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Although the expected benefits of the Mediterranean diet (MD) are comprehensive, its implementation is hampered by poor adherence. Several factors can affect adherence to MD guidelines. The current study aimed to explore sociodemographic and pregnancy-related determinants of MD adherence among Saudi women. A correlational cross-sectional research design was conducted on a snowball sample of 774 pregnant women from the Najran region, Saudi Arabia, using an online survey between February and May 2024. A self-administered questionnaire consisting of sociodemographic data, pregnancy-related characteristics, and the MD scale was used for data collection. The current study showed that only 32.2% of participants had high adherence to the MD, and 57.6% had moderate adherence. Regarding sociodemographic determinants of MD adherence, highly educated, older women with lower pre-pregnancy body mass index (BMI) and higher monthly income increased the probability of high adherence to the MD (p < 0.05). In addition, being physically active before or during pregnancy significantly increased the woman's probability of having higher adherence to the MD (p < 0.05). Concerning pregnancy-related determinants, having a planned pregnancy and regular antenatal care (ANC) increased the woman's probability of high adherence to the MD by nearly 1.3 times (p < 0.05). In addition, low adherence to the MD increases the risk of gestational diabetes. In conclusion, numerous sociodemographic and pregnancy-related determinacies can significantly affect a woman's adherence to the MD. Healthcare providers should address these determinants during the planning and implementation of pregnant women's nutritional counseling to make the counseling process woman-centered and more effective. [ABSTRACT FROM AUTHOR]

Introduction: Many studies report a lack of public awareness of the risk factors and complications of Diabetes Mellitus. Adequate glycemic control is crucial in preventing or delaying the onset of type 2 diabetes complications, and medication adherence is one of the key factors in achieving this goal. This study aimed to measure the knowledge about diabetes mellitus and practices regarding lifestyle factors and diabetes management in the study population in the Aseer region, of Saudi Arabia. Material and Methods: A descriptive cross-sectional survey was conducted in Abha, a city in the Aseer region of Saudi Arabia. The general population of 18 years of age and above, who were residing in the study area during the period of study, ie, January 2023 to June 2023, were included. The questionnaire was distributed through social media and e-mail for data collection. The descriptive variables were presented using frequency, percentage, and graphs. Pearson's chi-square test was used at a 5% level of significance. Multivariate tests were applied to further explore the findings of univariate analysis. The data were analyzed using SPSS version 20.0. Results: Out of the total 348 participants, a higher proportion was males (56.3%). About 78.7% of the participants were ever diagnosed with diabetes mellitus and 21.3% were never diagnosed with diabetes mellitus. Nearly 31.6% knew that the major cause of diabetes mellitus was obesity and 31.3% knew that it was a hereditary disease. About 42.2% of respondents exercised regularly and 27.6% were smokers. Adherence to prescribed anti-diabetic medications was seen in 63.2% of the respondents. Self-alterations in the timing and dose of prescribed anti-diabetic drugs were seen in 36.5% and 34.8%, respectively. About 60.1% had a moderate level of self-rated knowledge about Diabetes Mellitus, and 27.6% and 12.4% had good and poor self-rated knowledge levels of Diabetes mellitus, respectively. On multivariate analysis, the age group 60– 69 years had significant variations as compared to the other age groups on DM, bachelor's degree holders had significant variations as compared to other education variables, being married had significant differences as compared to those unmarried, those employed had significant variations as compared to the other occupation categories, and smokers had a significant impact on DM as compared to non-smokers. Conclusion: Findings indicated less number of respondents exercised regularly, low adherence to prescribed anti-diabetic medications and low levels of self-rated knowledge of diabetes mellitus. Enhancing the patients' knowledge of diabetes mellitus and improving their self-management and adherence to its medications is necessary through public health education. [ABSTRACT FROM AUTHOR]

Objective Saline vaginal douching prior to intravaginal prostaglandin application might increase the vaginal pH, leading to improvement of prostaglandin bioavailability, by which the outcomes of labor induction can be greatly improved. Thus, we aimed to evaluate the effect of vaginal washing with normal saline before insertion of vaginal prostaglandin for labor induction. Study Design A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI Web of Science from inception to March 2022. We selected randomized controlled trials (RCTs) that compared vaginal washing using normal saline versus no vaginal washing in the control group before intravaginal prostaglandin insertion during labor induction. We used RevMan software for our meta-analysis. Our main outcomes were the duration of intravaginal prostaglandin application, duration from intravaginal prostaglandin insertion to active phase of labor, duration from intravaginal prostaglandin insertion till total cervical dilatation, labor induction failure rate, incidence of cesarean section (CS), and rates of neonatal intensive care unit (NICU) admission and fetal infection postdelivery. Results Five RCTs were retrieved with a total number of 842 patients. Duration of prostaglandin application, duration from prostaglandin insertion to active phase of labor, and time interval from prostaglandin insertion to total cervical dilatation were significantly shorter among vaginal washing group (p < 0.05). Vaginal douching prior to prostaglandin insertion significantly decreased the incidence of failed labor induction (p < 0.001). After the removal of reported heterogeneity, vaginal washing was linked to a significant decline in CS incidence (p = 0.04). In addition, the rates of NICU admission and fetal infection were significantly lower in the vaginal washing group (p < 0.001). Conclusion Vaginal washing with normal saline before intravaginal prostaglandin insertion is a useful and easily applicable method for labor induction with good outcomes. Key Points Induction of labor is frequently used in the obstetrics field. We assessed vaginal washing impact before prostaglandin insertion for labor induction. Vaginal washing is an easily applicable method for labor induction with good outcomes. [ABSTRACT FROM AUTHOR]

Background: Postpartum depression (PPD) is a significant mental health concern affecting mothers globally. However, research on PPD prevalence and risk factors in Najran City, Saudi Arabia, is limited. Study Aim: this cross-sectional study aimed to determine the prevalence and risk factors associated with PPD among mothers in Najran City. Methodology: A questionnaire-based study was conducted from September 2023 to January 2024, involving 420 mothers aged 16–50 years with newborns (2–10 weeks after delivery). The questionnaire included demographic information and the Arabic version of the Edinburgh Postnatal Depression Scale (EPDS). Statistical analysis utilized SPSS software v. 26, including descriptive statistics, Mann–Whitney U test, Kruskal–Wallis H test, and logistic regression. Results: The majority of participants were aged 20–35 years (61.4%), Saudi nationals (87.6%), and had university education (51.4%). EPDS scores indicated that 66.7% of mothers screened positive for possible depression. Significant associations were found between higher EPDS scores and factors such as unemployment (p = 0.004), younger age (p = 0.003), caesarean delivery (p = 0.043), mental illness (p = 0.0001), lack of adequate family support (p = 0.0001), and higher stress levels (p = 0.0001). Conclusion: The study revealed a high prevalence of PPD among mothers in Najran City, with sociodemographic, obstetric, and psychosocial factors significantly influencing PPD risk. These findings emphasize the need for targeted interventions and support systems to address maternal mental health needs effectively. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to explore the effectiveness of preoperative multimedia educational sessions on the levels of anxiety and satisfaction among women undergoing cesarean section (CS). The Scopus, PubMed, and Cochrane databases were searched without language limitations for eligible randomized controlled trials (RCTs) published from their inception up to October 15, 2023. A random-effect meta-analysis was conducted, and the quality of this meta-analysis was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Seven RCTs (n = 1006 women) met the inclusion criteria. Preoperative multimedia sessions were found to significantly reduce anxiety levels (n = 6 RCTs, weighted mean difference: −3.10; 95 percent confidence intervals (CI): −4.48, −1.73; I2 = 44.24 percent, moderate certainty of evidence) compared to the control group. However, there was no significant difference between the two groups regarding women's satisfaction after surgery (n = 5 RCTs, risk ratio: 1.37; 95 percent CI: 0.76, 2.50; I2 = 98.26 percent, moderate certainty of evidence). Leave-one-out sensitivity analysis showed robustness of the outcomes. The findings of this meta-analysis suggest that providing multimedia educational programs before surgery could potentially have a beneficial effect on the levels of anxiety experienced by women undergoing CS. However, it is imperative to validate these results through larger samples and multi-centered RCTs. [ABSTRACT FROM AUTHOR]

Impaired vitamin D status is highly prevalent among women with UFs. The objective of this first-ever systematic review and meta-analysis was to summarize the effect of vitamin D supplementation on the size of uterine fibroids (UFs). We performed a comprehensive literature search for published randomized controlled trials (RCTs) in Medline, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to September 2022. Five trials including 511 participants (256 cases and 255 controls) were included. Pooling results from five trials, which compared size of UFs between experimental and placebo groups, revealed that vitamin D supplementation could significantly decrease the size of UFs (standardized mean difference [SMD]: −0.48, 95% confidence interval [CI]: −0.66, −0.31) and cause improvement in serum level of vitamin D compared to placebo group (SMD: 3.1, 95% CI: 0.66, 5.55). A significant effect was observed in the subset of trials administering vitamin D supplementation for >8 wk (SMD: −0.62, 95% CI: −0.88, −0.37). In conclusion, vitamin D supplementation significantly increases serum levels of vitamin D and reduces the size of UFs. However, larger, well-designed RCTs are still needed to determine the effect of vitamin D on other parameters of UFs. [ABSTRACT FROM AUTHOR]

Background. Labor pain is considered the worst pain in a woman's life. Hence, pain control should be essential to labor management at any level. There is scarce information, and there are gaps regarding the knowledge, attitude, and barriers to the utilization of nonpharmacological approaches for pain relief in Saudi Arabia. Therefore, the current study aims to evaluate nonpharmacological pain relief (NPPR)-related knowledge, attitudes, and barriers among obstetric care providers in Najran, Saudi Arabia. Methods. A cross-sectional analytical study was performed at maternity departments in Maternal and Children Hospital (MCH), Najran, Saudi Arabia, from April 1 to May 26 2023. The study involved 186 obstetric care providers (OPCs), physicians (19), nurses (144), and midwives (23). A structured self-reported questionnaire was used to collect data and involves five main sections: demographic data, work-related data, nonpharmacological pain relief-related attitude, perceived barriers, and knowledge quiz. The adjusted odds ratio (AOR) along with 95% CI was estimated to determine the factors associated with nonpharmacological pain relief-related knowledge and attitude using multivariate analysis in the binary logistic regression. Results. Over three-quarters (79%) of obstetric care providers had adequate knowledge of nonpharmacological pain relief methods. The majority (85.5%) of the participants had a positive attitude toward NPPR in labour pain management, with the mean scores ranging from 3.55-4.23 for all sub-items. Obstetric care providers acknowledged that patient belief, lack of time, and workload were the strongest barriers to offering nonpharmacological pain relief methods for labour pain 67.6%, 64.5%, and 61.3%, respectively. In binary logistic regression analysis, the in-service training related to non-pharmacological pain relief (AOR = 5.871 (2.174-15.857), p=0:000), (AOR = 3.942 (1.926-11.380), p=0:013) and years of work experience (AOR = 1.678 (1.080-2.564), p=0:019), (AOR = 1.740 (1.188-2.548), p-0:003) were significantly associated with obstetric care providers' knowledge and attitudes regarding nonpharmacological pain relief (p≤0:05). Conclusion. Although most OPCs have adequate knowledge and a positive attitude regarding NPPR, they need motivational strategies to enhance their utilization. In addition, an effort should be made to decrease OPCs' workload to provide more time for NPPR application and patient education. Training courses and in-service training can play an important role in enhancing NPPR knowledge and attitude and, consequently, its application. Also, in each working unit, the policymakers should provide clear guidelines and policies that enhance and control the utilization of NPPR. [ABSTRACT FROM AUTHOR]

Background: Fear of Childbirth (FOC) can significantly impact women's physical and psychological health; therefore, healthcare providers must provide proactive care, which means they have to intervene before FOC becomes tokophobia. This study's purpose is to evaluate the determinants of prenatal childbirth fear during the third trimester among low-risk expectant mothers. Methods: A cross-sectional comparative study was conducted at the Maternal and Children Hospital's outpatient clinics in Najran City, Saudi Arabia, from April to July 2023. The study involved 377 nulliparous and multiparous women, using a systemic random sampling technique. The data were collected using an interview schedule composed of questions related to demographic and obstetrics characteristics, the FOC questionnaire, and a multidimensional scale of perceived social support. Significant FOC predictors were examined using a binary logistic regression model. Results: There was a statistically significant difference between nulliparous and multiparous participants concerning FOC; 80.0% of nulliparous participants had significant FOC compared to 67.8% of multiparous participants (p = 0.011). A binary logistic regression clarified that regular antenatal care and family and spousal support were significantly negatively correlated with significant FOC among multiparous and nulliparous women (p < 0.05). For multiparas, FOC was associated with pregnancy planning and previous labor-related complications. In addition, friends' support was an important predictor of significantly lower FOC among nulliparous women (p < 0.05). Conclusions: Significant FOC was higher in nulliparous women when compared to multiparous women. Numerous obstetric variables and different types of social support play important roles in significant FOC. Special attention and support should be provided to high-risk women for proper FOC management during prenatal classes to improve their childbirth experiences. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis is one of the most frequent vaginal tract infections during pregnancy. It is characterized by elevated vaginal pH, milky, creamy discharge, and an amine- or fishy-smelling odor.Study Aim: Our study aimed to describe the characteristics and presenting manifestations of bacterial vaginosis in pregnant women.Methods: This cross-sectional analytical study included pregnant Saudi women who have been diagnosed with bacterial vaginosis. Data was collected using a self-administered questionnaire. We used the Statistical Package for Social Sciences (SPSS) version 26 for data management and statistical analysis.Results: The study included 456 women and found that 59.7% of people felt vulval itching, 7.7% reported swelling, 81% reported increased secretions, 62.5% reported dyspareunia, and 44.6% reported burning micturition. Thirty-one percent of individuals reported yellowish discharges, while 32.1% reported a foul odor. Older women with lower educational levels, who had vaginal itching and swelling, had significantly higher rates of burning urination.Conclusion: Our study found that most of the presenting symptoms were significantly associated with dyspareunia and dysuria. The study also shows that nearly all the participants recovered with proper treatment. We recommend healthcare systems meticulously detect and cure bacterial vaginosis as it is a preventable cause of complicated pregnancy. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The increasing Cesarean Section (CS) rates may be attributed to women's increasing requests for elective CS. High Fear of Childbirth (FOC), especially among nulliparous women, may be significantly associated with CS preference without medical indications. The current study aims to investigate the impact of childbirth fear on the mode of delivery preference among nulliparous women. Methods: A cross-sectional correlational study was performed in the Maternal and Children Hospital (MCH) from the beginning of October 2022 to the end of February 2023 and incorporated a convenience sample of 342 nulliparous women. The data was collected using a self-reported questionnaire comprising participants' demographic and obstetrics characteristics and the FOC questionnaire. A logistic regression model examined the relationship between CS preference and the other independent variables. Results: The results indicated that 74.3% of the nulliparous women preferred vaginal delivery, while 25.7% preferred Cesarean Section. Concerning childbirth-related fear, the highest mean scores were related to fear of clinical procedures, fear of harming or distressing the infant, and fear of pain 5.19 ± 1.13, 5.12 ± 1.27, and 5.09 ± 1.22, respectively. High FOC was present among 74.6%, moderate in 17.3%, and severe in 6.7% of the participants. Logistic regression analysis showed maternal age and monthly income were the significant sociodemographic determinants of choosing CS as the preferred delivery mode (p < 0.05). Moreover, the participants who had increased fear of harming or distressing the infant, fear from pain, fear from the body's ability to give birth, fear from not being involved in decision-making, and overall FOC had a higher probability of choosing CS as the preferred delivery mode compared to the participants who had lower fear (p < 0.05). Discussion: Having high FOC increases the CS preference among nulliparous women. Increased fear of harming or distressing the infant, fear from pain, fear from the body's ability to give birth, and fear from not being involved in decision-making seem to be significant dimensions of childbirth fear associated with CS preference among nulliparous women. [ABSTRACT FROM AUTHOR]

Objective: To evaluate ultrasound guidance effect in pain relief during intrauterine device (IUD) insertion. Methods: Four different databases were searched from inception till June 2022. We selected randomized controlled trials (RCTs) that compared transabdominal ultrasound guidance versus traditional non‐guided IUD insertion among women undergoing IUD placement for contraception. We used Revman software during performing our meta‐analysis. Our primary outcome was the pain score during IUD insertion as evaluated by the Visual Analog Scale (VAS). Our secondary outcomes were the procedure insertion time, satisfaction, and incidences of complications and misplaced IUDs. Results: Seven RCTs were retrieved with a total number of 1267 patients. There was a significant reduction in the VAS pain score during IUD insertion among the ultrasound‐guided group (MD = −1.91, 95% CI [−3.08, −0.73], P =.001). The procedure insertion time was significantly shorter within the ultrasound guidance group compared with the control group (MD = −1.35, 95% CI [−1.81, −0.88], P <.001). Moreover, more women were significantly satisfied with the procedure among the ultrasound‐guided group (P <.001). In addition, ultrasound‐guided IUD insertion was linked to significant decline in incidences of complications and misplaced IUDs. Conclusion: Ultrasound guidance can be used as a modified technique during IUD insertion as it decreases pain, procedure time, and rates of complications and misplaced IUDs with better patient satisfaction. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of antibiotic use by pregnant women in Najran, Saudi Arabia. Methods: A total of 125 women aged 18 to 45 with a full-term pregnancy participated from October to December 2019. Age, order of current pregnancy, body mass index (BMI), history of miscarriage, and comorbidity were used to estimate antibiotic use. Results: The majority were Saudis (67.2%), aged 30-35 (39.2%) years, with no history of miscarriage (53.6%), second order of pregnancy (26.4%), and going through weeks 20-25 of pregnancy (21.6%). A total of 26.4% of pregnant women had antibiotic prescriptions in the study population. Pregnant women under 30 years were less likely to receive antibiotics. Conclusion: The results found an association between maternal age, order of pregnancy and antibiotic use during pregnancy. An association was observed between maternal BMI and the occurrence of adverse drug reactions after antibiotic use. In addition, a history of miscarriage was negatively associated with the use of antibiotics during pregnancy. These predictors of antibiotic administration have the potential to serve as general health indicators and to direct preventative strategies aimed at increasing the rational use of antibiotics. [ABSTRACT FROM AUTHOR]

Insulin is the main metabolic regulator of fuel molecules in the diet, such as carbohydrates, lipids, and proteins. It does so by facilitating glucose influx from the circulation into the liver, adipose tissue, and skeletal myocytes. The outcome of which is subjected to glycogenesis in skeletal muscle and lipogenesis in adipose tissue, as well as in the liver. Therefore, insulin has an anabolic action while, on the contrary, hypoinsulinemia promotes the reverse process. Protein breakdown in myocytes is also encountered during the late stages of diabetes mellitus. The balance of the blood glucose level in physiological conditions is maintained by virtue of the interactive functions of insulin and glucagon. In insulin resistance (IR), the balance is disturbed because glucose transporters (GLUTs) of cell membranes fail to respond to this peptide hormone, meaning that glucose molecules cannot be internalized into the cells, the consequence of which is hyperglycemia. To develop the full state of diabetes mellitus, IR should be associated with the impairment of insulin release from beta-cells of the pancreas. Periodic screening of individuals of high risk, such as those with obesity, hypercholesterolemia, and pregnant nulliparous women in antenatal control, is vital, as these are important checkpoints to detect cases of insulin resistance. This is pivotal as IR can be reversed, provided it is detected in its early stages, through healthy dietary habits, regular exercise, and the use of hypoglycemic agents. In this review, we discuss the pathophysiology, etiology, diagnosis, preventive methods, and management of IR in brief. [ABSTRACT FROM AUTHOR]

Objectives: This research aimed to compare the incidence and severity of acute appendicitis (AA) before and during the COVID-19 pandemic. Materials and Methods: Two southern Saudi Arabian high-volume hospitals hosted this retrospective investigation. The COVID pandemic period (March-June 2020) and the pre-COVID period were identified (March-June 2019). The frequency, clinical manifestation, and severity of AA were compared for patients who underwent appendectomies during these periods. Results: In the study hospitals, total admissions decreased by 52.3% (95% confidence interval [CI]: 51.1%-53.3%) from 6231 patients during the pre-COVID period to 3261 patients during the COVID period. In the 2019 study period, 107 cases of AA were surgically treated, compared to 61 cases in 2020. The observed reduction rate was 57.1% (95% CI: 47.5%-66.8%). During the COVID period, the duration from the onset of symptoms to hospital admission and hospital admission to surgery was significantly shorter for patients. There were no significant differences between the COVID and pre-COVID periods in terms of the clinical picture or severity of AA. Conclusions: During the COVID era, there was a significant decrease in the number of AA patients hospitalized, which may indicate the efficacy of home treatment for mild cases. The successful measures taken by the Saudi Arabian government during the curfew, along with the optimal utilization of resources and logistics, resulted in the early presentation and management of AA, yielding results comparable to the pre-COVID era. [ABSTRACT FROM AUTHOR]

Background: Recurrent miscarriage is a condition that causes a lot of distress in couples, and approximately 50% of them are of unknown etiology. Numerous studies have demonstrated the role of hyperhomocysteinemia in vascular occlusions, including occlusion in the blood vessels in the placenta, which has the potential to result in recurrent loss of pregnancy. Objective: To determine homocysteine levels in Saudi women who had recurrent miscarriages of unknown etiology Design: A cross-sectional case-control study Setting: The study was conducted, at the outpatient clinic of Najran University Hospital and Maternity and Child Health Hospital, Najran, Saudi Arabia and this was compared to healthy controls, from 2018 to 2019. Subject and Methods: A cross-sectional case-control study was conducted to determine homocysteine levels in Saudi women who had recurrent miscarriages of unknown etiology, and this was compared to healthy controls, from 2018 to 2019. All participants were fully examined and evaluated by a consultant obstetrician in advance to exclude known causes of recurrent miscarriage. Plasma homocysteine concentrations were measured using homocysteine enzymatic assay. Main outcome measures: Plasma homocysteine concentrations Results: Eighty-eight women were included in this study; 58 had recurrent miscarriages and 30 were healthy controls. Approximately 22% of the patients and 6.6% of the healthy controls showed elevated homocysteine levels. The mean homocysteine concentration in the patients was 8.797±3.29 μmol/l, which was significantly higher than that in the controls, which was 7.17±4.96 μmol/l (P = 0.005). Conclusion: Hyperhomocysteinemia is a potential risk factor for recurrent miscarriages in Saudi women. Therefore, we recommend the inclusion of this investigation in the diagnostic protocols for recurrent miscarriage and further investigating the cause of the hyperhomocysteinemia. [ABSTRACT FROM AUTHOR]

Objective: To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated the efficacy and safety of isosorbide mononitrate (IMN) in promoting cervical ripening during labour induction.Methods: Six major databases were searched from inception until 22 April 2021. The risk of bias of included studies was assessed. Various endpoints (n = 21) were meta-analysed, and the endpoints were pooled as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI).Results: In total, 23 RCTs were included in this review, comprising 26 intervention arms and a total of 4305 patients (2210 and 2095 patients were allocated to the IMN and control groups, respectively). Pertaining to obstetric-related maternal outcomes, the pooled analysis showed that admission to delivery time and rate of caesarean delivery were significantly reduced in the IMN group. Moreover, the mean Bishop score and the mean change in Bishop score were significantly increased in the IMN group. Pertaining to drug-related maternal side effect outcomes, the pooled analysis showed that the rates of headache, palpitations, nausea and flushing were significantly lower in the IMN group. Pertaining to neonatal outcomes, the pooled analysis showed no significant difference between the two groups in terms of the rates of neonatal intensive care unit admission, neonatal death, fetal distress, meconium-stained water, Apgar score < 7 at 1 and 5 min, and mean Apgar score at 1 and 5 min.Conclusion: IMN correlated with several obstetric-related maternal outcomes. IMN was not associated with adverse neonatal outcomes, but was associated with substantial drug-related maternal side effects. [ABSTRACT FROM AUTHOR]

We aimed to conduct a systematic review and meta-analysis to compare the efficacy and safety of titrated oral misoprostol versus static oral misoprostol for labour induction. We searched for the available randomised clinical trials (RCTs) in the Cochrane Library, PubMed, ISI web of science, Scopus, and ClinicalTrials.gov. We included RCTs compared titrated oral misoprostol versus static regimen of oral misoprostol during labour induction. Our main outcomes were vaginal and caesarean delivery rates, uterine tachysystole, misoprostol side effects, and neonatal adverse events. Three RCTs met our inclusion criteria with a total number of 360 patients. The vaginal delivery rate did not significantly differ between both groups (p = 0.49). Titrated oral misoprostol was associated with significant increase in the caesarean delivery rate compared to static oral misoprostol (p = 0.04). Moreover, titrated oral misoprostol led to significant increase in the uterine tachysystole and misoprostol side effects (p = 0.01 & p = 0.003, respectively). There were no differences among both groups regarding different neonatal adverse events. In conclusion, titrated oral misoprostol increases the incidence of caesarean delivery, uterine tachysystole, and misoprostol side effects with a similar vaginal delivery rate compared to static dose misoprostol. Thus, static oral misoprostol should be used instead of titrated oral misoprostol during labour induction. What is already known on this subject? Different studies have evaluated titrated oral misoprostol administration for induction of labour and proved their efficacy in comparison with other induction methods. However, there is controversy among the published studies between titrated oral misoprostol and static oral misoprostol during induction of labour. A recent study concluded that hourly titrated misoprostol and static oral misoprostol are equally safe and effective when utilised for induction of labour with no fear of any adverse events. However, another study recommended static oral misoprostol administration for labour induction as it was linked to a lower caesarean section incidence, fewer drug side effects, and decline in complication rates in comparison with titrated oral misoprostol. What the results of this study add? Titrated oral misoprostol increases the incidence of caesarean delivery, uterine tachysystole, and misoprostol side effects with a similar vaginal delivery rate compared to static dose misoprostol. What the implications are of these findings for clinical practice and/or further research? Static oral misoprostol should be used instead of titrated oral misoprostol during labour induction. More future trials are required to confirm our findings. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of warm distension medium versus room temperature distension medium on pain control among patients undergoing office hysteroscopy. Methods: A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI web of science from inception to October 2021. We selected randomized clinical trials (RCTs) compared warmed saline distension medium in the intervention group versus room temperature distension medium in the control group among women undergoing diagnostic and/or operative office hysteroscopy. Revman software was utilized for performing our meta‐analysis. Our primary outcomes were pain scores evaluated by the visual analog scale (VAS) during and after the procedure. Our secondary outcome was the patient satisfaction between both groups. Results: Five RCTs met our inclusion criteria with a total number of 441 patients. We found warm saline was linked to a significant reduction in the VAS pain score during the procedure compared to the control group (mean difference [MD] = −1.12, 95% confidence interval [CI] [−1.80, −0.45], p = 0.001). Moreover, the VAS pain score after the procedure was significantly declined among the warm saline group (MD = −0.62, 95% CI [−0.97, −0.27], p = 0.005). Interestingly, more patients were significantly satisfied with warm saline distension medium application compared to room temperature group (odds ratio [OR] = 3.71, 95% CI [2.01, 6.86], p < 0.001). Conclusions: Warm saline application in office hysteroscopy is effective in reducing pain during and after the procedure as well as improvement in patient satisfaction. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are two increasing important problems among children. This study aims to explore the link between maternal polycystic ovary syndrome (PCOS) and the risk of ASD and ADHD in the offspring. The MOOSE guidelines were followed in the conduct of this meta-analysis. A literature search was done in PubMed/MEDLINE, Scopus, and Web of Science from inception until January 2021. The DerSimonian and Laird random-effects model was used to estimate the combined risk ratios (RR) and 95% confidence intervals (CI). Sensitivity analysis was also used to investigate the effect of each study on the combined results. Seven studies, with 1,358,696 participants, comprising 7,334 ADHD cases and 3,920 ASD cases, were included in this study. Children born to mothers with maternal PCOS had higher risks of developing ASD (RR = 1.46, 95% CI: 1.26–1.69, I2 = 64%) and ADHD (RR = 1.43, 95% CI: 1.35–1.41, I2 = 0%) when compared with children born to mothers without maternal PCOS. This study showed that there might be a link between maternal PCOS and the risk of developing ASD and ADHD in the offspring. This important issue must be considered in PCOS women during and after pregnancy. [ABSTRACT FROM AUTHOR]

Copyright of Gynecological Endocrinology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To systematically and meta-analytically investigate the efficacy and safety of vaginal dinoprostone versus placebo in pain relief during intrauterine device (IUD) insertion. PubMed, Scopus, Web of Science, and Cochrane Library were screened till 1 October 2020. Only randomised placebo-controlled studies were included and assessed for risk of bias. Main outcomes included IUD insertion related pain, patient satisfaction, provider ease of IUD insertion, and side effects. Pooled outcomes were summarised as standardised mean difference (SMD), weighted mean difference (WMD), or risk ratio (RR) with 95% confidence interval (95% CI). Five studies were included, comprising 862 patients; equally 431 patients received vaginal dinoprostone and placebo. All studies showed an overall low risk of bias. When compared to placebo, dinoprostone significantly correlated with decreased pain at tenaculum placement (SMD = −0.79, 95% CI [−1.43, −0.16], p = 0.01), decreased pain at uterine sounding (SMD = −0.88, 95% CI [−1.54, −0.22], p = 0.009), decreased pain at IUD insertion (SMD = −1.18, 95% CI [−1.74, −0.61], p < 0.001), decreased need for additional analgesia (RR = 0.34, 95% CI [0.22, 0.53], p < 0.001), increased patient satisfaction (SMD = 1.41, 95% CI [0.62, 2.20], p < 0.001), and increased provider ease of IUD insertion (SMD = −1.17, 95% CI [−1.62, −0.73], p < 0.001). Fever was statistically significantly higher in dinoprostone versus placebo group (RR = 3.73, 95% CI [1.47, 9.44], p = 0.006). All other side effects—including nausea, vomiting, shivering, diarrhoea, abdominal cramps, vasovagal attack, uterine perforation, and postprocedural bleeding—did not substantially differ between both groups. This first ever meta-analysis advocates that dinoprostone compared with placebo is safe, effective, and yields favourable analgesic outcomes during IUD insertion. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis is a frequent source of vaginal infection among reproductive‐aged women. Astodrimer gel is a novel drug which demonstrated favourable outcomes for treatment of patients with bacterial vaginosis. Aim: We attempted to conduct a systematic review and meta‐analysis of all randomized controlled trials (RCTs) which examined the efficacy and safety of astodrimer gel in patients with bacterial vaginosis. Methods: We searched four databases from inception to August 15, 2020, using relevant keywords. We identified all RCTs which surveyed the efficacy and safety of astodrimer gel in treating patients with bacterial vaginosis. We appraised the quality of the included RCTs using the Cochrane risk of bias assessment tool. We pooled dichotomous outcomes as numbers and totals and reported them as risk ratios (RR) with 95% confidence intervals (95% CI) under random‐ or fixed‐effects meta‐analysis models depending on heterogeneity. Results: Three eligible studies comprising four independent RCTs and 1165 patients were identified (614 and 551 patients received astodrimer gel and placebo, respectively). For efficacy outcomes (n = 320 astodrimer gel versus n = 260 placebo), astodrimer gel was significantly superior to placebo for all pooled efficacy outcomes, including clinical cure rate (at 9‐12 and 21‐30 days), microbiological Nugent cure rate (at 9‐12 and 21‐30 days), patient self‐reported absence of vaginal odor/discharge (at 9‐12 and 21‐30 days), resolution of Amsel criteria (at 9‐12 days) and percentage of patients who did not receive rescue therapy during study. With respect to safety outcomes (n = 614 astodrimer gel versus n = 551 placebo), astodrimer gel demonstrated equal tolerability to placebo for all pooled safety endpoints, expect unfavourably for vulvovaginal candidiasis and treatment‐related vulvovaginal candidiasis. Conclusions: Astodrimer gel is effective in treating bacterial vaginosis and corroborated by clinical (Amsel criteria) and microbiological (Nugent score) measurements as well as patient‐reported symptoms. Moreover, astodrimer gel is largely safe and associated with marginal rate of vulvovaginal candidiasis. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To conduct a systematic review and meta-analysis of randomized controlled trials on the clinical efficacy and safety of prophylactic tranexamic acid (TXA) versus control (normal saline/no treatment) during myomectomy.Methods: Six databases were screened from inception until 21-February-2022. The eligible studies were assessed for risk of bias. The outcomes were summarized as mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) in a random-effects model.Results: Seven studies, comprising eight arms and 571 patients (TXA = 304 patients, control = 267 patients) were analyzed. The included studies had an overall low risk of bias. The mean intraoperative blood loss (MD = -224.34 ml, 95% CI [-303.06, -145.61], p < 0.001), mean postoperative blood loss, and mean total blood loss were significantly reduced in favor of the prophylactic TXA group. Additionally, the mean postoperative hemoglobin (MD = 0.4 mg/dl, 95% CI [0.11, 0.68], p = 0.006) and mean postoperative hematocrit levels were significantly higher in favor of the prophylactic TXA group. While the mean hospital stay was significantly reduced in favor of the prophylactic TXA group (MD = -0.39 d, 95% [-0.74, -0.04], p = 0.03), there was no significant difference between both groups regarding the mean operation time and rate of blood transfusion. None of the participants in both groups developed any incidence of thromboembolic events. The rate of nausea was significantly higher in disfavor of the prophylactic TXA group (RR = 2.68, 95% CI [1.11, 6.43], p = 0.03).Conclusion: Among patients undergoing myomectomy, prophylactic TXA was largely safe and linked to substantial reductions in perioperative blood loss and related morbidities. [ABSTRACT FROM AUTHOR]