on Confidential Enquiries into Maternal Deaths in England and Wales," ectopic pregnancy accounted for 11.4% of all maternal deaths. Avoidable factors were found in 64% of deaths from ectopic pregnancy, the most common being delay in diagnosis and operative intervention. Ectopic pregnancy is the implantation of the conceptus outside the uterus or in an abnormal location within the uterus. Tubal gestation invariably has a multifactorial etiology and occurs owing to delay in the transport of the fertilized ovum. Table 1 lists causes. Salpingitis is the main cause of tubal pregnancy and now is considered to be due primarily to chlamydia. The consequences of tubal surgery, for whatever reason, and hormonal treatment also are major etiological factors. Every woman of reproductive age, especially if she has 1 or more etiological factors in her past history, who presents with a history of a missed period and irregular vaginal bleeding or abdominal pain, must be considered to have an ectopic pregnancy until proved otherwise. Diagnosis still is essentially a clinical one. In difficult cases use should be made of radioimmunoassay of beta hCG, ultrasonic scanning, and laparoscopy. In 25% of cases, a correct diagnosis was made only at laparotomy. Culdocentesis and endometrial biopsy are of limited use. In cases of ruptured ectopic pregnancy with circulatory collapse, immediate operative intervention is essential. In regard to contraception, the combined oral contraceptive (OC), in suppressing ovulation and thickening the cervical mucus, has a protective effect. Method failure does not increase the incidence of extrauterline pregnancy above normal. The progestagen-only pill is associated with a small increase in the risk of an initial and recurrent ectopic pregnancy. It does not suppress ovulation and may affect tubal motility, but it

  20. The glomerular filtration rate during pregnancy : Saline infusion enhances the glomerular filtration rate in the pregnant rat

    NARCIS (Netherlands)

    Faas, MM; Schuiling, GA; Klok, PA; Valkhof, N; Bakker, WW

    1996-01-01

    The glomerular filtration rate (GFR) of pregnant rats is generally believed to exceed non-pregnant values. This notion is primarily based upon standard inulin clearances. However, the inulin clearance requires continuous infusion of inulin usually dissolved in saline. Since saline infusion per se in

  1. Prime Time: 12-Month Sexual Health Outcomes of a Clinic-Based Intervention to Prevent Pregnancy Risk Behaviors

    Science.gov (United States)

    Sieving, Renee E.; McMorris, Barbara J.; Beckman, Kara J.; Pettingell, Sandra L.; Secor-Turner, Molly; Kugler, Kari; Garwick, Ann W.; Resnick, Michael D.; Bearinger, Linda H.

    2010-01-01

    Purpose Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy. This paper examines sexual risk behaviors and hypothesized psychosocial mediators after 12 months of the Prime Time intervention. Methods Randomized controlled trial with 253 girls ages 13-17 years meeting specified risk criteria. Intervention participants were involved in Prime Time programming plus usual clinic services for 18 months, control participants received usual clinic services. The intervention employed a combination of case management and peer leadership programs. Participants in this interim outcomes study completed self-report surveys at baseline and 12 months following enrollment. Surveys assessed sexual risk behaviors and psychosocial factors targeted for change by Prime Time. Results At the 12-month interim, the intervention group reported more consistent use of condoms, hormonal contraception and dual contraceptive methods with their most recent partner than did the control group. The intervention group also reported greater stress management skills with trends towards higher levels of pro-social connectedness at school and with family. No between-group differences were noted in psychosocial measures specific to sex and contraceptive use. Conclusions Preventing early pregnancy among high-risk adolescents requires multifaceted, sustained approaches. An important research focus involves testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have emphasized a dual approach of building protective factors while addressing risk. Findings suggest that youth development interventions through clinic settings hold promise in reducing pregnancy risk among high-risk youth. PMID:21783050

  2. Sensitivity, specificity, predictive value and accuracy of ultrasonography in pregnancy rate prediction in Sahelian goats after progesterone impregnated sponge synchronization

    Directory of Open Access Journals (Sweden)

    Justin Kouamo

    2014-09-01

    Full Text Available Aim: This study was aimed to evaluate the sensitivity, specificity, predictive value and accuracy of ultrasonography in pregnancy rate (PR prediction in Sahelian goats after progesterone impregnated sponge synchronization within the framework of caprine artificial insemination (AI program in Fatick (Senegal. Materials and Methods: Of 193 candidate goats in AI program, 167 were selected (day 50 in six villages. Estrus was synchronized by progesterone impregnated sponges installed for 11 days. Two days before the time of sponge removal (day 4, each goat was treated with 500 IU of equine chorionic gonadotropin and 50 μg of dcloprostenol. All goats were inseminated (day 0 with alpine goat semen from France at 45±3 h after sponge removal (day 2. Real-time B-mode ultrasonography was performed at day 50, day 13, day 0, day 40 and day 60 post-AI. Results: Selection rate, estrus response rate, AI rate, PR at days 40 and days 60 were 86.53%; 71.85%; 83.34%; 51% and 68% (p<0.05 respectively. Value of sensitivity, specificity, positive and negative predictive value, accuracy, total conformity, conformity of correct positive, conformity of correct negative and discordance of pregnancy diagnosis by trans-abdominal ultrasonography (TU were 98.03%; 63.26%; 73.52%; 3.12%; 81%; 81%; 50%; 31% and 19%, respectively. Conclusion: These results indicate that the TU can be performed in goats under traditional condition and emphasized the importance of re-examination of goats with negative or doubtful TU diagnoses performed at day 40 post-AI.

  3. Termination of pregnancy: attitudes and clinical experiences of Irish GPs and GPs-in-training.

    Science.gov (United States)

    Murphy, Mark; Vellinga, Akke; Walkin, Scott; MacDermott, Maeve

    2012-09-01

    Termination of pregnancy (ToP) is currently illegal in Ireland. In 2010, more than 4000 women travelled from Ireland to the UK for a ToP. The aims of this study were to assess the attitudes and clinical experiences of Irish General Practitioners (GPs) and GPs-in-training (GPRs) towards ToP. A postal survey was sent to 500 GPs in Ireland. An internet-based survey was sent to 244 GPRs. Quantitative and qualitative analysis was performed. Overall response was 44%. Four groups of doctor's opinions could be identified: (A) abortion can never be allowed (10%); (B) abortion can be allowed in limited circumstances (25%); (C) abortion should be available to all women (51%); and (D) no definite opinion (14%). Doctors in groups (A) and (B) were older and more often Catholic. Of doctors in group (C), 66% indicated an upper gestational limit of maximum 16 weeks. More than 40% of all respondents had at least one consultation specifically dealing with ToP within the past six months and 43% agreed with the statement that women's health suffers due to the travel related to ToP. Most responding GPs and GPRs (75%) support the provision of ToP in Ireland in certain circumstances. The qualitative analysis of this survey showed that the terms pro-life and pro-choice inappropriately describe the spectrum of opinions. This study highlights clinical situations in which women's health may be adversely affected due to the requirement to travel for ToP.

  4. Do high progesterone concentrations decrease pregnancy rates in embryo recipients synchronized with PGF2alpha and eCG?

    Science.gov (United States)

    Nogueira, Marcelo F Gouveia; Melo, Danilas S; Carvalho, Luciano M; Fuck, Egon J; Trinca, Luzia A; Barros, Ciro Moraes

    2004-05-01

    The objective of this study was to evaluate the effects of equine chorionic gonadotropin (eCG) treatment on the number of induced accessory corpora lutea (CL), plasma progesterone concentrations and pregnancy rate in cross-bred heifers after transfer of frozen-thawed (1.5M ethylene glycol) embryos. All recipients received 500 microg PGF2alpha (dl-cloprostenol, i.m.) at random stages of the estrous cycle (Day 0) and were observed for estrus for 7 days. On Day 14, heifers detected in estrus between 2 and 7 days after PGF2alpha treatment were randomly allocated to four groups ( n=83 per group) and given 0 (control), 200, 400, or 600 IU of eCG. Two days later (Day 16), these recipients were given PGF2alpha and observed for estrus. Six to eight days after detection of estrus, plasma samples were collected to determine progesterone concentration and ultrasonography was performed to observe ovarian structures. Heifers with multiple CL or a single CL >15 mm in diameter received an embryo by direct transfer. Embryos of excellent and good quality were thawed and transferred to the recipients by the same veterinarian. Pregnancy was diagnosed by ultrasonography and confirmed by transrectal palpation 21 and 83 days after embryo transfer (ET), respectively. Plasma progesterone concentrations on the day of transfer (Day 7 of the estrous cycle) were 3.9+/-0.7, 4.2+/-0.4,6.0+/-0.4 and 7.8+/-0.6 ng/ml for groups Control, 200, 400, and 600, respectively (Control versus treated groups P=0.009; 200 versus 400 and 600 groups P=0.0001; and 400 versus 600 P=0.012 ). Conception rates 83 days after ET were 41.9, 50.0, 25.0, and 20.9% for groups Control, 200, 400, and 600, respectively (200 versus 400 and 600 groups P=0.0036 ). In conclusion, an increase in progesterone concentration, induced by eCG treatment, did not improve pregnancy rates in ET recipients. Conversely, there was a decline in conception rates in the animals with the highest plasma progesterone concentrations.

  5. Clinical diagnostic value of combined determination of four serum markers (β-HCG, progesterone, VEGF, creatinekinase) for ectopic pregnancy before rupture

    International Nuclear Information System (INIS)

    Li Xianfeng; Wu Jin; Zhang Xiaoe; Duan Sujing

    2006-01-01

    Objective: To investigate the clinical diagnostic value of combined determination of 4 serum markers for unruptured ectopic pregnancy. Methods: Serum β-HCG, progesterone (P) (with RIA) vascular endothelial growth factor (VEGF) (with CLIA) and creatinekinase (CK) (with biochemical method) contents were determined twice (one day apart) in 50 subjects with suspected early ectopic pregnancy (before rupture) and 50 normal pregnant women. Results: Serum contents of β- HCG and P in the subjects with suspected ectopic pregnancy were significantly lower than those in the normal pregnant women (P 0.05). Conclusion: Combined determination of those four markers were helpful for the early diagnosis of unruptured ectopic pregnancy. (authors)

  6. Effect of Vitamin D3 Supplementation During Pregnancy on Risk of Persistent Wheeze in the Offspring: A Randomized Clinical Trial.

    Science.gov (United States)

    Chawes, Bo L; Bønnelykke, Klaus; Stokholm, Jakob; Vissing, Nadja H; Bjarnadóttir, Elín; Schoos, Ann-Marie M; Wolsk, Helene M; Pedersen, Tine Marie; Vinding, Rebecca K; Thorsteinsdóttir, Sunna; Arianto, Lambang; Hallas, Henrik W; Heickendorff, Lene; Brix, Susanne; Rasmussen, Morten A; Bisgaard, Hans

    2016-01-26

    Observational studies have suggested that increased dietary vitamin D intake during pregnancy may protect against wheezing in the offspring, but the preventive effect of vitamin D supplementation to pregnant women is unknown. To determine whether supplementation of vitamin D3 during the third trimester of pregnancy reduces the risk of persistent wheeze in the offspring. A double-blind, single-center, randomized clinical trial conducted within the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort. Enrollment began March 2009 with a goal of 708 participants, but due to delayed ethical approval, only 623 women were recruited at 24 weeks of pregnancy. Follow-up of the children (N = 581) was completed when the youngest child reached age 3 years in March 2014. Vitamin D3 (2400 IU/d; n = 315) or matching placebo tablets (n = 308) from pregnancy week 24 to 1 week postpartum. All women received 400 IU/d of vitamin D3 as part of usual pregnancy care. Age at onset of persistent wheeze in the first 3 years of life. Secondary outcomes included number of episodes of troublesome lung symptoms, asthma, respiratory tract infections, and neonatal airway immunology. Adverse events were assessed. Of the 581 children, persistent wheeze was diagnosed during the first 3 years of life in 47 children (16%) in the vitamin D3 group and 57 children (20%) in the control group. Vitamin D3 supplementation was not associated with the risk of persistent wheeze, but the number of episodes of troublesome lung symptoms was reduced, and the airway immune profile was up-regulated (principal component analysis, P = .04). There was no effect on additional end points. Intrauterine death was observed in 1 fetus (interpretation of the study is limited by a wide CI that includes a clinically important protective effect. clinicaltrials.gov Identifier: NCT00856947.

  7. Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Ayman A Al-Talib

    2016-01-01

    Full Text Available Objectives: To study the clinical presentation and treatment outcome of molar pregnancy at a Tertiary Care Hospital in Dammam, Saudi Arabia. Materials and Methods: Reviewed medical records of all molar pregnancy cases among all the deliveries at a tertiary care hospital in Dammam from 2005 to 2014, after approval by institutional ethical review committee. Data abstracted included patient′s age, parity, presenting symptoms, gestational age at diagnosis, uterine size, ultrasonographic findings, BhCG level at the time of diagnosis and at follow-up after evacuation, and blood loss during evacuation. Data was entered and analyzed using Excel; frequency distribution for categorical variables and descriptive statistics for continuous variables were computed. Results: Of a total of 25,000 deliveries in ten years, 22 cases of complete molar pregnancy were encountered: 0.9 cases of molar pregnancy per 1000 pregnancies. Majority of patients (63.7% were older than 35 years, and were nulliparous (45.5%. The commonest symptom was vaginal bleeding (86.4% followed by hyperemesis gravidarum (41.0%; Hyperthyroidism was seen in 1 patient (4.5%. Ovarian enlargement by theca-lutin cyst was seen in 3 patients (13.6%. The majority of patients (63.6% had normal BhCG within 9 weeks (63 days after suction curettage. The majority of the cases followed a benign course. Conclusion: Aged older than 35 years seems a risk factor and vaginal bleeding is the commonest presenting symptom. Early booking of pregnant women to antenatal care clinics and routine first trimester ultrasound made diagnosis easier and earlier before complications appear.

  8. Relationship between Receipt of a Social Protection Grant for a Child and Second Pregnancy Rates among South African Women: A Cohort Study

    Science.gov (United States)

    Rosenberg, Molly; Pettifor, Audrey; Nguyen, Nadia; Westreich, Daniel; Bor, Jacob; Bärnighausen, Till; Mee, Paul; Twine, Rhian; Tollman, Stephen; Kahn, Kathleen

    2015-01-01

    Background Social protection programs issuing cash grants to caregivers of young children may influence fertility. Grant-related income could foster economic independence and/or increase access to job prospects, education, and health services, resulting in lower pregnancy rates. In the other direction, these programs may motivate family expansion in order to receive larger grants. Here, we estimate the net effect of these countervailing mechanisms among rural South African women. Methods We constructed a retrospective cohort of 4845 women who first became eligible for the Child Support Grant with the birth of their first child between 1998 and 2008, with data originally collected by the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga province, South Africa. We fit Cox regression models to estimate the hazard of second pregnancy in women who reported grant receipt after birth of first child, relative to non-recipients. As a secondary analysis to explore the potential for grant loss to incentivize second pregnancy, we exploited a natural experiment created by a 2003 expansion of the program’s age eligibility criterion from age seven to nine. We compared second pregnancy rates between (i) women with children age seven or eight in 2002 (recently aged out of grant eligibility) to (ii) women with children age seven or eight in 2003 (remained grant-eligible). Results The adjusted hazard ratio for the association between grant exposure and second pregnancy was 0.66 (95% CI: 0.58, 0.75). Women with first children who aged out of grant eligibility in 2002 had similar second pregnancy rates to women with first children who remained grant-eligible in 2003 [IRR (95% CI): 0.9 (0.5, 1.4)]. Conclusions Across both primary and secondary analyses, we found no evidence that the Child Support Grant incentivizes pregnancy. In harmony with South African population policy, receipt of the Child Support Grant may result in longer spacing between pregnancies. PMID

  9. The role of social media in recruiting for clinical trials in pregnancy.

    Science.gov (United States)

    Shere, Mahvash; Zhao, Xiu Yan; Koren, Gideon

    2014-01-01

    Recruitment of women in the periconceptional period to clinical studies using traditional advertising through medical establishments is difficult and slow. Given the widespread use of the internet as a source for medical information and research, we analyze the impact of social media in the second phase of an ongoing randomized, open-label clinical trial among pregnant women. This study aims to assess the effectiveness of social media as a recruitment tool through the comparison of diverse recruitment techniques in two different phases of the trial. Recruitment in Phase 1 of the study consisted solely of traditional healthcare-based sources. This was compared to Phase 2 of the study where traditional recruitment was continued and expanded, while social media was used as a supplementary source. Yearly recruitment and recruitment rates in the two phases were compared using the Mann Whitney U test. The contributions of each recruitment source to overall recruitment were analyzed, and the impact of potential confounders on recruitment rate was evaluated using a multiple regression and Interrupted Time Series Analysis. In the first phase of the study, with over 56 months of recruitment using traditional sources, 35 women were enrolled in the study, resulting in a mean rate of ±0.62 recruits/month. In the 6 months implementing recruitment through social media, 45 women were recruited, for a 12-fold higher rate of ±7.5 recruits/month. Attrition rates remained constant, suggesting that social media had a positive impact on recruitment. The Interrupted Time Series Analysis detected a significant difference in recruitment after the intervention of social media (psocial media. Clinicians and scientists recruiting for clinical studies should learn how to use online social media platforms to improve recruitment rates, thus increasing recruitment efficiency and cost-effectiveness.

  10. The role of social media in recruiting for clinical trials in pregnancy.

    Directory of Open Access Journals (Sweden)

    Mahvash Shere

    Full Text Available Recruitment of women in the periconceptional period to clinical studies using traditional advertising through medical establishments is difficult and slow. Given the widespread use of the internet as a source for medical information and research, we analyze the impact of social media in the second phase of an ongoing randomized, open-label clinical trial among pregnant women. This study aims to assess the effectiveness of social media as a recruitment tool through the comparison of diverse recruitment techniques in two different phases of the trial.Recruitment in Phase 1 of the study consisted solely of traditional healthcare-based sources. This was compared to Phase 2 of the study where traditional recruitment was continued and expanded, while social media was used as a supplementary source. Yearly recruitment and recruitment rates in the two phases were compared using the Mann Whitney U test. The contributions of each recruitment source to overall recruitment were analyzed, and the impact of potential confounders on recruitment rate was evaluated using a multiple regression and Interrupted Time Series Analysis.In the first phase of the study, with over 56 months of recruitment using traditional sources, 35 women were enrolled in the study, resulting in a mean rate of ±0.62 recruits/month. In the 6 months implementing recruitment through social media, 45 women were recruited, for a 12-fold higher rate of ±7.5 recruits/month. Attrition rates remained constant, suggesting that social media had a positive impact on recruitment. The Interrupted Time Series Analysis detected a significant difference in recruitment after the intervention of social media (p<0.0001 with an evident increase in the number of recruits observed after the use of social media.Clinicians and scientists recruiting for clinical studies should learn how to use online social media platforms to improve recruitment rates, thus increasing recruitment efficiency and cost-effectiveness.

  11. Are there ethnic differences in pregnancy rates in African-American versus white women undergoing frozen blastocyst transfers?

    Science.gov (United States)

    Csokmay, John M; Hill, Micah J; Maguire, Marcy; Payson, Mark D; Fujimoto, Victor Y; Armstrong, Alicia Y

    2011-01-01

    To determine whether frozen-thawed blastocyst transfer pregnancy rates (PR) are lower in African-American compared with white women. Retrospective review of frozen blastocyst cycles. University-based assisted reproductive technology (ART) program. All patients who underwent a frozen blastocyst transfer between 2003 and 2008. None. Live birth rate. One hundred sixty-nine patients underwent transfer of a frozen-thawed blastocyst. African-American women had a higher incidence of leiomyoma (40% vs. 10%) and tubal and uterine factor infertility. There was no difference in the live birth rate for African-American patients (28.0%) compared with white patients (30.2%). Of the patients who underwent a frozen-thawed blastocyst transfer, 58% (n=98) had their fresh, autologous IVF cycle, which produced the cryopreserved blastocyst, at Walter Reed Medical Center. A higher peak serum E2 level was noted in African-American patients (5,355 pg/mL) compared with white patients (4,541 pg/mL). During the fresh cycle, the live birth rates between African-American and white patients were significantly different at 16.7% versus 39.7%, respectively. Live birth rates after frozen blastocyst transfer are not different between African-American and white women despite a fourfold higher incidence of leiomyomas in African-American women. Copyright © 2011. Published by Elsevier Inc.

  12. Clinical application of bilateral uterine arterial chemoembolization in the treatment of massive hemorrhage due to cesarean scar pregnancy

    International Nuclear Information System (INIS)

    Wan Jun; Gu Weijin; Wang Haiyun; Ye Lei; Wang Wei; Zhang Lei; Ji Lihua

    2009-01-01

    Objective: To investigate the clinical application of bilateral uterine arterial chemoembolization in treating massive hemorrhage due to uterine scar pregnancy after cesarean section. Methods: Sixteen patients with massive hemorrhage due to cesarean scar pregnancy were enrolled in the study, the mean blood loss was (2 200 ± 1 400) ml. With Seldinger technique, abdominal angiography by using a pig-tail catheter was carried out. When bilateral uterine arterial bleeding was confirmed, selective or super-selective catheterization was employed and bilateral uterine arterial chemoembolization with infusion of 5-Fu or methotrexate (MTX) together with gelatin sponge via the catheters was conducted. The clinical results were observed. Results: The technical success was achieved in all 16 patients. No recurrent bleeding occurred during a follow-up of 3-6 months. Conclusion: The emergency bilateral uterine arterial chemoembolization is a safe and effective treatment for massive hemorrhage due to cesarean scar pregnancy with no serious complications, therefore, this technique is worth being used in clinical practice. (authors)

  13. Malnutrition in pregnancy following bariatric surgery: three clinical cases of fetal neural defects

    OpenAIRE

    Pelizzo, Gloria; Calcaterra, Valeria; Fusillo, Mario; Nakib, Ghassan; Ierullo, Antonio Maria; Alfei, Alessandro; Spinillo, Arsenio; Stronati, Mauro; Cena, Hellas

    2014-01-01

    Objective Bariatric surgery results in decreased food intake and a variable degree of malabsorption. Without adequate supplementation, the most common complications of this surgery are nutritional disorders. Pregnancy following surgery for obesity is a particular condition requiring strict monitoring of nutrient intake necessary for fetal development and a favourable neonatal prognosis. Patients Malnutrition in pregnancy and congenital neural malformations are reported in three women who had ...

  14. A cross-sectional, clinical study to evaluate mobility of teeth during pregnancy using periotest

    Directory of Open Access Journals (Sweden)

    Poonam Sujeet Mishra

    2017-01-01

    Full Text Available Background and Objective: Over a century, an increased prevalence of gingival diseases associated with increasing plasma sex steroid hormone levels has been reported. These situations present unique challenges to the oral health-care professional. It is believed that hormonal fluctuations such as those associated with pregnancy, menstruation, and use of hormonal contraceptives lead to an increase in tooth mobility. However, this effect of female sex hormones on periodontal ligament and tooth-supporting alveolar bone has rarely been investigated. Hence, this study was conducted to understand the effect of hormonal changes during pregnancy on tooth mobility. Materials and Methods: Mobility of index teeth 16, 13, 21, 23, 24, 36, 33, 41, 43, and 44 was measured with periotest for fifty pregnant females at first trimester (12th week, second trimester (24th week, and third trimester (35th week. Simplified oral hygiene index, plaque index, Gingival index (GI, and probing depth were also evaluated during the three trimesters of pregnancy for each subject participating in the study. Statistical Analysis: The results of the study were subjected to statistical analysis. Data analysis was done by applying Z-test for comparing difference between two sample means. Results: A small but statistically significant influence on the periotest value was seen during the three trimesters of pregnancy. GI scores significantly increased throughout pregnancy despite no significant change in plaque levels. Conclusion: Pregnancy had a significant influence on tooth mobility. Highest value of tooth mobility was seen in the last month of pregnancy. The maximum severity of gingivitis was also seen during the third trimester of pregnancy.

  15. Comparative assessment of clinical rating scales in Wilson's disease.

    Science.gov (United States)

    Volpert, Hanna M; Pfeiffenberger, Jan; Gröner, Jan B; Stremmel, Wolfgang; Gotthardt, Daniel N; Schäfer, Mark; Weiss, Karl Heinz; Weiler, Markus

    2017-07-21

    Wilson's disease (WD) is an autosomal recessive disorder of copper metabolism resulting in multifaceted neurological, hepatic, and psychiatric symptoms. The objective of the study was to comparatively assess two clinical rating scales for WD, the Unified Wilson's Disease Rating Scale (UWDRS) and the Global Assessment Scale for Wilson's disease (GAS for WD), and to test the feasibility of the patient reported part of the UWDRS neurological subscale (termed the "minimal UWDRS"). In this prospective, monocentric, cross-sectional study, 65 patients (median age 35 [range: 15-62] years; 33 female, 32 male) with treated WD were scored according to the two rating scales. The UWDRS neurological subscore correlated with the GAS for WD Tier 2 score (r = 0.80; p < 0.001). Correlations of the UWDRS hepatic subscore and the GAS for WD Tier 1 score with both the Model for End Stage Liver Disease (MELD) score (r = 0.44/r = 0.28; p < 0.001/p = 0.027) and the Child-Pugh score (r = 0.32/r = 0.12; p = 0.015/p = 0.376) were weak. The "minimal UWDRS" score significantly correlated with the UWDRS total score (r = 0.86), the UWDRS neurological subscore (r = 0.89), and the GAS for WD Tier 2 score (r = 0.86). The UWDRS neurological and psychiatric subscales and the GAS for WD Tier 2 score are valuable tools for the clinical assessment of WD patients. The "minimal UWDRS" is a practical prescreening tool outside scientific trials.

  16. Utility of the Clinical Dementia Rating in Asian Populations

    Science.gov (United States)

    Lim, Wee Shiong; Chong, Mei Sian; Sahadevan, Suresh

    2007-01-01

    Consistent with the worldwide demographic trend of population aging, dementia is expected to become a burgeoning public health problem in Asian populations. Thus, there is a pressing need for reliable and valid methods of dementia diagnosis and staging that are applicable in heterogeneous Asian populations. The Clinical Dementia Rating (CDR) is an informant-based global assessment scale with established reliability and validity that has been widely utilized as a severity-ranking scale in many studies of Asian populations. From a diagnostic standpoint, the CDR is congruent with the Diagnostic and Statistical Manual of Mental Disorders approach of dementia diagnosis. It exhibits excellent discriminatory ability in the very mild stages of dementia, a useful property that is germane to the surging interest in mild cognitive impairment and related concepts. Limitations of the CDR include its length of administration, reliance on clinical judgment and collateral source information, and relative insensitivity as a measure of change in interventional studies. Since the exercise of clinical judgment is inherent in scoring, CDR raters should be mindful of the influence of cultural factors on premorbid lifestyle, informant reliability and performance in certain CDR test items (especially those pertaining to the categories of judgment and problem solving, community, and home and hobbies). Thus, in future studies that involve the nascent use of the CDR in Asian populations, it is recommended that any transcultural adaptation of CDR items be described in detail and appropriate validation studies be carried out before adopting the CDR as a yardstick measure of assessment. The potential of adapted versions of the CDR in chronic care settings and advanced cases should be explored. An integrative approach, combining brief informant interview in conjunction with brief objective cognitive testing, could be a viable strategy for dementia screening in the clinical and research setting

  17. Prevention of thrombosis in pregnancy: how practical are consensus derived clinical practice guidelines?

    LENUS (Irish Health Repository)

    Hayes-Ryan, D

    2012-11-01

    Thromboembolic disease (TED) has, for many years, consistently been identified as one of the leading causes of direct maternal mortality. In November 2009, the RCOG published a guideline on the prevention of TED that has been rapidly adopted by hospital trusts in the UK. The aim of our study was to determine the number and profile of women in our population that would require treatment with low molecular weight heparin (LMWH) and the cost implications of such treatment if these guidelines were implemented. A retrospective review of the first 100 women who delivered at the Coombe Women & Infants University Hospital (CWIUH) in 2010 was conducted and risk stratification applied at the relevant time points. A total of 51% were deemed to be at intermediate or high risk of TED at some point during pregnancy. In 35 of the 51 women (70%), this risk was attributable to factors such as age>35 years, parity≥3, BMI>30 kg\\/m2 or cigarette smoking. In our obstetric population, the percentage of women with these risk factors was: 25.5%, 8.5%, 19% and 16.7%, respectively. Implementation of this guideline would increase the hospital annual expenditure on LMWH by a factor of 17. The strategy of attributing risk by accumulating factors that individually have a low risk of TED and are prevalent in the population needs to be re-visited. The cost of implementation of these guidelines is not inconsiderable in the absence of data to indicate that clinical outcome is improved with their implementation.

  18. Clinically Determined and Self-Reported Dental Caries Status During and After Pregnancy Among Low-Income Hispanic Women

    Science.gov (United States)

    Weintraub, Jane A.; Gansky, Stuart A.; Santo, William; Ramos-Gomez, Francisco

    2014-01-01

    Objectives This analysis assessed, during and one-year after pregnancy: 1) the prevalence of and relationship between self-reported and clinically determined dental caries and oral health status, and whether self-reports are a potential proxy for professional determination; 2) factors associated with high levels of professionally determined or self-reported oral disease. Methods Data are from a randomized clinical trial of 301 pregnant, low-income Hispanic women at the California-Mexico border to compare two interventions to prevent early childhood caries. Interviews and dental examinations were conducted at enrollment (second trimester) and one-year post-partum (PP). Results During pregnancy and PP, 93% had untreated caries and most had gingival inflammation. Sensitivity and specificity of self-reported measures compared to dentists’ determinations were modest (ranging from 45–80% for sensitivity and 41–77% for specificity at both time points); positive predictive values for women reporting current tooth decay or fair/poor oral health were high (>94%), but negative predictive values were low (<23%). In a bivariate GEE model, factors associated with fair/poor self-reported oral health during and after pregnancy included self-reported dental symptoms (current tooth decay, bleeding gums without brushing), dental behaviors (not flossing) and number of decayed tooth surfaces. In a logistic regression model, the only significant factor PP associated with less extensive untreated disease was if women ever had their teeth cleaned professionally (OR=0.44). Conclusions There is a great need for dental treatment in this underserved population both during pregnancy and PP. Women may not be able to accurately recognize or act on their treatment needs. At baseline and PP, few demographic or behavioral factors were associated with either self-reported or clinically-determined oral disease (e.g., being less educated or acculturated and not flossing) in the bivariate

  19. Impact of patient satisfaction ratings on physicians and clinical care

    Directory of Open Access Journals (Sweden)

    Zgierska A

    2014-04-01

    Full Text Available Aleksandra Zgierska,1 David Rabago,1 Michael M Miller2–4 1Department of Family Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, 2American Society of Addiction Medicine, Chevy Chase, MD, 3Department of Psychiatry, University of Wisconsin-Madison, School of Medicine and Public Health, 4Herrington Recovery Center, Rogers Memorial Hospital, Oconomowoc, WI, USA Background: Although patient satisfaction ratings often drive positive changes, they may have unintended consequences. Objective: The study reported here aimed to evaluate the clinician-perceived effects of patient satisfaction ratings on job satisfaction and clinical care. Methods: A 26-item survey, developed by a state medical society in 2012 to assess the effects of patient satisfaction surveys, was administered online to physician members of a state-level medical society. Respondents remained anonymous. Results: One hundred fifty five physicians provided responses (3.9% of the estimated 4,000 physician members of the state-level medical society, or approximately 16% of the state's emergency department [ED] physicians. The respondents were predominantly male (85% and practicing in solo or private practice (45%, hospital (43%, or academia (15%. The majority were ED (57%, followed by primary care (16% physicians. Fifty-nine percent reported that their compensation was linked to patient satisfaction ratings. Seventy-eight percent reported that patient satisfaction surveys moderately or severely affected their job satisfaction; 28% had considered quitting their job or leaving the medical profession. Twenty percent reported their employment being threatened because of patient satisfaction data. Almost half believed that pressure to obtain better scores promoted inappropriate care, including unnecessary antibiotic and opioid prescriptions, tests, procedures, and hospital admissions. Among 52 qualitative responses, only three were positive. Conclusion

  20. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines.

    Directory of Open Access Journals (Sweden)

    Tessa E R Gillon

    Full Text Available Clinical practice guidelines (CPGs are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy to inform clinical practice.MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of Abstracts of Reviews of Effects (Ovid interface, Grey Matters, Google Scholar, and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13 in English, French, Dutch, or German. Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3-1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ≧80% on every domain of the AGREE II, a tool for assessing guideline methodological quality; two CPGs did so for 5/6 domains. Consistency was seen for (i definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii antihypertensive treatment of severe hypertension; (iv MgSO4 for eclampsia and severe pre-eclampsia; (v antenatal corticosteroids at <34 wks when delivery is probable within 7 days; (vi delivery for women with severe pre-eclampsia pre-viability or pre-eclampsia at term; and (vii active management of the third stage of labour with oxytocin. Notable inconsistencies were in: (i definitions of pre-eclampsia and severe pre-eclampsia; (ii target BP for non-severe hypertension; (iii timing of delivery for women with pre-eclampsia and severe pre-eclampsia; (iv MgSO4 for non-severe pre-eclampsia, and (v postpartum maternal monitoring.Existing international HDP CPGs have areas of consistency with which clinicians and

  1. Multiple Pregnancy

    Science.gov (United States)

    ... Education & Events Advocacy For Patients About ACOG Multiple Pregnancy Home For Patients Search FAQs Multiple Pregnancy Page ... Multiple Pregnancy FAQ188, July 2015 PDF Format Multiple Pregnancy Pregnancy How does multiple pregnancy occur? What are ...

  2. Pregnancy-related systemic lupus erythematosus: clinical features, outcome and risk factors of disease flares--a case control study.

    Science.gov (United States)

    Yang, Huaxia; Liu, Hui; Xu, Dong; Zhao, Lidan; Wang, Qian; Leng, Xiaomei; Zheng, Wenjie; Zhang, Fengchun; Tang, Fulin; Zhang, Xuan

    2014-01-01

    To investigate the clinical features, outcome, and risk factors of disease flares in patients with pregnancy-related lupus (PRL). Medical charts of 155 consecutive PRL inpatients were systematically reviewed, including demographic data, clinical features, laboratory findings, treatment, complications, and outcome. PRL cases were divided into active (a-PRL) (n = 82, 53.0%) and stable lupus (s-PRL) (n = 73, 47.0%). Compared with nonpregnant active female systemic lupus erythematosus (SLE) patients, a-PRL including new-onset lupus (n-PRL) and flare lupus (f-PRL) (n = 41 respectively), had a higher incidence of renal and hematological involvement but less mucocutaneous and musculoskeletal involvement (plupus flares and serological activity (hypocomplementemia and/or anti-dsDNA positivity) at the time of conception were associated with lupus flares in PRL mothers. SLE patients with a flare history and serological activity at the time of conception were at an increased risk of disease flares during pregnancy and puerperium. a-PRL patients were more prone to renal and hematological involvement, pregnancy complications, and a poorer prognosis despite more vigorous glucocorticoid treatment.

  3. Zika Virus and Pregnancy

    Medline Plus

    Full Text Available ... My ACOG ACOG Departments Donate Shop Career Connection Home Clinical Guidance & Publications Practice Management Education & Events Advocacy For Patients About ACOG Zika Virus and Pregnancy Home For Patients Zika Virus and Pregnancy Page Navigation ▼ ...

  4. Problems sleeping during pregnancy

    Science.gov (United States)

    ... sleeping References Balserak BI, Lee KA. Sleep and sleep disorders associated with pregnancy. In: Kryger M, Roth T, ... Elsevier; 2017:chap 156. Ibrahim S, Foldvary-Shaefer N. Sleep disorders in pregnancy: implications, evaluation, and treatment. Neurologic Clinics . ...

  5. Zika Virus and Pregnancy

    Medline Plus

    Full Text Available ... Career Connection Home Clinical Guidance & Publications Practice Management Education & Events Advocacy For Patients About ACOG Zika Virus ... and Pregnancy Page Navigation ▼ ACOG Pregnancy Book Patient Education FAQs Patient Education Pamphlets - Spanish Share: PEV002, September ...

  6. Improved fertility following conservative surgical treatment of ectopic pregnancy

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Lund, Claus Otto; Ottesen, Bent

    2003-01-01

    intrauterine pregnancy rate was significantly higher after tubotomy (88%) than after salpingectomy (66%) (log rank P ectopic pregnancy between the treatments (16% vs 17%). In patients with contralateral tubal......OBJECTIVE: To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Clinical University Center, Hvidovre Hospital, Copenhagen. POPULATION: Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic...... pregnancy between January 1992 and January 1999 and who actively attempted to conceive were followed for a minimum of 18 months. METHODS: Retrospective cohort study combined with questionnaire to compare reproductive outcome following salpingectomy or tubotomy for ectopic pregnancy. Cumulative probabilities...

  7. Association between the clinical classification of hypothyroidism and reduced TSH in LT4 supplemental replacement treatment for pregnancy in China.

    Science.gov (United States)

    Zhang, Lyu; Zhang, Zhaoyun; Ye, Hongying; Zhu, Xiaoming; Li, Yiming

    2016-01-01

    The study was aimed to evaluate the effects of levothyroxine (LT4) supplemental replacement treatment for pregnancy and analyze the associations between the clinical classification of hypothyroidism and reduced thyroid-stimulating hormone (TSH) in LT4 therapy. Totally, 195 pregnant women with hypothyroidism receiving routine prenatal care were enrolled. They were categorized into three groups: overt hypothyroidism (OH), subclinical hypothyroidism (SCH) with negative thyroperoxidase antibody (TPOAb), and SCH with positive TPOAb. The association between the clinical classification and reduced TSH in LT4 supplemental replacement treatment was assessed. The results indicated that reduced TSH was significantly different among the groups according to the clinical classifications (p = 0.043). The result was also significantly different between patients with OH and patients with SCH and negative TPOAb (p = 0.036). Similar result was reported for the comparison between patients with OH and patients with SCH and positive TPOAb (p = 0.016). Multiple variable analyses showed that LT4 supplementation, gestational age and the variable of clinical classifications were associated with reduced TSH independently. Our data suggested that the therapeutic effect of substitutive treatment with LT4 was significantly associated with different clinical classifications of hypothyroidism in pregnancy and the treatment should begin as soon as possible after diagnosis.

  8. Review: Alterations in placental glycogen deposition in complicated pregnancies: Current preclinical and clinical evidence.

    Science.gov (United States)

    Akison, Lisa K; Nitert, Marloes Dekker; Clifton, Vicki L; Moritz, Karen M; Simmons, David G

    2017-06-01

    Normal placental function is essential for optimal fetal growth. Transport of glucose from mother to fetus is critical for fetal nutrient demands and can be stored in the placenta as glycogen. However, the function of this glycogen deposition remains a matter of debate: It could be a source of fuel for the placenta itself or a storage reservoir for later use by the fetus in times of need. While the significance of placental glycogen remains elusive, mounting evidence indicates that altered glycogen metabolism and/or deposition accompanies many pregnancy complications that adversely affect fetal development. This review will summarize histological, biochemical and molecular evidence that glycogen accumulates in a) placentas from a variety of experimental rodent models of perturbed pregnancy, including maternal alcohol exposure, glucocorticoid exposure, dietary deficiencies and hypoxia and b) placentas from human pregnancies with complications including preeclampsia, gestational diabetes mellitus and intrauterine growth restriction (IUGR). These pregnancies typically result in altered fetal growth, developmental abnormalities and/or disease outcomes in offspring. Collectively, this evidence suggests that changes in placental glycogen deposition is a common feature of pregnancy complications, particularly those associated with altered fetal growth. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  9. Duration of pregnancy in relation to fish oil supplementation and habitual fish intake: a randomised clinical trial with fish oil

    DEFF Research Database (Denmark)

    Olsen, SF; Østerdal, ML; Salvig, JD

    2007-01-01

    )) from around week 20 (groups 1 and 2) or 6.3 g n-3 PUFA from week 33 (group 3). The control regimen was capsules with olive oil. Effect on timing of spontaneous delivery was examined by Cox regression, assuming elective delivery (occurring in 40%) as a censoring event. Analyses of effect of fish oil......OBJECTIVE: To examine the effect of fish oil supplementation on duration of pregnancy, conditional on the woman's habitual fish intake. DESIGN: Multicentre 1:1 randomised clinical trial of effect of fish oil in a high-risk population of pregnant women in whom habitual fish intake was assessed......); or with suspicion of IUGR or threatening preeclampsia in the current pregnancy (group 3, n=106). Women were stratified into low, middle, or high fish consumers. METHODS: The intervention group received fish oil capsules providing 2.7 g long-chain n-3 fatty acids per day (n-3 poly unsaturated fatty acids (PUFA...

  10. Relationship between ovulation rate and embryonic characteristics in gilts at 35 d of pregnancy

    NARCIS (Netherlands)

    Lima Alvares da Silva, Carolina; Broekhuijse, M.L.W.J.; Laurenssen, B.F.A.; Mulder, H.A.; Knol, Edward F.; Kemp, B.; Soede, N.M.

    2017-01-01

    This study investigated the relationship between ovulation rate (OR) and embryonic characteristics in gilts. Landrace (n = 86) and Yorkshire x Landrace (n = 212) gilts were inseminated with semen stored for 3 to 5 d (SS1, n = 59), 6 to7 d (SS2, n = 133), or 8 to 10 d (SS3, n = 106), and slaughtered

  11. Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study

    Directory of Open Access Journals (Sweden)

    Maria de Lourdes de Souza

    Full Text Available ABSTRACT Objective: analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil. Methods: a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests. Results: differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; p<0.001, have an infant with low birthweight (OR:1.1; CI:1.10-1.15; p<0.001 and low Apgar score at 5 minutes (OR:1.4; CI:1.34-1.45; p<0.001 than mothers ≥20 years, with the odds for adverse outcomes greater for those aged 10-14 years. Conclusion: this study provides evidence of fertility rates among adolescents remaining higher in regions of social and economic deprivation. Adolescent mothers and their infants more likely to experience adverse perinatal outcomes. Nurses, public health practitioners, health and social care professionals and educators need to work collaboratively to better target strategies for adolescents at greater risk; to help reduce fertility rates and improve outcomes.

  12. Pregnancy In Renal Transplant Recipients

    Directory of Open Access Journals (Sweden)

    H. Shahbazian

    2006-07-01

    Full Text Available Background:Correction of the uremic state by a functioning allograft often restores fertility in women of reproductive age. The rate of fertility significantly differs between industrial countries, developing and middle east countries.On the other hand the results of pregnancy in Kidney Transplantation (KTP patients are significantly better than hemodialysis patients,and pregnancy most often has no side effects on the function of the transplanted kidney.Objectives: The purpose of this study is to investigate the rate of fertility and results of pregnancy among KTP women, and the assessment of the function of transplanted kidneys during pregnancy among those who have received kidneys in Golestan Hospital from 1996 to 2003. Methods: All the transplanted women in child bearing age who were interested in accepting pregnancy were involved in this study. After pregnancy, all the patients were visited twice a month until the 32nd week of pregnancy and their histories were taken and regular clinical examination and necessary paraclinical assessments were carried out. After the 32nd week, they were visited weekly and other necessary assessments were done in addition to previous measures. Taking immunosuppressive drugs was continued with a minor dose reduction and consumption of harmful drugs like some antihypertensives was prohibited. Results: 16 out of 48 women who were at child bearing age and were interested in pregnancy got pregnant and totally 22 cases of pregnancy occurred. Four cases resulted in spontaneous or therapeutic abortion and 3 out of 18 remaining cases had intrauterine fetal death and the others had successful pregnancy. The most common complication was LBW and following that premature labor. Maternal complications were no more than the general population and the function of the transplanted kidney had no decline in most of the cases. Conclusion:Based on what was mentioned,it is concluded that successful KTP can increase the chance of

  13. The Effects of Intravenous Hydration on Amniotic Fluid Volume and Pregnancy Outcomes in Women with Term Pregnancy and Oligohydramnios: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mahnaz Shahnazi

    2012-08-01

    Full Text Available Introduction: Amniotic fluid is an important factor in the prediction of fetal survival. The aim of this research was to evaluate the effects of intravenous hydration of mothers on amniotic fluid volume and in turn on pregnancy outcomes. Methods: The current single blind controlled clinical trial was conducted on 20 pregnant mothers with amniot-ic fluid index of lower or equal to 5 cm and gestational age of 37-41 weeks. The subjects were divided into two groups of case and control through simple random sampling. Am-niotic fluid index was measured in all participants. The case group received one liter of isotonic saline during 30 minutes by the bolus method. Reevaluations of amniotic fluid index in both groups were made 90 minutes after baseline measurement. Independent t-test and paired t-test were used to compare the two groups and mean amniotic fluid in-dex before and after treatment, respectively. Results: Hydration of mothers significantly increased the amniotic fluid index in the case group (mean change: 1.5 cm; 95%CI: 0.46 - 2.64; P = 0.01. The mean change of amniotic fluid index in the control group did not significantly increase (P = 0.06. The elevation of amniotic fluid index in the hydra-tion group (32% was significantly higher than the control group (1% (P = 0.03. Conclusion: In this study intravenous hydration increased amniotic fluid index of mothers with term pregnancy and oligohydramnios. Since it caused no complications for the moth-er and the fetus, it can be used as an effective method in management of oligohydramnios.

  14. Heterotopic pregnancy in HIV women

    OpenAIRE

    Savasi, V.; Antonazzo, P.; Personeni, C.

    2016-01-01

    Heterotopic pregnancy occurs when intrauterine and ectopic pregnancy are concomitant; overall rate rises from 1/30.000 to 1.5/1000 in assisted reproductive technology pregnancies. HIV (human immunodeficiency virus) patients are at increased risk of heterotopic pregnancies due to the greater frequency of assisted reproductive technology and pelvic inflammatory disease. We report the first case of heterotopic pregnancy in HIV woman.

  15. Comparison of rates of and charges from pregnancy complications in users of extended and cyclic combined oral contraceptive (COC) regimens: a brief report.

    Science.gov (United States)

    Howard, Brandon; Trussell, James; Grubb, ElizaBeth; Lage, Maureen J

    2014-05-01

    To evaluate pregnancy complication rates and related charges in users of 84/7, 21/7 and 24/4 combined oral contraceptives (COCs). Data were obtained from the i3 InVision Data Mart™ retrospective claims database. Subjects were aged 15-40 years, first prescribed a COC between 1/1/2006 and 4/1/2011 and continuously insured for ≥1 year. 84/7 users were matched 1:1 to 21/7 and 24/4 users. Pregnancy-related complication rates and associated charges were significantly lower with 84/7 vs. 21/7 and 24/4 regimens. Preliminary data suggest 84/7 regimens may be associated with fewer pregnancy complications and lower related charges. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Orlistat in polycystic ovarian syndrome reduces weight with improvement in lipid profile and pregnancy rates

    Directory of Open Access Journals (Sweden)

    Pratap Kumar

    2014-01-01

    Full Text Available Background: The effects of exercise, metformin, and orlistat on anthropometric parameters, lipid profile, endocrine parameters, and ovulation in polycystic ovarian syndrome (PCOS women were compared. AIM: The aim was to study the efficacy of orlistat compared with metformin and exercise in PCOS. DESIGN: Randomized control trial. Methods: A total of 90 eligible PCOS women were randomly assigned to receive either of the two drugs (orlistat or metformin in combination with lifestyle interventions or as controls where they received lifestyle interventions alone. Anthropometric parameters were assessed at baseline and 4 weekly intervals for 3 months. Androgen levels, insulin resistance, ovulation and conception rates and lipid profile were also assessed at the end of study. Statistical Analysis: Statistical analysis was performed using the SPSS version 17.0. Results: The levels of fasting blood sugar, fasting insulin and homeostatic model assessment insulin resistance were comparable in three treatment groups. Mean total testosterone, serum hormone binding globulin, free androgen index, dehydroepiandrosterone sulfate in all arms were comparable and statistically nonsignificant. However, orlistat and metformin were more effective in reducing weight, body mass index, waist circumference and waist-hip ratio. However, side-effects were less with orlistat. Ovulation rate was 33.3%, 23.35% with orlistat and metformin group respectively, but were not statistically significant. In orlistat group, significant improvement was observed in lipid profile at the end of 3 months. Conception rates were 40% and 16.7% and 3.3% in orlistat, metformin group and control group respectively (P - 0.003. Weight loss was found to be the best predictor of ovulation with sensitivity with good sensitivity. Conclusion: Orlistat is as effective as metformin in reducing weight and achieves similar ovulation rates in obese PCOS patients. However, orlistat has minimal side

  17. Vitamin C supplementation in pregnancy--does it decrease rates of preterm birth? A systematic review.

    Science.gov (United States)

    Swaney, Paul; Thorp, John; Allen, Ian

    2014-02-01

    To assess the evidence available on the use of vitamin C supplementation greater than recommended dietary intake to reduce preterm birth rates. Systematic review of randomized controlled trials using vitamin C alone or with one other supplement other than iron. Trials must report preterm birth rates but can have other primary outcomes. Preterm birth is defined as birth at less than 37 weeks' gestational age for this review. Review focused on studies with populations representative of Organization for Economic Co-operation and Development countries. Inadequate level of evidence on the use of vitamin C alone to prevent preterm birth rates in low-risk populations based on one study. Three studies provided convincing evidence of no benefit in low-risk groups of use of vitamins C and E combined. Three studies provided adequate evidence of no benefit in high-risk groups of use of vitamins C and E combined. The available evidence supports no benefit gained from using vitamin C to prevent preterm birth. Evidence does not support limiting use of vitamin C supplementation for other indications. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  18. Living in stressful neighbourhoods during pregnancy: an observational study of crime rates and birth outcomes.

    Science.gov (United States)

    Clemens, Tom; Dibben, Chris

    2017-04-01

    Patterns of adverse birth outcomes vary spatially and there is evidence that this may relate to features of the physical environment such as air pollution. However, other social characteristics of the environment such as levels of crime are relatively understudied. This study examines the association between crime rates and birth weight and prematurity. Maternity inpatient data recorded at birth, including residential postcode, was linked to a representative 5% sample of Scottish Census data and small area crime rates from Scottish Police forces. Coefficients associated with crime were reported from crude and confounder adjusted models predicting low birth weight (crime rates were associated with strong and significant reductions in mean birth weight and increases in the risks of both a small for gestational age baby and premature birth. These effects, with the exception of prematurity, were robust to adjustment for individual characteristics including smoking, ethnicity and other socio-economic variables as well as area based confounders including air pollution. Mean birth weight was robust to additional adjustment for neighbourhood income deprivation. The level of crime in a mother's area of residence, which may be a proxy for the degree of threat felt and therefore stress experienced, appears to be an important determinant of the risk of adverse birth outcomes. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association.

  19. Improved fertility following conservative surgical treatment of ectopic pregnancy

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Lund, Claus Otto; Ottesen, Bent

    2003-01-01

    OBJECTIVE: To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Clinical University Center, Hvidovre Hospital, Copenhagen. POPULATION: Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic...... pregnancy between January 1992 and January 1999 and who actively attempted to conceive were followed for a minimum of 18 months. METHODS: Retrospective cohort study combined with questionnaire to compare reproductive outcome following salpingectomy or tubotomy for ectopic pregnancy. Cumulative probabilities...... of pregnancy for each group were calculated by the Kaplan-Meier estimator and compared by Cox regression analysis to control for potential confounders. MAIN OUTCOME MEASURES: Intrauterine pregnancy rates and recurrence rates of ectopic pregnancy after surgery for ectopic pregnancy. RESULTS: The cumulative...

  20. Clinical value of serum C-reactive protein, procalcitonin, and lipase in predicting severe acute pancreatitis during pregnancy

    Directory of Open Access Journals (Sweden)

    LI Xianping

    2016-10-01

    Full Text Available Objective To investigate clinical value of serum C-reactive protein (CRP, procalcitonin (PCT, and lipase in predicting severe acute pancreatitis (SAP during pregnancy. Methods A retrospective analysis was performed for the clinical data of 126 pregnant women with acute pancreatitis (AP who were treated in Nongken Sanya Hospital from January 2011 to January 2016. According to the severity of AP, the patients were divided into control group (pregnancy complicated by mild-to-moderate AP, 71 patients and observation group (pregnancy complicated by SAP, 55 patients. The clinical features of AP in pregnancy were compared between the two groups. The laboratory markers including venous leukocyte count, hemoglobin, plasma albumin, blood amylase, CRP, PCT, and lipase were observed. The t-test was used for comparision of continuos data between groups, and the chi-square test was used for comparision of categorial data between groups, and the receiver operating characteristic (ROC curves were plotted for statistically significant markers to assess their sensitivities and specificities. Results The observation group had significantly higher serum levels of lipase, PCT, and CRP than the control group (lipase: 857.73±158.61 U/L vs 590.19±138.67 U/L, χ2=7.689, P<0.01; PCT: 10.07±4.55 ng/ml vs 5.89±2.13 ng/ml, χ2=15.492, P<0.01; CRP: 269.93±63.61 mg/L vs 202.64±39.58 mg/L, χ2=7.500, P<0.01. According to the ROC curves, serum lipase, PCT, and CRP had areas under the ROC curve of 0.920, 0.841, and 0.832, respectively, with corresponding cut-off values of 712 U/L, 7.6 ng/ml, and 262.0 mg/L, sensitivities of 87.9%, 83.5%, and 81.3%, and specificities of 83.2%, 86.1%, and 78.9%, respectively. Conclusion Increased serum levels of lipase, PCT, and CRP have a great value in the diagnosis of SAP during pregnancy.

  1. Adolescent pregnancy.

    Science.gov (United States)

    Short, J D; Slusher, I L

    1994-01-01

    Kentucky has the fourth highest percentage of infants born to teenage mothers in the US. Risk factors for adolescent pregnancy are poor academic performance, family history of adolescent pregnancy, absence of one or both biological parents in the home, troubled family relationships, family violence, history of substance abuse, and poor self-concept. Pregnancy adds new developmental requirements to the continual developmental crisis of adolescence. Some of these developmental requirements are dealing with pregnancy and birth of a child and peer and family reactions and relationships. Pregnant teens are at high risk for anemia, preeclampsia, preterm delivery, and low birth weight infants. The health care team must assess the abilities, needs, practices, and priorities of teens. Nurses should promote health and positive health practices in teens. They should focus on prevention of adolescent pregnancy and on meeting the needs of pregnant teens. Adolescent pregnancy interventions include education and adolescent-centered special programs. Peer groups, role playing, videos, and computer games are individualized and effective education techniques for teens. Formal adolescent pregnancy prevention programs are abstinence education, knowledge-based programs, and clinic-focused or school-based programs. A combination of approaches is more effective than using just one approach. Adolescent pregnancy prevention interventions should promote the value of education, discourage substance abuse, and provide counseling for victims of child abuse. Pregnant teens should receive prenatal care as soon as possible. One health care agency should combine physical care, psychosocial support, and education for teens. Kentucky schools help pregnant teens continue their education and help them obtain information and support for care for themselves and their babies. Nurses can be effective at reducing the number of unwanted teen pregnancies.

  2. Diet density in rearing and reproductive phases influences carcass composition, pregnancy rate and litter performance of primiparous rabbit does

    Directory of Open Access Journals (Sweden)

    Paulo Sérgio dos Santos Teixeira

    2017-06-01

    Full Text Available The objective was to evaluate the effect of the interaction of diet density in the rearing phase×diet density in the reproductive phase on carcass composition, pregnancy rate, and litter performance of primiparous rabbit does. The experiment followed a 2×2×2 factorial (2 seasons, 2 diet densities in the rearing phase and 2 diet densities in reproductive phase, that is, from mating to weaning of the first litter. The reference diet (RD contained 184 g/kg of crude protein (CP, 165 g/kg of acid detergent fibre (ADF and 10.5 MJ/kg of digestible energy (DE. The low-density diet (LD had 147 g/kg of CP, 24 g/kg of ADF and 8.4 MJ/kg of DE. The treatments were applied from 70 d of age until weaning of the first litter at 35 d of age. Ninety-six females from the Botucatu Genetic Group (24 females/experimental group were mated at 142 d of age. On day 12 of gestation, 23 does were slaughtered to evaluate weights of carcass, organs and dissectible fat, and embryo implantation rate. No effects of diet density in the rearing or in the reproductive phases were detected on feed intake of does during the reproductive phase. Does fed LD during the rearing phase showed lower body weight at mating (3574±47 vs. 3866±43 g, P=0.0001 and during most of the reproductive phase, but they lost less weight in the peripartum. Perirenal fat was lighter in these does (72.8±10.0 vs. 102.1±9.6 g, P=0.048 and they showed a lower pregnancy rate (76.1 vs. 91.7%, P=0.045. The does fed RD in the reproductive phase were heavier during this phase (4055±40 g vs. 3887±41 g, P=0.0044. The does fed LD in rearing phase and RD in the reproductive phase showed larger litters at weaning, due to decreased kit mortality, than those fed RD in both phases (6.16±0.47 vs. 3.93±0.71, P=0.0361. Litters were lighter at weaning when LD was fed in the reproductive phase (3582±201 vs. 4733±187, P<0.0001. Feeding a low-density diet during the rearing phase and a reference diet during the

  3. Using two on-going HIV studies to obtain clinical data from before, during and after pregnancy for HIV-positive women

    Directory of Open Access Journals (Sweden)

    Huntington Susie E

    2012-07-01

    Full Text Available Abstract Background The UK Collaborative HIV Cohort (UK CHIC is an observational study that collates data on HIV-positive adults accessing HIV clinical care at (currently 13 large clinics in the UK but does not collect pregnancy specific data. The National Study of HIV in Pregnancy and Childhood (NSHPC collates data on HIV-positive women receiving antenatal care from every maternity unit in the UK and Ireland. Both studies collate pseudonymised data and neither dataset contains unique patient identifiers. A methodology was developed to find and match records for women reported to both studies thereby obtaining clinical and treatment data on pregnant HIV-positive women not available from either dataset alone. Results Women in UK CHIC receiving HIV-clinical care in 1996–2009, were found in the NSHPC dataset by initially ‘linking’ records with identical date-of-birth, linked records were then accepted as a genuine ‘match’, if they had further matching fields including CD4 test date. In total, 2063 women were found in both datasets, representing 23.1% of HIV-positive women with a pregnancy in the UK (n = 8932. Clinical data was available in UK CHIC following most pregnancies (92.0%, 2471/2685 pregnancies starting before 2009. There was bias towards matching women with repeat pregnancies (35.9% (741/2063 of women found in both datasets had a repeat pregnancy compared to 21.9% (1502/6869 of women in NSHPC only and matching women HIV diagnosed before their first reported pregnancy (54.8% (1131/2063 compared to 47.7% (3278/6869, respectively. Conclusions Through the use of demographic data and clinical dates, records from two independent studies were successfully matched, providing data not available from either study alone.

  4. Using two on-going HIV studies to obtain clinical data from before, during and after pregnancy for HIV-positive women.

    Science.gov (United States)

    Huntington, Susie E; Bansi, Loveleen K; Thorne, Claire; Anderson, Jane; Newell, Marie-Louise; Taylor, Graham P; Pillay, Deenan; Hill, Teresa; Tookey, Pat A; Sabin, Caroline A

    2012-07-28

    The UK Collaborative HIV Cohort (UK CHIC) is an observational study that collates data on HIV-positive adults accessing HIV clinical care at (currently) 13 large clinics in the UK but does not collect pregnancy specific data. The National Study of HIV in Pregnancy and Childhood (NSHPC) collates data on HIV-positive women receiving antenatal care from every maternity unit in the UK and Ireland. Both studies collate pseudonymised data and neither dataset contains unique patient identifiers. A methodology was developed to find and match records for women reported to both studies thereby obtaining clinical and treatment data on pregnant HIV-positive women not available from either dataset alone. Women in UK CHIC receiving HIV-clinical care in 1996-2009, were found in the NSHPC dataset by initially 'linking' records with identical date-of-birth, linked records were then accepted as a genuine 'match', if they had further matching fields including CD4 test date. In total, 2063 women were found in both datasets, representing 23.1% of HIV-positive women with a pregnancy in the UK (n = 8932). Clinical data was available in UK CHIC following most pregnancies (92.0%, 2471/2685 pregnancies starting before 2009). There was bias towards matching women with repeat pregnancies (35.9% (741/2063) of women found in both datasets had a repeat pregnancy compared to 21.9% (1502/6869) of women in NSHPC only) and matching women HIV diagnosed before their first reported pregnancy (54.8% (1131/2063) compared to 47.7% (3278/6869), respectively). Through the use of demographic data and clinical dates, records from two independent studies were successfully matched, providing data not available from either study alone.

  5. Laparoscopic Excision of Coexisting Left Tubal and Right Pseudotubal Pregnancy after Conservative Management of Previous Ectopic Pregnancy with Methotrexate: An Unusual Clinical Entity

    Directory of Open Access Journals (Sweden)

    Panayotis Xiromeritis

    2015-01-01

    Full Text Available Tubal pregnancy concerns 97% of all ectopic pregnancies. Treatment can be either surgical (salpingostomy or salpingectomy or medical (methotrexate administration. We present a case of a pseudotubal pregnancy after methotrexate treatment of a previous ectopic pregnancy. A37-year-old woman was diagnosed with ectopic pregnancy in the left Fallopian tube. A year ago, she had an ectopic pregnancy in the right tube, which was successfully treated with intramuscular methotrexate. During laparoscopy, two tubal masses were revealed, one in each Fallopian tube, and bilateral salpingectomy was performed. Histological analysis confirmed tubal pregnancy in the left Fallopian tube and presence of endosalpingitis in the right tube with no signs of chorionic villi. The optimal management of such cases has not yet been clarified. However, evaluation of tubal patency after a medically treated ectopic pregnancy would permit proper counsel of the patient on her fertility options, in order to choose the appropriate method of conception to achieve and accomplish a future pregnancy.

  6. Effects of gonadotropin-releasing hormone administration or a controlled internal drug-releasing insert after timed artificial insemination on pregnancy rates of dairy cows.

    Science.gov (United States)

    Jeong, Jae Kwan; Choi, In Soo; Kang, Hyun Gu; Hur, Tai Young; Kim, Ill Hwa

    2016-12-30

    This study investigated the effects of gonadotrophin-releasing hormone (GnRH) administration (Experiment 1) and a controlled internal drug-releasing (CIDR) insert (Experiment 2) after timed artificial insemination (TAI) on the pregnancy rates of dairy cows. In Experiment 1, 569 dairy cows that underwent TAI (day 0) following short-term synchronization with prostaglandin F 2α were randomly allocated into two groups: no further treatment (control, n = 307) or injection of 100 µg of gonadorelin on day 5 (GnRH, n = 262). In Experiment 2, 279 dairy cows that underwent TAI (day 0) following Ovsynch were randomly allocated into two groups: no further treatment (control, n = 140) or CIDR insert treatment from days 3.5 to 18 (CIDR, n = 139). The probability of pregnancy following TAI did not differ between the GnRH (34.4%) and control (31.6%, p > 0.05) groups. However, the probability of pregnancy following TAI was higher (odds ratio: 1.74, p < 0.05) in the CIDR group (51.1%) than in the control group (39.3%). Overall, CIDR insert treatment at days 3.5 to 18 increased pregnancy rates relative to non-treated controls, whereas a single GnRH administration on day 5 did not affect the pregnancy outcomes of dairy cows.

  7. Effect of oral contraceptive pill pretreatment on ongoing pregnancy rates in patients stimulated with GnRH antagonists and recombinant FSH for IVF. A randomized controlled trial.

    Science.gov (United States)

    Kolibianakis, Efstratios M; Papanikolaou, Evangelos G; Camus, Michel; Tournaye, Herman; Van Steirteghem, Andre C; Devroey, Paul

    2006-02-01

    The objective of this randomized controlled trial was to assess the effect of oral contraceptive pill (OCP) pretreatment on the probability of ongoing pregnancy in patients treated with a GnRH antagonist for IVF. A fixed dose of 200 IU recombinant FSH (rFSH) was started in 425 patients either on day 2 of the menstrual cycle (non-OCP group: n = 211) or 5 days after discontinuing the OCP (OCP group: n = 214). GnRH-antagonist was initiated on day 6 of stimulation, and triggering of final oocyte maturation was performed with 10,000 IU of HCG. Ongoing pregnancy rates per started cycle in the non-OCP and OCP group were 27.5% and 22.9%, respectively [95% confidence interval (CI) of the difference: -3.7 to +12.8]. Pregnancy loss was significantly increased in the OCP (36.4%) compared with the non-OCP group (21.6%) (95% CI of the difference: -28.4 to -2.3). Pretreatment with OCP, as compared with initiation of stimulation on day 2 of the cycle in patients treated with GnRH antagonist and recombinant FSH, appears to be associated with a not significant difference in ongoing pregnancy rates per started cycle and results in a significantly higher early pregnancy loss.

  8. Effects of gonadotropin-releasing hormone administration or a controlled internal drug-releasing insert after timed artificial insemination on pregnancy rates of dairy cows

    Science.gov (United States)

    Jeong, Jae Kwan; Choi, In Soo; Kang, Hyun Gu; Hur, Tai Young

    2016-01-01

    This study investigated the effects of gonadotrophin-releasing hormone (GnRH) administration (Experiment 1) and a controlled internal drug-releasing (CIDR) insert (Experiment 2) after timed artificial insemination (TAI) on the pregnancy rates of dairy cows. In Experiment 1, 569 dairy cows that underwent TAI (day 0) following short-term synchronization with prostaglandin F2α were randomly allocated into two groups: no further treatment (control, n = 307) or injection of 100 µg of gonadorelin on day 5 (GnRH, n = 262). In Experiment 2, 279 dairy cows that underwent TAI (day 0) following Ovsynch were randomly allocated into two groups: no further treatment (control, n = 140) or CIDR insert treatment from days 3.5 to 18 (CIDR, n = 139). The probability of pregnancy following TAI did not differ between the GnRH (34.4%) and control (31.6%, p > 0.05) groups. However, the probability of pregnancy following TAI was higher (odds ratio: 1.74, p < 0.05) in the CIDR group (51.1%) than in the control group (39.3%). Overall, CIDR insert treatment at days 3.5 to 18 increased pregnancy rates relative to non-treated controls, whereas a single GnRH administration on day 5 did not affect the pregnancy outcomes of dairy cows. PMID:27030200

  9. Malnutrition in pregnancy following bariatric surgery: three clinical cases of fetal neural defects.

    Science.gov (United States)

    Pelizzo, Gloria; Calcaterra, Valeria; Fusillo, Mario; Nakib, Ghassan; Ierullo, Antonio Maria; Alfei, Alessandro; Spinillo, Arsenio; Stronati, Mauro; Cena, Hellas

    2014-06-14

    Bariatric surgery results in decreased food intake and a variable degree of malabsorption. Without adequate supplementation, the most common complications of this surgery are nutritional disorders. Pregnancy following surgery for obesity is a particular condition requiring strict monitoring of nutrient intake necessary for fetal development and a favourable neonatal prognosis. Malnutrition in pregnancy and congenital neural malformations are reported in three women who had previously undergone bariatric surgery (1, 5 and 18 years before pregnancy, respectively). Two patients underwent the Roux en Y bypass and one bilio-pancreatic diversion with gastroplasty. None of the three received pre-conceptional nutritional counselling. Patients 1 and 2 did not undergo postoperative nutritional surveillance; nutrient supplementation was started at 22 and 20 weeks gestation, respectively. In patient 3, supplementation was stopped at six weeks gestation. Newborns 1 and 2 presented with dorsal myelomeningocele and ventricular dilation. Both underwent surgery and a ventriculo-peritoneal shunt was inserted in the first month of life. Newborn 3 had microcephaly, bilateral microphthalmia and sensorineural deafness. Diet and nutritional status, before and during pregnancy, play an important role in the early processes of fetal development and neonatal outcome. Women of childbearing age who have had bariatric surgery, should be encouraged to follow a well-balanced diet as part of a weight management strategy. They should be advised to take recommended maternal supplements.

  10. [Clinical analysis of pregnancy and postpartum cardiovascular complications in Marfan syndrome].

    Science.gov (United States)

    Xie, Jin-sheng; Li, Bin; Sun, Yan-qing; Guan, Xin-liang; Xu, Bao-wei; Qiao, Zhi-yu

    2007-11-01

    To investigate the management of pregnancy and cardiovascular complications in women with Marfan syndrome (MFS). From October 1994 to September 2006, 30 patients with MFS undergoing cardiovascular surgery were studied retrospectively. In the labor of 46 offsprings given birth by 30 women, 5 cases (11%) were performed elective cesarean section because of the existence of aortic complication, and 12 (26%) were diagnosed as MFS. The gestation in two patients was terminated due to deterioration of aortic abnormalities during their third trimester, and they received surgical treatment with Bentall procedure. Two developed acute aortic dissection during labor and post delivery respectively. With the manipulation of anticoagulation peripartum, one who had the implantation with mechanical prosthesis went through pregnancy and delivery uneventfully. The average duration between delivery and cardiovascular surgery was (15 +/- 9) years. Vaginal delivery can be done safely in patients with the MFS who do not have or have mild cardiovascular system abnormalities, aortic dissection, or other important cardiac abnormalities, cesarean section should be the preferred method of delivery. Women with MFS are at increased risk for dissection and congestive heart failure during pregnancy and should be counseled before pregnancy about these risks, as well as the inheritance of the condition.

  11. Placental pathology and clinical trials : Histopathology data from prior and study pregnancies may improve analysis

    NARCIS (Netherlands)

    Khong, T. Y.; Ting, M.; Gordijn, S. J.

    Placental pathology may explain adverse outcomes and reveal likely recurrent lesions. Stratifying women into intervention arms of a perinatal trial on the basis of the placental histopathological findings of the index pregnancy and evaluating the effect of the interventions against the placental

  12. Thyroid disease in pregnancy: new insights in diagnosis and clinical management.

    Science.gov (United States)

    Korevaar, Tim I M; Medici, Marco; Visser, Theo J; Peeters, Robin P

    2017-10-01

    Adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Overt thyroid disease is associated with a wide range of adverse obstetric and child development outcomes. An increasing number of studies now indicate that milder forms of thyroid dysfunction are also associated with these adverse pregnancy outcomes. The definitions of both overt and subclinical thyroid dysfunction have changed considerably over the past few years, as new data indicate that the commonly used fixed upper limits of 2.5 mU/l or 3.0 mU/l for thyroid-stimulating hormone (TSH) are too low to define an abnormal thyroid function. Furthermore, some studies now show that the reference ranges are not necessarily the best cut-off for identifying pregnancies at high risk of adverse outcomes. In addition, data suggest that thyroid peroxidase autoantibody positivity and high or low concentrations of human chorionic gonadotropin seem to have a more prominent role in the interpretation of thyroid dysfunction than previously thought. Data on the effects of thyroid disease treatment are lacking, but some studies indicate that clinicians should be aware of the potential for overtreatment with levothyroxine. Here, we put studies from the past decade on reference ranges for TSH, determinants of thyroid dysfunction, risks of adverse outcomes and options for treatment into perspective. In addition, we provide an overview of the current views on thyroid physiology during pregnancy and discuss strategies to identify high-risk individuals who might benefit from levothyroxine treatment.

  13. Pregnancy and conception rate after two intravaginal inseminations with dog semen frozen either with 5% glycerol or 5% ethylene glycol.

    Science.gov (United States)

    Rota, Ada; Milani, C; Romagnoli, S; Zucchini, P; Mollo, A

    2010-03-01

    The primary goal of this study was to compare the effects of 5% ethylene glycol (EG) and 5% glycerol (G) on fertility of frozen-thawed dog semen following intravaginal insemination. The sperm-rich fraction of the ejaculate of three male dogs was collected, pooled and divided into two aliquots, and then frozen with a Tris-glucose-egg yolk-citric acid extender containing either 5% G or 5% EG. A total of 10 bitches were inseminated twice, five with G-frozen-thawed semen and five with EG-frozen-thawed semen; intravaginal inseminations were performed the 4th and the 5th day after the estimated LH peak; four straws, thawed in a 37 degrees C water bath for 1 min and diluted in a Tris buffer, were used for insemination (200 x 10(6) spermatozoa); the insemination dose was introduced in the cranial vagina of the bitch using a sterile plastic catheter. Ovariohysterectomy was performed in all bitches between days 29 and 31 after the calculated LH surge, and pregnancy status, and the number of conceptuses and corpora lutea were recorded. All bitches were pregnant. Neither the number of conceptuses, nor the ratio of conceptuses to corpora lutea (conception rate) was significantly different between groups. In this first screening, with a limited number of bitches, EG-frozen semen did not show a higher fertility than G-frozen semen when used for two intravaginal inseminations. Irrespective of the semen used, conception rate was 0.50.

  14. Enhanced Ovarian Folliclular Development by Metformin Does Not Correlate with Pregnancy Rate: A Randomized Trial

    Directory of Open Access Journals (Sweden)

    Zahra Basirat

    2012-01-01

    Full Text Available Background: Polycystic ovary syndrome (PCOS is a common, complex endocrinedisorder for women of productive age. A high incidence of ovulation failure in womenwith PCOS is related to insulin resistance. Some studies have assessed the effects ofhyperinsulinemia and insulin resistance in relationship with insulin sensitizing agentssuch as Metformin (Met. These medicines have been suggested new scope for ovulationstimulation enhancement with Clomiphene Citrate (CC in PCOs women. The aimof this study is to compare the effectiveness of adding Met to CC in women with PCOS.Materials and Methods: This multicenter, single-blind, randomized controlled trialstudy was performed on 334 PCOS patients from 2007 to 2009. Patients were randomlydivided into two groups and ovulation induction was performed with either CC alone orCC + Met. The treatment was continued for three cycles, then the mature follicle andpregnancy rates were evaluated.Results: In the CC + Met group, 68% had at least one dominant follicle in the first cyclethat was significant (p<0.001, and 31.7% had one in the second cycle. In the CC group54.5% in the first cycle, 31.7% second cycle, and 6.9% ovulated in the third cycle. Thepregnancy rate was 28.7% in CC + Met group and 24.6% in the CC group, with no significantdifferences between the two groups.

  15. [Clinical and experimental studies on the pathogenesis in pregnancy induced hypertension].

    Science.gov (United States)

    Hidaka, A

    1988-08-01

    Placental ischemia is one of the etiological factors of pregnancy induced hypertension (PIH), however, the pathogenesis of placental and renal ischemia has not been clarified. The purposes of this investigation are (1) to clarify the fetomaternal hemodynamic changes in PIH and the influence of maternal postural change on fetomaternal hemodynamics, measured by thermodilution method, impedance cardiography and pulsed doppler method during pregnancy, (2) to provide to relationship between intrauterine resting tonus and maternal hemodynamics, that is, blood pressure, placental and renal blood flow measured by electromagnetic flowmeter and thermocouple method, and renal nerve activity, and (3) to study the influence of placental ischemia on vascular sensitivity to angiotensin II measured by Magnus method in animal experiment. (1) The increase in C.O and blood volume were recognized from the beginning of pregnancy to 24 GW, and subsequently, the decreasing tendency were found from about 32 GW to the onset of labor. However this decreasing tendency were subsided in the lateral position. These circulatory changes were observed in both normotensive and PIH cases, and especially, the decrease in C.O and blood volume in late pregnancy were more remarkable in PIH than that in normotensive pregnancy. From the results of Starling curve, left ventricular work was more hyperdynamic status in PIH than that in normotensive pregnancy, these results show that there are a compensatory mechanism against high vascular resistance in PIH. A/B (S/D) ratio in uterine artery, umbilical artery and fetal aorta were lowered in II-nd and III-rd trimester and more decreased in the lateral position from the supine position, on the other hand these ratio in PIH were elevated respectively. These results show that there are the aortocaval compression by the heavy tensive uterus and subsequent sluice flow mechanism in fetoplacental circulation in the supine position in late pregnancy. (2) These

  16. Aquatic Activities During Pregnancy Prevent Excessive Maternal Weight Gain and Preserve Birth Weight: A Randomized Clinical Trial.

    Science.gov (United States)

    Bacchi, Mariano; Mottola, Michelle F; Perales, Maria; Refoyo, Ignacio; Barakat, Ruben

    2018-03-01

    The aim of the present study was to examine the influence of a supervised and regular program of aquatic activities throughout gestation on maternal weight gain and birth weight. A randomized clinical trial. Instituto de Obstetricia, Ginecología y Fertilidad Ghisoni (Buenos Aires, Argentina). One hundred eleven pregnant women were analyzed (31.6 ± 3.8 years). All women had uncomplicated and singleton pregnancies; 49 were allocated to the exercise group (EG) and 62 to the control group (CG). The intervention program consisted of 3 weekly sessions of aerobic and resistance aquatic activities from weeks 10 to 12 until weeks 38 to 39 of gestation. Maternal weight gain, birth weight, and other maternal and fetal outcomes were obtained by hospital records. Student unpaired t test and χ 2 test were used; P values ≤.05 indicated statistical significance. Cohen's d was used to determinate the effect size. There was a higher percentage of women with excessive maternal weight gain in the CG (45.2%; n = 28) than in the EG (24.5%; n = 12; odds ratio = 0.39; 95% confidence interval: 0.17-0.89; P = .02). Birth weight and other pregnancy outcomes showed no differences between groups. Three weekly sessions of water activities throughout pregnancy prevents excessive maternal weight gain and preserves birth weight. The clinicaltrial.gov identifier: NCT 02602106.

  17. Clinical course and perinatal transmission of chronic hepatitis B during pregnancy: A real-world prospective cohort study.

    Science.gov (United States)

    Chen, Zhi-Xian; Gu, Gui-Fang; Bian, Zhao-Lian; Cai, Wei-Hua; Shen, Yi; Hao, Yan-Li; Zhang, Sheng; Shao, Jian-Guo; Qin, Gang

    2017-08-01

    To determine the clinical course and perinatal transmission of chronic hepatitis B during pregnancy in a real life setting. A total of 221 singleton pregnant women with detectable HBV-DNA levels (≥10 3 copies/mL) were enrolled during January 2011 to June 2015. Forty-three high viraemic patients (≥10 6 copies/mL) received telbivudine in the 2 nd or 3 rd trimester according to their intention, while 89 high viraemic and 79 low viraemic (≥10 3 and <10 6 copies/mL) patients were the control cohorts. Primary endpoint was the pregnancy outcomes and secondary endpoint the perinatal transmission including intrauterine infection, immunoprophylaxis failure and occult infection. In all, 209 patients completed pregnancy with 209 infants, while 2 in telbivudine-treated cohort had unexplained late stillbirths. Twenty-nine (70.7%) of telbivudine-treated patients and 3 (3.4%) of untreated high viraemic controls achieved undetectable HBV-DNA levels prior delivery. At 7 months postpartum, immunoprophylaxis failure was significantly lower (2.4%) in telbivudine-treated cohort, compared with 16.9% and 10.1% in untreated high and low viraemic cohorts, respectively. Low viraemic patients may also need antiviral therapy since they bear moderate risk for perinatal transmission of HBV. However, more multicenter, large-scale studies are required before antepartum antiviral therapy is routinely recommended in patients with detectable viral loads. Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  18. Clinical Application of Heart Rate Variability after Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Heikki Veli Huikuri

    2012-02-01

    Full Text Available AbstractHeart rate (HR variability has been extensively studied in patients surviving an acute myocardial infarction (AMI. The majority of studies have shown that patients with reduced or abnormal HR variability/turbulence have an increased risk of mortality within few years after an AMI. Various measures of HR dynamics, such as time-domain, spectral, and non-linear measures of HR variability, as well as HR turbulence, have been used in risk stratification of post-AMI patients. The prognostic power of various measures, except of those reflecting rapid R-R interval oscillations, has been almost identical, albeit some non-linear HR variability measures, such as short-term fractal scaling exponent, and HR turbulence, have provided somewhat better prognostic information than the others. Abnormal HR variability predicts both sudden and non-sudden cardiac death after AMI. Because of remodeling of the arrhythmia substrate after AMI, early measurement of HR variability to identify those at high risk should likely be repeated later in order to assess the risk of fatal arrhythmia events. Future randomized trials using HR variability/turbulence as one of the pre-defined inclusion criteria will show whether routine measurement of HR variability/turbulence will become a routine clinical tool for risk stratification of post-AMI patients.

  19. Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study.

    Science.gov (United States)

    Souza, Maria de Lourdes de; Lynn, Fiona Ann; Johnston, Linda; Tavares, Eduardo Cardoso Teixeira; Brüggemann, Odaléa Maria; Botelho, Lúcio José

    2017-04-06

    analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil. a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests. differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; pprematuros (OR:1,1; IC:1,08-1,13; pprematuro (OR:1,1; IC:1,08-1,13; p<0,001), bebé con peso bajo al nacer (OR:1,1; IC:1,10-1,15; p<0,001) y puntuación de Apgar baja a los 5 minutes (OR:1,4; IC:1,34-1,45; p<0,001) fue superior para madres entre 15 y 19 años en comparación con madres ≥20 años, con mayores chances de resultados negativos para aquellas entre 10 y 14 años de edad. este estudio evidencia que las tasas de fertilidad entre las adolescentes siguen superiores en regiones de pobreza social y económica. Madres adolescentes y sus bebés tienen mayor probabilidad de efectos perinatales adversos. Enfermeros, trabajadores de salud pública, profesionales de salud y asistencia social y educadores deben colaborar para mejor dirigir estrategias a adolescentes con riesgo superior; para fines de ayudar a reducir las tasas de fertilidad y mejorar los resultados.

  20. The period of the follicular phase during which the uterus of mares shows estrus-like echotexture influences the subsequent pregnancy rate

    NARCIS (Netherlands)

    Mateu-Sánchez, S; Newcombe, J R; Garcés-Narro, C; Cuervo-Arango, J

    2016-01-01

    The interval from both spontaneous and prostaglandin (PGF)-induced luteolysis to ovulation is greatly variable in mares. Several reports have shown a positive association between the length of the interval from PGF treatment to ovulation (ITO) and the subsequent pregnancy rate (PR). However, it is

  1. Sexual Health Outcomes at 24 Months for a Clinic-Linked Intervention to Prevent Pregnancy Risk Behaviors

    Science.gov (United States)

    Sieving, Renee E.; McRee, Annie-Laurie; McMorris, Barbara J.; Beckman, Kara J.; Pettingell, Sandra L.; Bearinger, Linda H.; Garwick, Ann W.; Oliphant, Jennifer A.; Plowman, Shari; Resnick, Michael D.; Secor-Turner, Molly

    2015-01-01

    Importance Preventing early pregnancy among vulnerable adolescents requires innovative and sustained approaches. Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy. Objective To evaluate sexual risk behaviors and related outcomes with a 24-month postbaseline survey, 6 months after the conclusion of the Prime Time intervention. Design Randomized controlled trial. Setting Community and school-based primary care clinics. Participants Of 253 sexually active 13- to 17-year-old girls meeting specified risk criteria, 236 (93.3%) completed the 24-month follow-up survey. Intervention Offered during an 18-month period, Prime Time includes case management and youth leadership programs. Main Outcome Measures Self-reported consistency of condom, hormonal, and dual-method contraceptive use with most recent male sex partner and number of male sex partners in the past 6 months. Results At 24-month follow-up, the intervention group reported significantly more consistent use of condoms, hormonal contraception, and dual-method contraception than the control group. Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex, and reductions in the perceived importance of having sex. No between-group differences were found in the number of recent male sex partners. Conclusions and Relevance This study contributes to what has been a dearth of evidence regarding youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful but few efforts have emphasized a dual approach of strengthening sexual and nonsexual protective factors while addressing risk. Findings suggest that health services grounded in a youth development framework can lead to long-term reductions in sexual risk among vulnerable youth. PMID:23440337

  2. PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian hyperstimulation syndrome

    Directory of Open Access Journals (Sweden)

    Yovich JL

    2016-08-01

    Full Text Available John L Yovich,1,2,* Birgit Alsbjerg,3,4,* Jason L Conceicao,1 Peter M Hinchliffe,1 Kevin N Keane1,2,* 1PIVET Medical Centre, Perth, 2School of Biomedical Science, Curtin Health Innovation Research Institute Bioscience, Curtin University, Perth, WA, Australia; 3The Fertility Clinic, Skive Regional Hospital, Skive, 4Faculty of Health, Aarhus University, Aarhus, Denmark *These authors contributed equally to this work Abstract: The first PIVET algorithm for individualized recombinant follicle stimulating hormone (rFSH dosing in in vitro fertilization, reported in 2012, was based on age and antral follicle count grading with adjustments for anti-Müllerian hormone level, body mass index, day-2 FSH, and smoking history. In 2007, it was enabled by the introduction of a metered rFSH pen allowing small dosage increments of ~8.3 IU per click. In 2011, a second rFSH pen was introduced allowing more precise dosages of 12.5 IU per click, and both pens with their individual algorithms have been applied continuously at our clinic. The objective of this observational study was to validate the PIVET algorithms pertaining to the two rFSH pens with the aim of collecting ≤15 oocytes and minimizing the risk of ovarian hyperstimulation syndrome. The data set included 2,822 in vitro fertilization stimulations over a 6-year period until April 2014 applying either of the two individualized dosing algorithms and corresponding pens. The main outcome measures were mean oocytes retrieved and resultant embryos designated for transfer or cryopreservation permitted calculation of oocyte and embryo utilization rates. Ensuing pregnancies were tracked until live births, and live birth productivity rates embracing fresh and frozen transfers were calculated. Overall, the results showed that mean oocyte numbers were 10.0 for all women <40 years with 24% requiring rFSH dosages <150 IU. Applying both specific algorithms in our clinic meant that the starting dose was not altered for

  3. Effect of postweaning heifer development system on average daily gain, pregnancy rates, and subsequent feed efficiency as a pregnant heifer.

    Science.gov (United States)

    Springman, S A; Nielson, H R; Meyer, T L; Funston, R N

    2017-12-01

    A 3-yr study utilized 300 Angus-based, spring-born heifers to evaluate postweaning heifer development systems on gain, reproductive performance, and feed efficiency as a pregnant heifer. Heifers were blocked by BW and randomly assigned to graze corn residue (CR), upland range (RANGE), or were fed 1 of 2 diets in a drylot differing in energy levels: high (DLHI) or low (DLLO). Heifers developed on DLHI and DLLO were managed within the drylot for 166 d in yr 1, 150 d in yr 2, and 162 d in yr 3. Heifers developed on RANGE grazed winter range for an equivalent amount of days each yr as the DLHI and DLLO heifers. Heifers assigned to CR grazed for 103 d in yr 1, 84 d in yr 2, and 97 d in yr 3 before being transported to graze winter range for the remainder of the treatment period. All heifers were managed as a single group following the treatment period. Artificial insemination and natural mating were utilized during breeding. Percent of mature BW prior to the breeding season was greater ( = 0.02) for DLHI (67%) compared with RANGE (59%) and CR (58%). Pregnancy rates to AI were not different ( = 0.51) among treatments (59 ± 6%), and final pregnancy rates were also not different (87 ± 4%, = 0.54). A subset of AI-pregnant heifers from each treatment were placed in a Calan gate feeding system. Heifers were allowed a 20-d acclimation period before beginning the 90 d trial at approximately 170 d in gestation. Heifers were offered ad libitum hay; amount offered was recorded daily and orts collected weekly. Initial BW was not different ( = 0.58) among treatments (459 ± 11 kg). Body weight at the end of the trial (497 ± 17 kg) was also not different ( = 0.41). Intake was not different ( = 0.33), either as DMI (10.00 ± 1.07 kg) or residual feed intake (0.018 ± 0.190). There was no difference in ADG ( = 0.36, 0.42 ± 0.23 kg/d) among treatments. Although the total development cost was not different among treatments ( = 0.99), there was a $41 difference ( feed efficiency as a

  4. Effect of Vitamin D3 Supplementation During Pregnancy on Risk of Persistent Wheeze in the Offspring A Randomized Clinical Trial

    DEFF Research Database (Denmark)

    Chawes, Bo L.; Bonnelykke, Klaus; Stokholm, Jakob

    2016-01-01

    during the third trimester of pregnancy reduces the risk of persistent wheeze in the offspring. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, single-center, randomized clinical trial conducted within the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort. Enrollment began March 2009......, asthma, respiratory tract infections, and neonatal airway immunology. Adverse events were assessed. RESULTS: Of the 581 children, persistent wheeze was diagnosed during the first 3 years of life in 47 children (16%) in the vitamin D3 group and 57 children (20%) in the control group. Vitamin D3...

  5. Sensitization rate and clinical profile of Congolese patients with rhinitis

    NARCIS (Netherlands)

    Nyembue, Tshipukane Dieudonné; Ntumba, Wivine; Omadjela, L. August; Muyunga, Christophe; Hellings, Peter W.; Jorissen, Mark

    2012-01-01

    In the African continent, the sensitization pattern and clinical profile are unknown in patients with rhinitis/rhinosinusitis attending the outpatient ear, nose, and throat (ENT) clinics. We therefore aimed to analyze the clinical characteristics of rhinitis/rhinosinusitis patients in Democratic

  6. Teenage pregnancy: who suffers?

    Science.gov (United States)

    Paranjothy, S; Broughton, H; Adappa, R; Fone, D

    2009-03-01

    In this review, we examine the epidemiology of teenage pregnancy (girls aged 15-17 years) in the UK and consider the evidence for its impact on the health and well-being of the mother, the baby, the father and society. There has been some decrease in the teenage pregnancy rate over the last decade in the UK but rates are still considerably higher than those in other European countries. Pregnancy and childbirth during the teenage years are associated with increased risk of poorer health and well-being for both the mother and the baby, possibly reflecting the socio-economic factors that precede early pregnancy and childbirth. There is little evidence concerning the impact of teenage fatherhood on health and future studies should investigate this. The effect on society is a perpetuation of the widening gap in health and social inequalities. Public health interventions should aim to identify teenagers who are vulnerable and support those who are pregnant with evidence based interventions such as teenage antenatal clinics and access to initiatives that provide support for early parenthood.

  7. Diagnosis and treatment of 163 patients with ectopic pregnancy in exceptional site

    OpenAIRE

    Jie ZOU; Meng-han LU; Zheng GUAN; Hui LIU; Ya-li LI

    2013-01-01

    Objective  To explore the clinical characteristics, reasons for misdiagnosis and treatment of ectopic pregnancies in exceptional sites. Methods  A retrospective analysis was performed based on the clinical data of 163 patients with ectopic pregnancy in exceptional site concerning clinical characteristics, type of ectopic pregnancy, preoperative diagnosis and misdiagnosis rate, and treatment and outcomes in our hospital from Jan. 2007 to Jun. 2012. Results  The incidence of exceptional site ec...

  8. 17-Hydroxyprogesterone caproate to prolong pregnancy after preterm rupture of the membranes: early termination of a double-blind, randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Combs C Andrew

    2011-12-01

    Full Text Available Abstract Background Progestational agents may reduce the risk of preterm birth in women with various risk factors. We sought to test the hypothesis that a weekly dose of 17-hydroxyprogesterone caproate (17P given to women with preterm rupture of the membranes (PROM will prolong pregnancy and thereby reduce neonatal morbidity. Methods Double-blind, placebo-controlled randomized clinical trial. Women with PROM at 23.0 to 31.9 weeks of gestation were randomly assigned to receive a weekly intramuscular injection of 17P (250 mg in 1 mL castor oil or placebo (1 mL castor oil. The primary outcome was the rate of continuing the pregnancy until 34.0 weeks of gestation or until documentation of fetal lung maturity at 32.0 to 33.9 weeks of gestation. Planned secondary outcomes were duration of latency period and rate of composite neonatal morbidity. Enrollment of 111 participants per group, 222 total, was planned to yield 80% power to detect an increase in the primary outcome from 30% with placebo to 50% with 17P. Results Twelve women were enrolled of whom 4 were randomly assigned to receive 17P and 8 to receive placebo. The trial was terminated prematurely because of two separate issues related to the supply of 17P. No adverse events attributable to 17P were identified. Conclusion Because of premature termination, the trial does not have adequate statistical power to evaluate efficacy or safety of 17P in women with PROM. Nonetheless, ethical principles dictate that we report the results, which may contribute to possible future metaanalyses and systematic reviews. Trial Registration ClinicalTrials.gov: NCT01119963 Supported by a research grant from the Center for Research, Education, and Quality, Pediatrix Medical Group, Sunrise, FL

  9. Pregnancy after breast cancer: Are young patients willing to participate in clinical studies?

    Science.gov (United States)

    Pagani, Olivia; Ruggeri, Monica; Manunta, Silvia; Saunders, Christobel; Peccatori, Fedro; Cardoso, Fatima; Kaufman, Bella; Paluch-Shimon, Shani; Gewefel, Hanan; Gallerani, Elisa; Abulkhair, O Malkahi; Pistilli, Barbara; Warner, Ellen; Saloustros, Emmanouil; Perey, Lucien; Zaman, Khalil; Rabaglio, Manuela; Gelber, Shari; Gelber, Richard D; Goldhirsch, Aron; Korde, Larissa; Azim, Hatem A; Partridge, Ann H

    2015-06-01

    Young patients with breast cancer (BC) are often concerned about treatment-induced infertility and express maternity desire. Conception after BC does not seem to affect outcome, but information in estrogen-receptor positive (ER+) disease is not definitive. From September 2012-March 2013, 212 evaluable patients with ER+ early BC, pregnancy. Overall, 37% of respondents were interested in the study; younger patients (≤30 years) reported higher interest (57%). Motivation in younger patients treated >30 months was higher (83%) than in older women (14%), interest was independent of age in patients treated for ≤30 months. A prospective study in this patient population seems relevant and feasible. The International-Breast-Cancer-Study-Group (IBCSG), within the Breast-International-Group (BIG) - North-American-Breast-Cancer-Groups (NABCG) collaboration, is launching a study (POSITIVE) addressing ET interruption to allow pregnancy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Preimplantation Genetic Diagnosis and Natural Conception: A Comparison of Live Birth Rates in Patients with Recurrent Pregnancy Loss Associated with Translocation.

    Directory of Open Access Journals (Sweden)

    Shinichiro Ikuma

    Full Text Available Established causes of recurrent pregnancy loss (RPL include antiphospholipid syndrome, uterine anomalies, parental chromosomal abnormalities, particularly translocations, and abnormal embryonic karyotypes. The number of centers performing preimplantation genetic diagnosis (PGD for patients with translocations has steadily increased worldwide. The live birth rate with PGD was reported to be 27-54%. The live birth rate with natural conception was reported to be 37-63% on the first trial and 65-83% cumulatively. To date, however, there has been no cohort study comparing age and the number of previous miscarriages in matched patients undergoing or not undergoing PGD. Thus, we compared the live birth rate of patients with RPL associated with a translocation undergoing PGD with that of patients who chose natural conception.After genetic counseling, 52 patients who desired natural conception and 37 patients who chose PGD were matched for age and number of previous miscarriages and these comprised the subjects of our study. PGD was performed by means of fluorescence in situ hybridization analysis. The live birth rates on the first PGD trial and the first natural pregnancy after ascertainment of the carrier status were 37.8% and 53.8%, respectively (odds ratio 0.52, 95% confidence interval 0.22-1.23. Cumulative live birth rates were 67.6% and 65.4%, respectively, in the groups undergoing and not undergoing PGD. The time required to become pregnancy was similar in both groups. PGD was found to reduce the miscarriage rate significantly. The prevalence of twin pregnancies was significantly higher in the PGD group. The cost of PGD was $7,956 U.S. per patient.While PGD significantly prevented further miscarriages, there was no difference in the live birth rate. Couples should be fully informed of the similarity in the live birth rate, the similarity in time to become pregnancy, the advantages of PGD, such as the reduction in the miscarriage rate, as well as

  11. Validity of clinical and patient ratings of tremor disability among older adults.

    Science.gov (United States)

    Lundervold, Duane A; Pahwa, Rajesh; Ament, Patrick A; Corbin, D Edward

    2003-10-01

    To evaluate the validity of the clinical tremor disability interview using a performance-based measure, patient ratings of tremor disability, and bedside tremor severity ratings of upper extremity (UE) action/intention (A/I) and postural (P) tremor. Sixteen older adult essential tremor patients (mean age=75.4 years, sd=5.7 years) took part in a study evaluating the validity of clinical and self-rating scales of tremor disability. A neurologist obtained bedside clinical ratings of UE A/I and P tremor of each limb and completed a clinical tremor disability rating. A second investigator, blind to neurological exam results obtained a clinical disability rating using the same measure, patient rated tremor disability ratings and conducted a performance-based disability assessment. Clinical tremor disability ratings were not significantly related to functional performance-based or patient ratings of tremor disability. Bedside clinical ratings of tremor severity also were not associated with clinical or patient-rated tremor disability. Patient ratings were significantly correlated with performance-based ratings. Further research is needed to validate a brief, sensitive clinical rating scale of tremor disability among older adults. Use of bedside ratings of tremor severity may be problematic and possibly estimate tremor disability. Empirical evaluation of differences in rating methods needs to be directly addressed.

  12. Prediction of preeclampsia in type 1 diabetes in early pregnancy by clinical predictors

    DEFF Research Database (Denmark)

    Vestgaard, Marianne; Sommer, Miriam Colstrup; Ringholm, Lene

    2018-01-01

    .8-17.1) as well as high blood pressure within the normotensive range. HbA1C, body mass index and nulliparity were positively associated with preeclampsia, but not consistently. CONCLUSION: The prevalence of preeclampsia in women with type 1 diabetes was 17%. In early pregnancy pre-existing hypertension and high...... blood pressure within the normotensive range as well as presence of microangiopathy were predictors of preeclampsia. Poor glycaemic control, obesity and nulliparity probably also contribute to the increased risk....

  13. Epigallocatechin gallate enhances treatment efficacy of oral nifedipine against pregnancy-induced severe pre-eclampsia: A double-blind, randomized and placebo-controlled clinical study.

    Science.gov (United States)

    Shi, D-D; Guo, J-J; Zhou, L; Wang, N

    2018-02-01

    Oral nifedipine is commonly used to treat pre-eclampsia, one of the most severe complications during pregnancy, but its clinical efficacy is less than ideal. Epigallocatechin gallate (EGCG), a natural compound from green tea, could benefit cardiovascular health especially hypertension. We investigated the clinical efficacy of EGCG, when complemented with oral nifedipine, in treating pre-eclampsia. A total of 350 pregnant women with severe pre-eclampsia were recruited and randomized to receive oral nifedipine, together with placebo (NIF+placebo) or EGCG (NIF+EGCG). The primary treatment outcome was the time needed to control blood pressure and interval time before a new hypertensive crisis, whereas the secondary treatment outcome was the number of treatment doses to effectively control blood pressure, maternal adverse effects and neonatal complications. Comparing NIF+EGCG group to NIF+placebo group, the time needed to control blood pressure was significantly shorter (NIF+EGCG 31.2±16.7 minutes, NIF+placebo 45.3±21.9 minutes; 95% CI 9.7-18.5 minutes), whereas interval time before a new hypertensive crisis was significantly prolonged (NIF+EGCG 7.2±2.9 hours, NIF+placebo 4.1±3.7 hours; 95% CI 2.3-3.9 hours), and the number of treatment dosages needed to effectively control blood pressure was also lower. Between the two treatment groups, no differences in incidence rates of maternal adverse effects or neonatal complications were observed. EGCG is both safe and effective in enhancing treatment efficacy of oral nifedipine against pregnancy-induced severe pre-eclampsia, but formal validation is required prior to its recommendation for use outside of clinical trials. © 2017 John Wiley & Sons Ltd.

  14. Magnetic resonance imaging of clinically stable late pregnancy bleeding: beyond ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Masselli, Gabriele; Gualdi, Gianfranco [Sapienza University, Radiology Dea Department, Umberto I Hospital, Rome (Italy); Brunelli, Roberto; Perrone, Giuseppina [Sapienza University, Department of Gynecology and Obstetrics, Umberto I Hospital, Rome (Italy); Parasassi, Tiziana [Institute of Neurobiology and Molecular Medicine, National Research Council, Rome (Italy)

    2011-09-15

    To compare the accuracy of magnetic resonance (MRI) and colour Doppler-ultrasound (US) in the diagnosis of late pregnancy bleeding and to assess the accuracy of the different MR sequences in visualizing the origin of haemorrhage. 42 patients in the third trimester of pregnancy underwent to US and MRI for the evaluation of painless vaginal bleeding. Multiplanar HASTE, True Fisp, 3D T1 GRE and sagittal DWI sequences were acquired. Two radiologists, blinded to the results of US, reviewed each case, resolving by consensus any discrepancy. Reference standards were surgical and pathological findings. The reference standards identified 22 placenta previa, 11 placental abruptions (1 coincident with a placental chorioangioma), 1 thrombohaematoma and 1 fibroma with haemorrhagic degeneration. MRI identified correctly all these condition with an interobserver agreement of 0.955. DWI and T1 weighted sequences were statistically superior to Haste and True Fisp sequences in detecting the cause of bleeding (p <.001). US had 6 false negatives and 2 false positive results, its diagnostic accuracy resulting lower than MRI (p =.001). MRI accurately evaluates pregnancy bleeding with an excellent interobserver agreement and can grant new and additional data when US is negative. (orig.)

  15. Human placental growth hormone in ectopic pregnancy: Detection in maternal blood, immunohistochemistry and potential clinical implication.

    Science.gov (United States)

    Hübener, Christoph; Bidlingmaier, Martin; Wu, Zida; Diebold, Joachim; Strasburger, Christian J; Mahner, Sven; Hasbargen, Uwe; Delius, Maria

    2017-12-01

    To investigate human placental growth hormone (hGH-V) in ectopic pregnancy (EP): detection in maternal blood, correlation with immunohistochemistry and possible role as a marker for the course of EP. Women presenting in the outpatient or emergency department of a tertiary care university hospital with a positive pregnancy test and strong suspicion of EP by ultrasound and/or symptoms were eligible for the study (n=70). Tissue specimens from the surgically treated patients (n=50) were examined by histopathology as well as by a hGH-V specific immohistochemistry set-up. A highly sensitive hGH-V specific immunoassay was used to analyse serum samples collected before treatment, day 1 post surgery samples and serial samples for medical treatment. In EP patients' sera hGH-V was shown to be measurable for the first time (n=18). HGH-V however could not be detected in all patients' sera. HCG levels were significantly higher in the hGH-V serum positive group (p 0.001). HGH-V was localized to the syncytiotrophoblast in all specimens of EP examined by immunohistochemistry (n=10) regardless of the detection in the patient's blood. Placental growth hormone (hGH-V) was shown to be present both in ectopic pregnancy patients' sera and tissue. It may serve as a biomarker for monitoring the course and treatment of EP. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Rapid Antiretroviral Therapy Initiation for Women in an HIV-1 Prevention Clinical Trial Experiencing Primary HIV-1 Infection during Pregnancy or Breastfeeding.

    Directory of Open Access Journals (Sweden)

    Susan Morrison

    Full Text Available During an HIV-1 prevention clinical trial in East Africa, we observed 16 cases of primary HIV-1 infection in women coincident with pregnancy or breastfeeding. Nine of eleven pregnant women initiated rapid combination antiretroviral therapy (ART, despite having CD4 counts exceeding national criteria for ART initiation; breastfeeding women initiated ART or replacement feeding. Rapid ART initiation during primary HIV-1 infection during pregnancy and breastfeeding is feasible in this setting.

  17. Successful delivery in a patient with clinically amyopathic dermatomyositis during pregnancy despite first-trimester acute exacerbation of interstitial lung disease.

    Science.gov (United States)

    Ochiai, Moeko; Sato, Eri; Tanaka, Eiichi; Tochihara, Mari; Shimizu, Yoko; Osawa, Hikota; Sidara, Kumi; Sugimoto, Naoki; Hoshi, Daisuke; Kawaguchi, Yasushi; Taniguchi, Atsuo; Yamanaka, Hisashi

    2017-03-01

    A 37-year-old woman with rheumatoid arthritis and interstitial lung disease (ILD) developed clinically amyopathic dermatomyositis (CADM) after achieving pregnancy through in vitro fertilization. She was given oral prednisolone, which improved her respiratory status, and delivered a healthy baby at 35 weeks' gestation. There are few reports of successful outcomes for CADM during pregnancy; to the best of our knowledge, this is the first report of successful delivery in a patient with both CADM and ILD.

  18. Ectopic ovarian pregnancy

    International Nuclear Information System (INIS)

    Sachdev, P.S.; Jatoi, N.; Memon, R.A.; Sachdev, C.S.

    2003-01-01

    A case of ectopic ovarian pregnancy is presented occurring in a 24 years old woman after natural conception. The clinical diagnosis was ruptured tubal pregnancy. Gross findings were suggestive of ruptured corpus luteum cyst on exploration. The histopathological examination of specimen brought forward the diagnosis of ovarian pregnancy. (author)

  19. Concentrate supplementation during pregnancy and lactation of ewes affects the growth rate of lambs from a variety of crosses

    Directory of Open Access Journals (Sweden)

    Jacira Neves da Costa Torreão

    2014-10-01

    Full Text Available The objective of this study was to determine how concentrate supplementation during late third gestation and lactation affects ewe and offspring performance from birth to weaning. Thirty-six ewes and their offspring (n = 32 were used. Eighteen Morada Nova and 18 Santa Inês ewes were artificially inseminated with semen from Dorper ram and distributed in a completely randomized factorial arrangement (2 × 2 consisting of two supplementation levels (5 and 15 g kg-1 of BW and two breeds (Morada Nova and Santa Inês or two crosses (Dorper × Morada Nova and Dorper × Santa Inês. The ewes were weighed, their body condition was evaluated during pregnancy, and the weaning weight of the lambs at up to 70 days old was measured. There was no effect of breed or supplementation on the prolificacy or type of birth. The Santa Inês ewes had a faster rate of development, although the weight loss during lactation was lower in the Morada Nova ewes. The weight development of the Dorper × Santa Inês lambs during the maternal-dependent phase was 34 g/100 g higher than that of the other cross, with no difference in the maternal-independent phase. Dorper × Santa Inês lambs gain more weight during the 70 days of development. However, the Dorper × Morada Nova lambs show a better response in terms of production efficiency when comparing the weight of the lambs with the weight of the sheep.

  20. Effect of Pregnancy on Postural Tachycardia Syndrome

    Science.gov (United States)

    Kimpinski, Kurt; Iodice, Valeria; Sandroni, Paola; Low, Phillip A.

    2010-01-01

    OBJECTIVES: To compare the clinical presentation, autonomic dysfunction, and pregnancy outcomes in parous and nulliparous women with postural tachycardia syndrome (POTS) and in women with POTS before and after pregnancy. PATIENTS AND METHODS: This study consists of women who had at least 1 pregnancy during which time they met criteria for POTS between May 1993 and July 2009. All patients underwent standard autonomic testing. POTS was defined as a heart rate (HR) increase of greater than 30 beats/min on head-up tilt (HUT) with symptoms of orthostatic intolerance. Patients' charts were reviewed retrospectively to determine pregnancy outcomes. RESULTS: Clinical characteristics related to POTS did not differ between parous and nulliparous women except for disease duration (parous, 3.7±2.6; nulliparous, 2.1±2.2; Pchange in HR on HUT: parous, 42.6±12.0 beats/min; nulliparous, 41.3±10.6 beats/min; P=.39). Of 116 total pregnancies, adverse pregnancy outcomes were reported in 9% and maternal complications in 1%. No complication was related to POTS. There was a trend toward modest improvement in autonomic dysfunction before and after pregnancy (change in HR on HUT: before pregnancy, 38.1±22.7 beats/min; after pregnancy, 21.9±14.9 beats/min; P=.07). CONCLUSION: The long-term impact of pregnancy on POTS does not appear to be clinically important. However, there does appear to be a trend toward improvement in the short-term postpartum period. Adverse pregnancy events were similar to those seen in the general public and do not present a barrier to women with POTS who want to have children. PMID:20516426

  1. MRI for appendicitis in pregnancy: is seeing believing? clinical outcomes in cases of appendix nonvisualization.

    Science.gov (United States)

    Al-Katib, Sayf; Sokhandon, Farnoosh; Farah, Michael

    2016-12-01

    The primary objective of this study was to determine the clinical outcomes in cases of appendix nonvisualization with MRI in pregnant patients with suspected appendicitis and the implications of appendix nonvisualization for excluding appendicitis. Fifty-eight pregnant patients with suspected appendicitis evaluated with MRI at three centers from a single institution were retrospectively reviewed by three radiologists with varying levels of abdominal imaging experience. All scans were performed on a 1.5-Tesla Siemens unit. Cases were evaluated for diagnostic quality, visualization of the appendix, presence of appendicitis, and alternate diagnoses. Clinical outcomes were gathered from the electronic medical record. Of the 58 patients who underwent MRI for suspected appendicitis, 50 cases were considered adequate diagnostic quality by all three radiologists. The rate of appendix visualization among the three radiologists ranged from 60 to 76% (p = 0.44). The appendix was nonvisualized by at least one of the three radiologists in 25 cases (50%). Of these, none had a final diagnosis of appendicitis including one patient who underwent appendectomy. MRI suggested an alternate diagnosis in 6 (24%) patients with appendix nonvisualization. For the three reviewers, the agreement level on whether or not the appendix was visualized on the MRI had a Light's kappa value of 0.526, indicating a "moderate" level of agreement (p value appendicitis confers a significant reduction in the risk of appendicitis compared to all comers as long as the study is adequate diagnostic quality and there are no secondary signs of appendicitis present.

  2. Clinically determined and self-reported dental status during and after pregnancy among low-income Hispanic women.

    Science.gov (United States)

    Weintraub, Jane A; Finlayson, Tracy L; Gansky, Stuart A; Santo, William; Ramos-Gomez, Francisco

    2013-01-01

    This analysis assessed, during and 1 year after pregnancy: a) the prevalence of and relationship between self-reported and clinically determined dental caries and oral health status, and whether self-reports are a potential proxy for professional determination; and b) factors associated with high levels of professionally determined or self-reported oral disease. Data are from a randomized clinical trial of 301 pregnant, low-income Hispanic women at the California-Mexico border to compare two interventions to prevent early childhood caries. Interviews and dental examinations were conducted at enrollment (second trimester) and 1-year postpartum (PP). During pregnancy and PP, 93 percent had untreated caries and most had gingival inflammation. Sensitivity and specificity of self-reported measures compared to dentists' determinations were modest (ranging from 45-80 percent for sensitivity and 41-77 percent for specificity at both time points); positive predictive values for women reporting current tooth decay or fair/poor oral health were high (>94 percent), but negative predictive values were low (<23 percent). In a bivariate GEE model, factors associated with fair/poor self-reported oral health during and after pregnancy included self-reported dental symptoms (current tooth decay, bleeding gums without brushing), dental behaviors (not flossing) and number of decayed tooth surfaces. In a logistic regression model, the only significant factor PP associated with less extensive untreated disease was if women ever had their teeth cleaned professionally (OR = 0.44). There is a great need for dental treatment in this underserved population both during pregnancy and PP. Women may not be able to accurately recognize or act on their treatment needs. At baseline and PP, few demographic or behavioral factors were associated with either self-reported or clinically determined oral disease (e.g., being less educated or acculturated and not flossing) in the bivariate analyses

  3. Clinical experience from Thailand: noninvasive prenatal testing as screening tests for trisomies 21, 18 and 13 in 4736 pregnancies.

    Science.gov (United States)

    Manotaya, S; Xu, H; Uerpairojkit, B; Chen, F; Charoenvidhya, D; Liu, H; Petcharaburanin, N; Liu, Y; Tang, S; Wang, X; Dansakul, S; Thomsopa, T; Gao, Y; Zhang, H; Xu, H; Jiang, Hui

    2016-03-01

    The purpose of this article is to report the clinical experience and performance of massively parallel sequencing-based noninvasive prenatal testing (NIPT) as a screening method in detecting trisomy 21, 18, and 13 (T21/T18/T13) in a mixed-risk population in Thailand. In a 30-month period, 121 medical centers in Thailand offered NIPT as clinical screening tests for fetal T21, T18, and T13 in the mixed-risk population. All NIPT-positive cases were recommended to undergo invasive prenatal diagnosis. A total of 4736 participants received the NIPT test, including 2840 high-risk pregnancies, either with advanced maternal age or positive serum biochemical tests, and 1889 low-risk pregnancies without conventional indications; 99.9% (4732/4736) of the participants with a median maternal age of 35 years old received reports, and 1.3% (63/4732) were classified as test positive, including 36 T21, 19 T18, and 8 T13; 82.5% (52/63) took prenatal diagnosis, and 11.5% (6/52) false-positive cases were observed. The positive predictive values for the detection of T21, T18, and T13 were 94.4%, 79.0%, and 87.5%, respectively. With stringent protocol, our prospective large-scale multicenter nationwide study demonstrated that NIPT showed excellent performance as screening tests for the detection of fetal T21, T18, and T13 in mixed-risk pregnancies in Thailand. © 2016 John Wiley & Sons, Ltd.

  4. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis.

    Science.gov (United States)

    López, Néstor J; Da Silva, Isabel; Ipinza, Joaquín; Gutiérrez, Jorge

    2005-11-01

    PT/LBW than women who received periodontal treatment (OR 2.76; 95%CI 1.29 to 5.88; P = 0.008). Periodontal treatment significantly reduced the PT/LBW rate in this population of women with pregnancy-associated gingivitis. Within the limitations of this study, we conclude that gingivitis appears to be an independent risk factor for PT/LBW for this population.

  5. A Flexible System for Processing Clinical Performance Ratings: Illustrative Applications in a Residency and Four Clerkships.

    Science.gov (United States)

    Cason, Gerald J.; And Others

    The Performance Rating portion of the University of Arkansas for Medical Sciences (UAMS) Objective Test Scoring and Performance Rating (OTS-PR) system is designed to help the clinical teacher evaluate students' clinical performance. The system collects, processes, and reports ratings of learners' performances in clinical settings. The system's 160…

  6. Clinical experience from Thailand noninvasive prenatal testing as screening tests for trisomies 21, 18 and 13 in 4736 pregnancies

    DEFF Research Database (Denmark)

    Manotaya, S.; Xu, H.; Uerpairojkit, B.

    2016-01-01

    PurposeThe purpose of this article is to report the clinical experience and performance of massively parallel sequencing-based noninvasive prenatal testing (NIPT) as a screening method in detecting trisomy 21, 18, and 13 (T21/T18/T13) in a mixed-risk population in Thailand. MethodsIn a 30-month...... period, 121 medical centers in Thailand offered NIPT as clinical screening tests for fetal T21, T18, and T13 in the mixed-risk population. All NIPT-positive cases were recommended to undergo invasive prenatal diagnosis. ResultsA total of 4736 participants received the NIPT test, including 2840 high......-risk pregnancies, either with advanced maternal age or positive serum biochemical tests, and 1889 low-risk pregnancies without conventional indications; 99.9% (4732/4736) of the participants with a median maternal age of 35years old received reports, and 1.3% (63/4732) were classified as test positive, including...

  7. Appendicitis during pregnancy.

    OpenAIRE

    Guttman, Rachelle; Goldman, Ran D.; Koren, Gideon

    2004-01-01

    QUESTION: A 26-year-old patient in our clinic, who was 18 weeks pregnant at the time, experienced acute abdominal pain and was diagnosed with appendicitis. The inflamed appendix was successfully removed. Is her pregnancy at risk? ANSWER: Appendicitis is not rare during pregnancy and is associated with increased reproductive risk. Women who have undergone appendectomy during pregnancy are at higher risk of fetal loss, especially in early pregnancy and with appendiceal perforation, and of prema...

  8. The clinical efficacy of methotrexate and 5-fluorouracil in the interventional treatment of uterine incisional pregnancy after cesarean section: a comparative study

    International Nuclear Information System (INIS)

    Zhang Lei; Gu Weijin; Wan Jun; Ji Lihua; Wang Haiyun; Wang Ying; Ji Fang; Chen Qing

    2012-01-01

    Objective: To compare the interventional therapeutic efficacy of methotrexate (MTX) with that of 5-fluorouracil (5-FU) in treating uterine incisional pregnancy after cesarean section. Methods: A total of 92 patients with uterine incisional pregnancy after cesarean section, who were admitted to the hospital during the period from 2007 to 2010, were randomly divided into two groups: group MTX and group 5-FU. Patients in group MTX (n=46) received intra-arterial infusion of MTX (60-200) mg, which was followed by arterial embolization. Patients in group 5-FU (n=46) received intra-arterial infusion of 5-FU (1000-1250) mg, which was followed by arterial embolization. After the treatment the serum β-HCG and progesterone levels were determined daily for three succeeding days. The patients were followed up for three months. The clinical results were compared between the two groups. Results: The cure rates in group MTX and group 5-FU were 97.2% and 100%, respectively. No significant difference in cure rate existed between the two groups (P>0.05). A rapid fall in the serum β-HCG and progesterone levels within 1-3 days after the treatment were detected in 40 cases of group MTX and 38 cases of group 5-FU, and the decreasing extent was over 50%-80%, but the difference between the two groups was not significant (P>0.05). At the operation day, all patients of both groups had abdominal pain, and three patients in group MTX and 2 patients in 5-FU group had nausea and vomiting, but the difference between the two groups was not significant (P>0.05). During the follow-up period, no significant difference in the recovery time of the mental cycle and the hormone levels were found between the two groups (P>0.05). Conclusion: For the interventional treatment of uterine incisional pregnancy after cesarean section, the use of MTX has the same clinical efficacy as the use of 5-FU does. (authors)

  9. Renal Morphology, Clinical Findings, and Progression Rate in Mesoamerican Nephropathy.

    Science.gov (United States)

    Wijkström, Julia; González-Quiroz, Marvin; Hernandez, Mario; Trujillo, Zulma; Hultenby, Kjell; Ring, Anneli; Söderberg, Magnus; Aragón, Aurora; Elinder, Carl-Gustaf; Wernerson, Annika

    2017-05-01

    Mesoamerican nephropathy (MeN) is a chronic kidney disease affecting rural inhabitants in Central America. We have previously described the renal morphology in 8 patients from El Salvador. To confirm the renal pathology, we have studied kidney biopsies from patients with MeN in Nicaragua. Follow-up urine and blood samples from both biopsy studies were collected to investigate the natural history. Case series. In the kidney biopsy study, 19 male sugarcane workers in Nicaragua with suspected MeN were investigated with questionnaires, kidney biopsies, and blood and urine analysis. Inclusion criteria were age 20 to 65 years and plasma creatinine level of 1.13 to 2.49mg/dL or estimated glomerular filtration rate (eGFR) of 30 to 80mL/min/1.73m 2 . Exclusion criteria were proteinuria with protein excretion > 3g/24 h, uncontrolled hypertension, diabetes mellitus, or other known kidney disease. In the follow up-study, blood and urine from the kidney biopsy study in Nicaragua (n=18) and our previous biopsy study of MeN cases in El Salvador (n=7) were collected 1 to 1.5 and 2 to 2.5 years after biopsy, respectively. Renal morphology, clinical, and biochemical characteristics, change in eGFR per year. eGFR was calculated using the CKD-EPI creatinine (eGFR cr ), cystatin C (eGFR cys ), and creatinine-cystatin C (eGFR cr-cys ) equations. In the kidney biopsy study, participants had a mean eGFR cr of 57 (range, 33-96) mL/min/1.73m 2 . 47% had low plasma sodium and 21% had low plasma potassium levels. 16 kidney biopsies were representative and showed glomerulosclerosis (mean, 38%), glomerular hypertrophy, and signs of chronic glomerular ischemia. Mild to moderate tubulointerstitial damage and mostly mild vascular changes were seen. In the follow up-study, median duration of follow-up was 13 (range, 13-27) months. Mean change in eGFR cr was -4.4±8.4 (range, -27.7 to 10.2) mL/min/1.73m 2 per year. Most patients had stopped working with sugarcane cultivation. 3 biopsy specimens

  10. Biomarkers for Ectopic Pregnancy and Pregnancy of Unknown Location

    Science.gov (United States)

    Senapati, Suneeta; Barnhart, Kurt T.

    2013-01-01

    Early pregnancy failure is the most common complication of pregnancy, and 1–2% of all pregnancies will be ectopic. As one of the leading causes of maternal morbidity and mortality, diagnosing ectopic pregnancy and determining the fate of a pregnancy of unknown location are of great clinical concern. Several serum and plasma biomarkers for ectopic pregnancy have been investigated independently and in combination. The following is a review of the state of biomarker discovery and development for ectopic pregnancy and pregnancy of unknown location. PMID:23290746

  11. Sleep disorders in pregnancy

    Directory of Open Access Journals (Sweden)

    Lopes Eliane Aversa

    2004-01-01

    Full Text Available CONTEXT: The precise function of sleep in animals and human beings is still unknown, and any sort of physical, social or psychological variation may change the normal sleep-wake cycle. PURPOSE: This research aims is to determine the sleep disorders (SD for each of the three trimesters of the pregnancy comparing them to the pre-pregnancy state (PG. METHOD: SD were investigated in three hundred pregnant women 11- to 40-years-old through with a brief clinical interview based on directed questions. One hundred pregnant women were considered for each trimester. RESULTS: The rate of pregnant women with insomnia increased by 23% in the 2nd trimester (p< 0.005; the rate for excessive daytime sleepiness (EDS by 15% in the 1st trimester (p<0.003, 55% in the 2nd trimester (p<0.001 and by 14% in the 3rd trimester (p<0.002; the rate for mild sleepiness increased by 33% in the 2nd trimester (p<0.002 and by 48% in the 3rd trimester (p<0.001; the rate for specific awakenings increased by 63% in the 1st trimester, by 80% in the 2nd trimester and by 84% in the 3rd trimester (p<0.001. CONCLUSION: SD were more frequent during pregnancy comparatively to PG state, mostly at the expenses of EDS and specific awakenings.

  12. The diagnosis and treatment of tubal pregnancy with selective salpingography

    International Nuclear Information System (INIS)

    Li Qunying

    2000-01-01

    Objective: To study feasibility of diagnosing and treating tubal pregnancy with selective salpingography. methods: 13 women diagnosed clinically as ectopic pregnancy without abdominal bleeding were studied and confirmed as tubal pregnancy with selective salpingography, MTX was then injected through fallopian tube. Urine hCG, blood β-hCG and US were studied during follow-up. Results: 12 cases tubal pregnancy were confirmed as well as 1 case of intra-uterine pregnancy. X-ray showed a localized dilation of fallopian tube, half-loop, ring-like or irregular shaped filling defect. In one case, cluster of grapes appearance of contrast medium could be seen at the umbrella end of fallopian tube. Of the 12 cases of tubal pregnancy, 10 were successfully treated, the successful rate was 83%. Conclusion: Selective salpingography is a simple safe and effective method of diagnosing and treating tubal pregnancy

  13. A novel integration effort to reduce the risk for alcohol-exposed pregnancy among women attending urban STD clinics.

    Science.gov (United States)

    Hutton, Heidi E; Chander, Geetanjali; Green, Patricia P; Hutsell, Catherine A; Weingarten, Kimberly; Peterson, Karen L

    2014-01-01

    Alcohol-exposed pregnancy (AEP) is a significant public health problem in the United States. Sexually transmitted disease (STD) clinics serve female clients with a high prevalence of heavy alcohol consumption coupled with ineffective contraceptive use. Project CHOICES (Changing High-Risk AlcOhol Use and Increasing Contraception Effectiveness) is an evidence-based, brief intervention to lower risk of AEP by targeting alcohol and contraceptive behaviors through motivational interviewing and individualized feedback. We describe our experience integrating and implementing CHOICES in STD clinics. This endeavor aligns with CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention's program collaboration and service integration strategic priority to strengthen collaborative work across disease areas and integrate services provided by related programs at the client level.

  14. Pregnancy Outcomes in Chinese Patients with Systemic Lupus Erythematosus (SLE): A Retrospective Study of 109 Pregnancies.

    Science.gov (United States)

    Ku, Ming; Guo, Shuiming; Shang, Weifeng; Li, Qing; Zeng, Rui; Han, Min; Ge, Shuwang; Xu, Gang

    2016-01-01

    Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that primarily affects women during their reproductive years. The interaction between SLE and pregnancy remains debated. The objective of this study was to analyze the fetal and maternal outcomes of Chinese women with SLE. A total of 109 pregnancies in 83 SLE patients from June 2004 to June 2014 at a tertiary university hospital were reviewed retrospectively. Patients' characteristics, clinical and laboratory data during pregnancy were obtained from electronic medical records. After exclusion of elective abortions, the live birth rate was 61.5%. Significantly, APS (antiphospholipid syndrome), disease activity, hypertension, hypocomplementemia, thrombocytopenia, and anemia during pregnancy were more commonly observed in fetal loss pregnancies than in live birth pregnancies. Compared to the 64 women with a history of SLE, 19 women with new-onset lupus during pregnancy had worse pregnancy outcome. Furthermore, the 64 patients with a history of SLE were divided into lupus nephritis group and SLE group (non-renal involvement). We found that the lupus nephritis group had worse maternal outcome than the SLE group. We conclude that new-onset lupus during pregnancy predicts both adverse maternal and fetal outcomes, while a history of lupus nephritis predicts adverse maternal outcomes. It is essential to provide SLE women with progestational counseling and regular multispecialty care during pregnancy.

  15. Pregnancy Outcomes in Chinese Patients with Systemic Lupus Erythematosus (SLE: A Retrospective Study of 109 Pregnancies.

    Directory of Open Access Journals (Sweden)

    Ming Ku

    Full Text Available Systemic lupus erythematosus (SLE is a multisystem autoimmune disease that primarily affects women during their reproductive years. The interaction between SLE and pregnancy remains debated. The objective of this study was to analyze the fetal and maternal outcomes of Chinese women with SLE. A total of 109 pregnancies in 83 SLE patients from June 2004 to June 2014 at a tertiary university hospital were reviewed retrospectively. Patients' characteristics, clinical and laboratory data during pregnancy were obtained from electronic medical records. After exclusion of elective abortions, the live birth rate was 61.5%. Significantly, APS (antiphospholipid syndrome, disease activity, hypertension, hypocomplementemia, thrombocytopenia, and anemia during pregnancy were more commonly observed in fetal loss pregnancies than in live birth pregnancies. Compared to the 64 women with a history of SLE, 19 women with new-onset lupus during pregnancy had worse pregnancy outcome. Furthermore, the 64 patients with a history of SLE were divided into lupus nephritis group and SLE group (non-renal involvement. We found that the lupus nephritis group had worse maternal outcome than the SLE group. We conclude that new-onset lupus during pregnancy predicts both adverse maternal and fetal outcomes, while a history of lupus nephritis predicts adverse maternal outcomes. It is essential to provide SLE women with progestational counseling and regular multispecialty care during pregnancy.

  16. Progesterone level on the day of hCG administration in relation to the pregnancy rates of patients undergoing assisted reproduction techniques.

    Science.gov (United States)

    Oliveira, Renato de; Cabral, Fernanda Godoy; Carvalho, Waldemar de Almeida Pereira; Cordts, Emerson Barchi; Bianco, Bianca; Barbosa, Caio Parente

    2017-01-01

    To evaluate the predictive capacity for pregnancy of the progesterone level on the day of administering human chorionic gonadotropin, in women submitted to assisted reproductive techniques. An observational study with 914 women submitted to assisted reproductive techniques from August 2014 to June 2016. Total pregnancy rate was 34.58%; in that, the pregnancy rate in women 38 years was, respectively, 42.3%, 38.7% and 16.1% (p<0.001). For embryo transfer in the same cycle, and progesterone of 1.3ng/dL, sensitivity was 4.78%, specificity, 84.18%, accuracy, 56.72%, positive likelihood ratio of 0.3019, and negative likelihood ratio of 1.1312, with receiver operating characteristic curve of 0.46 (95%CI: 0.42-0.49). The progesterone level on the day of administering human chorionic gonadotropin of 1.3ng/dL differs from that empirically adopted at the study site (1.7ng/dL), and has a better predictive capacity for pregnancy in the patients studied. However, the low sensitivity of this examination raises questions about its real importance.

  17. Effect of the treatment with myo-inositol plus folic acid plus melatonin in comparison with a treatment with myo-inositol plus folic acid on oocyte quality and pregnancy outcome in IVF cycles. A prospective, clinical trial.

    Science.gov (United States)

    Rizzo, P; Raffone, E; Benedetto, V

    2010-06-01

    The aim of the study was to evaluate the efficacy of a treatment with myo-inositol plus folic acid plus melatonin compared with myo-inositol plus folic acid alone on oocyte quality in women underwent in vitro fertilization (IVF) cycles. A prospective, clinical trial. Starting on the day of GnRH administration, 65 women undergoing IVF cycles were randomized in two groups to receive myo-inositol plus folic acid plus melatonin (32 women, group A), and myo-inositol plus folic acid (33 women, group B), administered continuously. Primary endpoints were number of morphologically mature oocytes retrieved (MII oocytes), embryo quality, and pregnancy rate. Secondary endpoints were the total number of oocytes retrieved (immature and mature oocytes), fertilization rate per number of retrieved oocytes and embryo cleavage rate. The mean number of oocytes retrieved did not differ between the two groups (7.88 +/- 1.76 vs 7.67 +/- 1.88; P=0.65). Whereas the group cotreated with melatonin reported a significantly greater mean number of mature oocytes (6.56 +/- 1.64 vs 5.76 +/- 1.56; P=0.047) and a lower mean number of immature oocytes (1.31 +/- 0.74 vs. 1.91 +/- 0.68; P=0.001). The mean number of embyos of top-quality (class 1 and 2) resulted higher in the group A (1.69 +/- 0.64 vs 1.24 +/- 0.75; P=0.01). Fertilization rate did not differ between the two groups. A total of 22 pregnancies were obtained (13 in group A and 9 in group B; P=0.26). Clinical pregnancy rate and implantation rate were in tendency higher in the group cotreated with melatonin, although the differences did not reach statistical significance. Biochemical pregnancy rate and abortion rate were similar in both groups. melatonin ameliorates the activity of myo-inositol and folic acid by improving oocyte quality and pregnancy outcome in women with low oocyte quality history.

  18. Frequency and predisposing factors of leg cramps in pregnancy: a prospective clinical trial

    Directory of Open Access Journals (Sweden)

    Sohrabvand F

    2009-12-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Leg cramp is the painful contraction of the muscles that often occurs at night. Pregnancy is the most common cause of muscle cramps that usually occur in the second trimester of pregnancy. Although the reasons of the spasms had not been determined, the imbalance between the absorption and elimination of serum electrolytes such as Ca, Mg and potassium and also insufficiency of some vitamins and probably the changes in activities of motor neurons of spinal cord, can be the source of these problems. The aim of this study was the evaluation of frequency and predisposing factors of leg cramps."n"nMethods: In a cross sectional descriptive analytic study, a group of 400 women in the third trimester of pregnancy were asked to record the symptoms of leg cramp. Their education level and job recorded and their total serum level of Ca and Mg was measured in the first visit. Exclusion criteria included systemic medical conditions such as thyroid disease, diabetes, osteoporosis and prenatal disorders such as gestational diabetes mellitus and preeclampsia and patient cooperation."n"nResults: In our study the prevalence of leg cramp was 54.75%. There was a statistically significant relationship between leg cramp and serum

  19. Marked improvement in the success rate of medical management of early pregnancy failure following the implementation of a novel institutional protocol and treatment guidelines: a follow-up study.

    Science.gov (United States)

    Colleselli, V; Nell, T; Bartosik, T; Brunner, C; Ciresa-Koenig, A; Wildt, L; Marth, C; Seeber, B

    2016-11-01

    To analyze the success rate, time to passage of tissue and subjective patient experience of a newly implemented protocol for medical management of early pregnancy failure (EPF) over a 2-year period. A retrospective chart review of all patients with early pregnancy failure primarily opting for medical management was performed. 200 mg mifepristone were administered orally, followed by a single vaginal dose of 800 mcg misoprostol after 36-48 h. We followed-up with our patients using a written questionnaire. 167 women were included