Search

Study design Because of current demographic developments, a hypothesis was proposed whereby older female patients aged > 65 years can be safely operated using minimally invasive, robotic-assisted surgery, despite having more preoperative comorbidities. A comparative cohort study was designed to compare the age group ≥ 65 years (older age group, OAG) with the age group Patients and methods Consecutive RAS procedures performed between 2016 and 2021 at the Women’s University Hospital of Jena and the Robotic Center Eisenach to treat benign or oncological indications were included in the study. The age groups were compared according to their preoperative comorbidities (ASA, Charlson comorbidity index [CCI], cumulative illness rating scale – geriatric version [CIRS-G]) and perioperative parameters such as Clavien-Dindo (CD) classification of surgical complications. Analysis was performed using Welch’s t-test, chi2 test, and Fisher’s exact test. Results A total of 242 datasets were identified, of which 63 (73 ± 5 years) were OAG and 179 were YAG (48 ± 10 years). Patient characteristics and the percentage of benign or oncological indications did not differ between the two age groups. Comorbidity scores and the percentage of obese patients were higher in the OAG group: CCI (2.7 ± 2.0 vs. 1.5 ± 1.3; p Conclusion Although preoperative comorbidity was higher in the group of older female patients, no differences were found between age groups with regard to perioperative outcomes following robotic-assisted gynecological surgery. Patient age is not a contraindication for robotic gynecological surgery.

Nan Yu,* Ting Zhou,* Haiying Sun, Peiying Fu, Ronghua Liu Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ronghua Liu, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv., Wuhan, Hubei, 430030, People’s Republic of China, Tel +86-27-63639807, Fax +86 (27) 83663078, Email liuzhu38@126.comAbstract: Port site metastasis (PSM) is considered an uncommon and rare complication in gynecologic malignancies with unclear treatment recommendations or guidelines. Thus, we report the treatment strategies and outcomes of two cases of PSMs following gynecologic malignancies and a review of the literature to provide much information about the most frequent sites of PSMs and the incidence of PSMs in different gynecological tumors. A 57-year-old woman underwent laparoscopic radical surgery for right ovarian serous carcinoma in June 2016 followed by postoperative chemotherapy. Because PSMs were present near the port site of the bilateral iliac fossa, the tumors were completely removed on August 4, 2020, and the patient received chemotherapy. She has shown no signs of relapse. During the same period, a 39-year-old woman underwent laparoscopic type II radical hysterectomy for endometrial adenocarcinoma involving the endometrium and cervix on May 4, 2014, without adjuvant treatment. In July 2020, a subcutaneous mass under her abdominal incision was removed, and chemotherapy plus radiotherapy was administered. Metastasis was found in the left lung in September 2022, but there was no abnormality in the abdominal incision. We showed the two cases of PSMs, reviewed articles to provide some new insights about the incidences of PSMs in the gynecologic tumors, and discussed the proper preventive strategies.Keywords: ovarian cancer, endometrial cancer, port site, metastasis

Abdulhakim Abdurahman Kureba,1 Wondimu Gudu,1 Anteneh Mersha,1 Elias Jemal,2 Abdulfetah Abdulkadir Abdosh1 1Department of Obstetrics and Gynecology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Department of Obstetrics and Gynecology, Haramaya University Hiwot Fana Comprehensive Specialized Hospital, Harar, EthiopiaCorrespondence: Abdulhakim Abdurahman Kureba, Department of Obstetrics and Gynecology, St. Paul’s Hospital Millennium Medical College, 1271, Swaziland St, Addis Ababa, Ethiopia, Tel +251911937561, Email abdulhakim317@gmail.comBackground: Isoimmunization is a process of immunizing an antigen-negative pregnant individual with a paternally derived fetal antigen. Although the Rh systems contain many antigen subtypes (D, C, c, E, e), the RhD antigen is highly immunogenic. This research aimed to investigate the perinatal Outcome of pregnant women with RhD sensitization at St. Paul’s Hospital Millennium Medical College (SPHMMC), Ethiopia.Methodology: A facility-based retrospective cross-sectional study was conducted on 98 pregnant women with RhD alloimmunization at SPHMMC from September 11, 2016, to September 10, 2021. SPSS 26 was used for data analysis. Descriptive statistics were utilized to assess the perinatal outcome of pregnant women with RhD alloimmunization. Fisher’s exact test was used to determine which association, and a P value < 0.05 was considered statistically significant.Results: From the 98 pregnancies (06 - hydropic, 92 - non-hydropic) at high risk for fetal anemia, 45.9% of cases had MCA-PSV above 1.5MoM. Among these, 21.42% of all fetuses received an intrauterine transfusion. Forty-three IUTs were performed in 21 fetuses. The median number of transfusions per fetus was two. About 52.4% of the transfused fetuses had severe anemia, and 28.6% had moderate anemia. Prediction of MCA PSV ≥ 1.5MOM in diagnosing moderate-severe anemia in pregnant women with RhD sensitization 81%. General neonatal survival of alloimmunizations was 93.8%, 90.5% with IUT, 50% with hydrops fetalis, and 96.7% without hydrops.Conclusion: This research provides evidence that MCA PSV ≥ 1.5MoM is modest predictor of moderate-severe anemia in untransfused fetuses. This study was a step toward the development of more extensive and multicenter studies on the Perinatal Outcome of pregnant women with RhD sensitization in Ethiopia. Extra studies are needed to evaluate strategies for estimates of fetal anemia after blood transfusion as a result of the absence of information on the IUT database.Keywords: intrauterine transfusion, RhD alloimmunization, fetal hydrops, fetal anemia

Trang Thi Hanh Do,1 Quyen Thi Tu Bui,2 Bui Thi Thu Ha,3 Thi Minh Le,3 Vui Thi Le,3 Quynh-Chi Thai Nguyen,3 Kimberly Joyce Lakin,4 Tung Thanh Dang,5 Loi Van Bui,5 Thien Cong Le,5 An Thi Ha Tran,5 Hien Thi Thu Pham,5 Tuan Van Nguyen5 1Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam; 2Faculty and Fundamental Sciences, Hanoi University of Public Health, Hanoi, Vietnam; 3Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi, Vietnam; 4Nossal Institute for Global Health, Melbourne School of Population and Global Health, Melbourne, Victoria, Australia; 5The National Institute of Mental Health, Bach Mai Hospital, Hanoi, VietnamCorrespondence: Quyen Thi Tu Bui, Department of Biostatistics, Faculty of Fundamental Sciences, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi, Vietnam, Tel +84 912 225 245, Fax +84 24 6266 2385, Email btq@huph.edu.vnPurpose: Detection of antenatal common mental disorders in low-resource settings like Vietnam is important and requires a reliable, valid and practical screening tool. Currently, there is no such tool validated for use among pregnant women in Vietnam. This study aims to assess the validity of the Vietnamese version of the 20-item Self Reporting Questionnaire (SRQ-20) by evaluating its reliability, factorial structure, and performance in detecting common mental disorder (CMD) symptoms, thereby identifying the optimum cut-off score for CMD screening among pregnant women in Vietnam.Participants and Methods: A total of 210 pregnant women from four rural communes participated in a face-to-face interview using the Vietnamese version of the SRQ-20, followed by a clinical diagnostic interview based on ICD-10 diagnostic criteria of CMDs. The reliability of the SRQ-20 was assessed by calculating the scale’s Cronbach’s alpha to measure internal consistency. Factor analyses were undertaken to examine the factor structure of the instrument. The Receiver Operating Characteristic (ROC) curve analysis was performed to assess the performance of the SRQ-20 against the clinical diagnosis and to identify the optimum cut-off score.Results: Internal consistency was good, with a Cronbach’s alpha of 0.87. Factor analyses resulted in a 4-factor solution. The area under the ROC curve (AUC) for detection of CMDs was 0.90. The optimum cut-off score of the SRQ-20 for detection of CMD symptoms among Vietnamese pregnant women was 5/6.Conclusion: The Vietnamese version of the SRQ-20 has the capacity to detect CMDs among pregnant women effectively and is recommended for use as a screening tool for CMDs in antenatal care settings in Vietnam.Keywords: SRQ-20, screening, common mental disorders, pregnant women, Vietnam

Essa Tawfiq,1 Mohammad Rafi Fazli,2 Abdul Wahed Wasiq,3 Muhammad Haroon Stanikzai,4 Amena Mansouri,5 Sayed Ataullah Saeedzai6 1Department of Epidemiology and Biostatistics, School of Population Health, the University of Auckland, Auckland, New Zealand; 2Department of Surgery, Faculty of Medicine and Health Science, the University of Auckland, Auckland, New Zealand; 3Internal Medicine Department, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan; 4Public Health Department, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan; 5Formerly Ghalib Teaching Hospital, Herat, Afghanistan; 6Ministry of Public Health, Kabul, AfghanistanCorrespondence: Essa Tawfiq, Building 507, Level 1, Room 1038, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand, Tel +64 210661149, Email e.tawfiq@auckland.ac.nzPurpose: Initiating antenatal care (ANC) visits by pregnant women during first trimester, known as timely initiation of ANC visits, is crucial for wellbeing of mothers and their unborn babies. We examined whether sociodemographic characteristics of pregnant women predict timely initiation of ANC visits.Patients and Methods: Data collected for the Afghanistan Health Survey 2018 (AHS 2018) were analyzed. A binary outcome variable was created as women with ANC visits in 0– 3 months (first trimester) vs women with ANC visits in ≥ 4 months of pregnancy. A multivariable generalized linear model was employed.Results: A total of 6862 ever-married women, aged 14– 49 years, with a history of pregnancy, including current pregnancy, were included. The prevalence of timely initiation of ANC visits was 55.8%. The likelihood (OR = odds ratio) of timely initiation of ANC visits was higher in women aged 30– 39 years [OR 1.12 (95% CI: 1.00– 1.25)], in women who could read and write [OR 1.12 (95% CI: 0.99– 1.21)], in women who used public primary care facilities [OR 1.14 (95% CI: 1.01– 1.28)], in women who received consultation on ANC from a doctor or midwife [OR 1.22 (95% CI: 0.72– 2.08), OR 1.13 (95% CI: 0.67– 1.92)] respectively, in women at fourth and highest quintiles of wealth status [OR 1.24 (95% CI: 1.04– 1.48), OR 1.14 (95% CI: 0.92– 1.40)] respectively, in women who intended to become pregnant [OR 1.56 (95% CI: 1.35– 1.81)], in women who used the internet [OR 1.53 (95% CI: 1.13– 2.06)], and in women who listened to radio [OR 1.16 (95% CI: 1.03– 1.30)]. However, the likelihood was lower in women who had given birth at least twice [OR 0.67 (95% CI: 0.50– 0.89)], and in women who lived in rural areas [OR 0.87 (95% CI: 0.75– 1.00)].Conclusion: To promote timely initiation of ANC visits, healthcare interventions to increase availability of midwives and doctors, and improve accessibility to primary care clinics, especially in rural areas, need to be implemented.Keywords: ANC, timely ANC, early ANC, late ANC

Shuya Chen,1 Yunhan Deng,2 Yan Zhai,2 Yang Zhan,3 Xue Li,4 Jiandong Wang,1 Huimin Bai2 1Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 2Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 4Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Jiandong Wang, Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Qihelou Street, Dongcheng District, Beijing, 100006, People’s Republic of China, Tel +0086-13910566755, Email wangjiandongxy@ccmu.edu.cn Huimin Bai, Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +0086-01085231765, Email bhmdoctor@sina.comPurpose: To reveal the clinical status and construct a predictive prognostic model for patients with uterine leiomyosarcoma (uLMS) at International Federation of Gynecology and Obstetrics (FIGO) stage I.Patients and Methods: The medical records of patients with stage I uLMS during the study period were retrospectively reviewed. Multiple imputation, Martingale residuals and restricted cubic spline were used for data processing. Univariate and multivariate analyses were used to determine independent prognostic factors. The Schoenfeld individual test was used to verify the proportional hazards (PH) assumption. The predictive ability of the nomogram was validated internally.Results: Ultimately, 102 patients were included. The median age at diagnosis was 51 years old. During the medium follow-up time of 68 months, 55 (53.9%) patients developed recurrence. The median recurrence interval was 32 months. The most common metastatic site was the lung (27 cases). Eventually, 38 (37.3%) patients died of uLMS. The 3-year and 5-year overall survival rates were 66.0% and 52.0%, respectively. Age at diagnosis > 49 years, larger tumor size, MI> 10/10HPF, presence of LVSI and Ki-67 labeling index (LI) > 25% (P=0.0467, 0.0077, 0.0475, 0.0294, and 0.0427, respectively) were independent prognostic factors. The PH assumption remained inviolate. The concordance index was 0.847, the area under the time-dependent receiver operating characteristic curve surpassed 0.7, and the calibration curve showed gratifying consistency.Conclusion: Age at diagnosis, tumor size, MI, LVSI, and Ki-67 LI were identified as independent prognostic factors for stage I uLMS. This prognostic nomogram would provide personalized assessment with superior predictive performance.Keywords: uterine leiomyosarcoma, prognosis, nomogram, risk stratification

Kebede Embaye Gezae,1 Kidanemariam Alem Berhie,1 Assefa Ayalew Gebresilassie,2 Mache Tsadik2 1Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia; 2Department of Reproductive Health, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, EthiopiaCorrespondence: Kebede Embaye Gezae, Email aredom14@gmail.comBackground: Though optimal antenatal care (ANC4+) use is absolutely critical, only 43% of women had ANC4+ in Ethiopia and nearly 64% in Tigray in 2019. Furthermore, only 20% of women had their first ANC visit during their first trimester in 2016. However, there is no literature on area based disparity of ANC4+ use in Tigray. Therefore, this study is aimed to generate evidence for ANC4+ use using the Kilite-Awlaelo Health and Demographic Surveillance System (KA-HDSS) database.Methods: A population-based longitudinal study was employed on 5,414 women from 12 kebelles included in the KA-HDSS site of Tigray. A pregnancy database was used as a source of data. A Line graph was used to depict the trend of ANC4+ use. A stratified robust Poisson model was fitted to estimate the incidence rate ratio (IRR) for women from rural and urban areas separately.Results: The ANC4+ coverage was 36.3% (95% CI=35.0– 37.6%) – 34.2% in rural versus 52.8% urban areas, with an increasing linear trend. Single marital status (IRR=1.29; 95% CI=1.17– 1.42); able to read and write (IRR=1.15; 95% CI=1.01– 1.32); primary education (IRR=1.22; 95% CI=1.11– 1.34); ANC follow-up (2015– 2018) (IRR=1.42; 95% CI=1.23– 1.64); previous pregnancy exposure (IRR=2.20; 95% CI=1.98– 2.45); and having 6+ children (IRR=1.11; 95% CI=1.01– 1.21) determined ANC4+ use for rural women. Marital status (Divorced/widowed/separated) (IRR=0.79; 95% CI=0.66– 0.95); primary education (IRR=1.44; 95% CI=1.16– 1.79); ANC follow-up (2015– 2018) (IRR=2.00; 95% CI=1.59– 2.50); previous pregnancy exposure (IRR=1.54; 95% CI=1.31– 1.80); and having 6+ children (IRR=1.18; 95% CI=1.07– 1.31) determined the ANC4+ use for urban women.Conclusion: The optimal ANC coverage is significantly low, with significant disparity by geographical area and increasing trend. However, further efforts have to be made to maximize the optimal use of ANC, particularly for women from rural areas.Keywords: determinants, optimal ANC, women, KA-HDSS, trend, Tigray

Kerry L Sutcliffe,1 Kate Levett,1– 3 Hannah G Dahlen,4 Elizabeth Newnham,5 Linda M MacKay6 1School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia; 2Adjunct Fellow, NICM Health Research Institute, and THRI, Western Sydney University, Sydney, NSW, Australia; 3Honorary Fellow, Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, NSW, Australia; 4School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia; 5School of Nursing & Midwifery, University of Newcastle, Newcastle, NSW, Australia; 6School of Arts & Sciences, University of Notre Dame Australia, Sydney, NSW, AustraliaCorrespondence: Kerry L Sutcliffe, School of Medicine, University of Notre Dame Australia, Auburn Clinical School, 88-90 Water Street, Auburn, Sydney, NSW, 2144, Australia, Tel +61 451771723, Email kerry.sutcliffe@nd.edu.auAbstract: The effectiveness of childbirth education (CBE) has long been debated with studies showing contradictory outcomes for mothers and babies. Understanding how what is learned in CBE is translated into practice during labor and birth is an area that requires investigation as this may be a mediating factor in its effectiveness. Bowen family system theory’s concept of differentiation of self, the ability to be guided by and to act from one’s beliefs and values, is an organizing principle that may affect how relational factors affect the use and application of CBE at the time of birth. The ability to act with emotional maturity when faced with a stressor, such as childbirth, depends on an individual’s capability to separate thoughts from the more reactive feeling process. Recognizing how one’s level of differentiation interacts with the anxious responses of others may assist pregnant women and birth partners to make decisions more objectively about how they want to manage the birthing process. For the health professional, understanding the interplay of relationship variables, physiological stress, anxiety and individual reactivity may allow for the provision of more thoughtful evidence-based practice, which may increase objectivity, and aid communication and decision-making for women during birth. Bowen theory, as a comprehensive systems-based approach to understanding human functioning under stress, offers a novel approach to exploring the application of CBE during birth.Keywords: antenatal education, Bowen family systems, anxiety, human functioning, birth partner, relationship factors

Minh Tam Le,1,2 Nguyen Dac Nguyen,1,2 Nhu Quynh Thi Tran,1 Duong Dinh Le,3 Quoc Huy Vu Nguyen,2 Thanh Ngoc Cao1,2 1Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam; 2Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam; 3Department of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, VietnamCorrespondence: Minh Tam Le, Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen street, 53000, Vietnam, Email leminhtam@hueuni.edu.vnObjective: This study aimed to identify the factors that influence follicular output rate (FORT) and follicle-to-oocyte index (FOI) among infertile Vietnamese women, as described by the Poseidon classification of poor responders.Methods: This cross-sectional analysis includes women who received IVF/ICSI treatment at Hue University Hospital, Vietnam, between January 2017 and December 2019. The study population was divided into four groups: Group 1 (age < 35, AFC ≥ 5 and AMH ≥ 1.2 ng/mL, number of oocytes retrieved in the previous cycle ≤ 9), group 2 (age ≥ 35; AFC ≥ 5 and AMH ≥ 1.2 ng/mL, number of oocytes retrieved in the previous cycle ≤ 9), group 3 (age < 35; AFC < 5 and/or AMH < 1.2 ng/mL) and group 4 (age ≥ 35; AFC < 5 and/or AMH < 1.2 ng/mL). All of the patients underwent controlled ovarian stimulation utilizing GnRH antagonist.Results: A total of 243 cases were recruited into groups 1 (n = 44), 2 (n = 33), 3 (n = 54), and 4 (n = 112). There were statistically significant differences between the four groups in terms of age, infertility type, menstrual cycle, body mass index (BMI) and waist-hip ratio (WHR), endocrine tests, and total retrieved oocytes (p 0.05). The average number of oocytes per participant was 7.27, with the highest number occurring in group 1 (10.77) and the lowest occurring in group 4 (5.59). There was a relationship between FORT and BMI (ß: − 0.146, p=0.039), FSH starting dose (ß: 0.146, p=0.030), and AMH (ß:0.166, p=0.015). No statistically significant correlation was detected between FOI and other variables.Conclusion: The starting dose of FSH for ovarian stimulation and AMH concentration were positively associated with FORT in individuals with a poor prognosis, whereas BMI was negatively correlated with FORT; No other parameters were found to correlate with FOI.Keywords: follicular output rate, FORT, follicle-to-oocyte index, FOI, Poseidon, ovarian response

Thora Y Chai,1– 3 Karen Byth,2,4 Jacob George,2,5,6 Dharmintra Pasupathy,3 N Wah Cheung1– 3 1Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Australia; 2Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; 3Reproduction and Perinatal Centre, The University of Sydney, Sydney, NSW, Australia; 4Western Sydney Local Health District Research Education Network, Westmead, NSW, Australia; 5Storr Liver Centre, Westmead Millennium Institute for Medical Research, Westmead, NSW, Australia; 6Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, NSW, AustraliaCorrespondence: Thora Y Chai, Email thora.chai@sydney.edu.auObjective: To determine whether an elevated hepatic steatosis index (HSI), a non-invasive test for possible metabolic dysfunction-associated fatty liver disease (MAFLD), is associated with the development of adverse pregnancy outcomes.Material and Methods: A retrospective cohort study was conducted on adult women with singleton pregnancies who delivered at two tertiary hospitals from August 2014 to December 2017. Aspartate aminotransaminase (AST) and alanine aminotransaminase (ALT) levels obtained 12 months pre-gravid, or during pregnancy but prior to screening for gestational diabetes mellitus (GDM), were extracted and linked with oral glucose tolerance test results. The HSI was calculated using the following equation: 8 × (ALT/AST ratio) + BMI (+2 if female; +2 if diabetes mellitus present) and considered elevated if > 36. Multiple logistic regression analysis was used to quantify the association between elevated HSI and each composite adverse pregnancy outcome after adjusting for independent maternal risk factors.Results: Over 40-months, 11929 women were eligible and of these, 1885 had liver enzymes collected. Women with an elevated HSI (> 36) were more likely multiparous and overweight/obese compared to those women with a non–elevated HSI (≤ 36). Elevated HSI was significantly associated with a composite of adverse maternal outcomes (adjusted odds ratio (aOR) 1.55 95% CI 1.11– 2.17, p=0.01), although a non-significant increased risk of a composite of adverse neonatal outcomes occurred after multivariable adjustment (aOR 1.17, 95% CI 0.94– 1.45, p=0.17).Conclusion: Over and above known maternal risk factors, women with elevated HSI were more likely to develop adverse maternal, but not adverse neonatal outcomes.Keywords: liver steatosis, pregnancy outcomes, liver function tests, maternal health, neonatal health

Research Question What are the growth patterns of uterine myomas in untreated premenopausal women? Which factors influence the growth rate of uterine myomas in premenopausal women? Method All premenopausal women who presented to the outpatient myoma consultation clinic between January 2005 and March 2022 at least twice were screened. Exclusion criteria were hormonal therapy, pregnancy, and postmenopausal status. Results A total of 189 patients were included in our study which focused on the respective largest uterine myoma of each woman. An ideal linear growth over time was assumed. Most myomas (82%) increased in size. The mean annual growth of these myomas was 68.42 cm3. The most important prognostic factor for growth was the initial size of the myoma. The absolute annual growth of myomas measuring > 50 cm3 at first presentation was higher compared to smaller myomas (p Conclusion Overall, it is difficult to make an individual prognosis about the growth pattern of a uterine myoma in a specific patient. It should be noted especially in asymptomatic patients that spontaneous regression of myoma size can also occur in premenopausal women.

Brian Barasa Masaba, Rose Mmusi-Phetoe Department of Health Studies, University of South Africa (UNISA), College of Human Sciences, School of Social Sciences, Pretoria, South AfricaCorrespondence: Brian Barasa Masaba, Email 63714094@mylife.unisa.ac.zaBackground: Migori County is categorized among regions with worst maternal survival rates in Kenya. The county’s current maternal mortality ratio (MMR) is 673 deaths per 100 000 live births. A need exists for a context-specific strategy to mitigate the persistent high maternal mortalities in rural Kenya. The researchers aimed to develop a strategy for reducing the maternal mortality ratio (MMR) in Migori, Kenya.Methods: An explanatory sequential mixed methods design was utilised. The design was characterised by two separate studies, an initial quantitative followed by a qualitative study. The final phase entailed integration of data from the two separate studies. The findings, extensive literature review and three delays of maternal mortality theoretical framework informed the development of the strategy.Results: The strategy for implementation considered three strategic areas, namely, interventions targeting first delays, interventions targeting second delays, interventions targeting third delays.Conclusion: The priority interventions needed are those that enable: 1) Pregnant mothers to receive quality peripartum care in Migori hospitals, 2) Strengthened and efficient referral systems of obstetric emergencies and 3) Community knowledge empowerment on safe pregnancy and culture shift. These interventions would significantly transform the health-care system towards maternal mortality reduction. The Kenyan government and non-profit organisations should be involved in the implementation of the proposed strategy.Keywords: community empowerment, determinants, health systems, interventions, maternal delays, maternal mortality, obstetric care, obstetric complications, pregnancy, quality care, referral, strategy

Zaenb Alsalman,1 Marwa Shafey,2 Laila Al Ali3 1Departments of Family and Community Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia; 2Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Ministry of Health, Dammam, Saudi ArabiaCorrespondence: Zaenb Alsalman, Departments of Family and Community Medicine, College of Medicine, King Faisal University, Po Box 3311, Al Ahsa, 36346, Saudi Arabia, Tel +966545611633, Email Alsalman.zainab@hotmail.com; zalsalman@KFU.edu.saIntroduction: Intimate partner violence (IPV) is a growing hot topic in Saudi Arabia and primary health care (PHC) physicians play a significant role in preventing it. Our objective was to assess the PHC Physicians’ readiness and barriers to identify, screen, and respond to IPV in Saudi Arabia.Methods: A cross-sectional study recruited physicians working in PHC centers in Saudi Arabia. Data was collected using a modified online self-administered questionnaire based on the PREMIS “The Physician Readiness to Identify and Manage IPV.” The questionnaire consisted of respondent profile, perceived preparedness and knowledge, actual knowledge, practice issues, and opinion regarding barriers.Results: Among 169 PHC physicians, 60.9% had never experienced any formal IPV training. Around one-fifth of participants have a good perceived and actual knowledge, whereas one-third have a good perceived preparedness. Nearly half of the participants (46.7%) do not screen for IPV and two-thirds of them (66.3%) have never identified an IPV case during the previous 6 months. The logistic regression model showed that family physicians were 2.27 times more likely to have a good knowledge than a general practitioner, and participants with IPV training were more likely to have a good level of perceived preparedness, perceived knowledge, and more likely to perform screening of IPV.Conclusion: The low level of PHC physicians’ readiness to identify and respond to IPV is worrisome. Findings emphasize the urgent need for an IPV training program, a supportive work environment, and a clear referral system in order to help the practitioner to provide comprehensive services and ensure safety plans for abused women.Keywords: intimate partner violence, primary health care, women, family physicians, Saudi Arabia

Purpose: This study investigated the dietary behavior of experienced shiftwork nurses and aimed to identify factors related to dietary behavior. Methods: This study was a secondary analysis based on the Shift Work Nurses’ Health and Turnover study among Korean nurses. In total, 247 experienced shiftwork nurses were included in this study. The participants’ dietary behavior, depression, level of occupational stress, fatigue, physical activity, and general characteristics were measured. Using SPSS ver. 28.0, data were analyzed to obtain descriptive statistics and Pearson correlation coefficients. The independent t-test, one-way analysis of variance, the Kruskal-Wallis test, and multiple regression analysis were also conducted. Results: The dietary behavior score of the participants using the Mini-Dietary Assessment Index was 29.35±5.67. Thirty percent of the participants were depressed, the participants experienced moderate occupational stress, and 74.1% of the participants engaged in an inadequate amount of physical activity. The factors influencing shiftwork nurses’ dietary behavior were having child(ren) (β=.16, p=.027), depression (β=–.13, p=.032), level of occupational stress related to occupational climate (β=–.13, p=.035), and an inadequate amount of physical activity (β=–.17, p=.006). These factors explained 10.4% of the variance in experienced shiftwork nurses’ dietary behavior scores. Conclusion: Experienced nurses with child(ren) tended to have healthier diets. However, a higher level of occupational stress related to occupational climate, depression, and engaging in an inadequate amount of physical activity were associated with a higher risk of having an unhealthy diet. Therefore, strategies are needed to encourage physical activity and alleviate adverse occupational climate and depression among experienced nurses.

Purpose: As more newborns have received expanded newborn screening (NBS) for metabolic disorders, the overall number of false-positive results has increased. The purpose of this study was to explore the nature of the psychological impacts experienced by mothers related to the NBS process. Methods: An online parenting community in Korea was selected, and questions regarding NBS were collected using web crawling for the period from October 2018 to August 2021. In total, 634 posts were analyzed. The collected unstructured text data were preprocessed, and keyword analysis, topic modeling, and visualization were performed. Results: Of 1,057 words extracted from posts, the top keyword based on ‘term frequency-inverse document frequency’ values was “hypothyroidism,” followed by “discharge,” “close examination,” “thyroid-stimulating hormone levels,” and “jaundice.” The top keyword based on the simple frequency of appearance was “XXX hospital,” followed by “close examination,” “discharge,” “breastfeeding,” “hypothyroidism,” and “professor.” As a result of LDA topic modeling, posts related to inborn errors of metabolism (IEMs) were classified into four main themes: “confirmatory tests of IEMs,” “mother and newborn with thyroid function problems,” “retests of IEMs,” and “feeding related to IEMs.” Mothers experienced substantial frustration, stress, and anxiety when they received positive NBS results. Conclusion: The online parenting community played an important role in acquiring and sharing information, as well as psychological support related to NBS in newborn mothers. Nurses can use this study’s findings to develop timely and evidence-based information for parents whose children receive positive NBS results to reduce the negative psychological impact.

Purpose: Uncertainty and restrictions on daily life have increased fear, stress, and depression during the coronavirus disease 2019 (COVID-19) pandemic. Depression is the most common mental health problem in pregnant women. The purpose of this study was to evaluate the levels of fear and stress related to COVID-19 experienced by pregnant women, as well as their levels of depression, and to examine the factors associated with depression during pregnancy.Methods: This was a cross-sectional, correlational study conducted among 153 pregnant women who visited a maternity hospital in Busan, South Korea. A self-reported questionnaire was used for data collection from December 18, 2021 to March 8, 2022. Data were analyzed using descriptive statistics, the independent t-test, one-way analysis of variance, Pearson correlation coefficients, and multiple regression. Results: Pregnant women experienced a moderate level of fear related to COVID-19, with an average score of 21.55±4.90. The average score for depression during pregnancy was 14.86±11.10, with 50.3% of the participants experiencing depression (13). The factors associated with depression during pregnancy were fear of COVID-19, contact with a confirmed case of COVID-19, being in the third trimester of pregnancy, high stress levels due to difficulties experienced from social distancing measures, and unintended pregnancy. These five statistically significant factors explained 35.0% of variance in depression during pregnancy.Conclusion: Considering the prevalence of depression in pregnant women during the COVID-19 pandemic, it is necessary to develop interventions to reduce anxiety by providing correct information and alleviating the stress of social distancing.

Purpose: Coronavirus disease 2019 (COVID-19) has spread widely throughout the world, causing psychological problems such as fear, anxiety, and stress. During the COVID-19 pandemic, pregnant women have been concerned about both their own health and the health of their fetuses, and these concerns could negatively affect maternal-fetal attachment. Thus, this study aimed to explore the level of COVID-19 stress, resilience, and maternal-fetal attachment among pregnant women during the COVID-19 pandemic, and to identify factors influencing maternal-fetal attachment.Methods: In total, 118 pregnant women past 20 weeks gestation were recruited from two maternity clinics in Daegu, Korea, to participate in this descriptive correlational study during COVID-19. The factors influencing maternal-fetal attachment were analyzed using hierarchical multiple regression analysis.Results: The mean scores for COVID-19 stress, resilience, and maternal-fetal attachment were 57.18±10.32 out of 84, 67.32±15.09 out of 100, and 77.23±9.00 out of 96, respectively. Nulliparous pregnant women reported greater maternal-fetal attachment than multiparous pregnant women (p=0.03). Religious pregnant women also reported greater maternal-fetal attachment than non-religious pregnant women (p=.039). Resilience (β=.29, p=.002), COVID-19 stress (β=.20, p=.030) and parity (β=–.17, p=.047) were factors influencing maternal-fetal attachment, and these factors explained 26.4% of the variance in maternal-fetal attachment (F=10.12, p

Purpose: The aim of this study was to conduct a scoping review of knowledge and information delivery modes related to preconception care (PCC) among adolescent girls and women Methods: A scoping review was performed on studies selected from five electronic databases (Cochrane Library, PubMed, Science Direct, CINAHL/EBSCO, and ProQuest), published between 2012 and 2022, with predetermined keywords and criteria. We included English-language research articles available in full text and excluded irrelevant articles.Results: This study included eight articles, comprising seven quantitative studies and one qualitative study conducted among adolescent girls and women. Five were from low- and middle-income countries and three were from high-income countries. The synthesized themes generated from the data were PCC knowledge and PCC information delivery modes and effectiveness. In general, adolescent girls and women were found to have basic PCC knowledge, including risk prevention and management and a healthy lifestyle, although more extensive knowledge was found in higher-income countries than in lower-income countries. The delivery modes of PCC information have grown from individual face-to-face conventional methods, which are used predominantly in lower-income countries, to more effective digital mass media.Conclusion: Globally, many women still have insufficient knowledge regarding PCC, as not all of them receive access to PCC information and support. PCC promotion efforts should be initiated earlier by involving a wider group of reproductive-age women and combining individual, in-group, face-to-face, and electronic delivery modes.

Purpose: Supportive interventions to improve breastfeeding practice are needed in nursing. This study investigated the effects of pectoralis major myofascial release massage (MRM) on breast pain and engorgement among breastfeeding mothers and on breast milk intake and sleep patterns among newborns. Methods: Breastfeeding mothers who had delivered between 37 and 43 weeks and had 7- to 14-day-old newborns were recruited from a postpartum care center in Gunpo, Korea. Participants were randomized to the MRM or control group. The outcome variables were breast pain and breast engorgement among breastfeeding mothers and breast milk intake and sleep time among newborns. The experimental treatment involved applying MRM to separate the pectoralis major muscle and the underlying breast tissue in the chest. After delivery, the first MRM session (MRM I) was provided by a breast specialist nurse, and the second (MRM II) was administered 48 hours after MRM I. Results: Following MRM, breast pain (MRM I: t=−5.38, p

Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people. Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on. Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.

Objective These recommendations from the AGG (Committee for Obstetrics, Department of Maternal Diseases) on how to treat thyroid function disorder during pregnancy aim to improve the diagnosis and management of thyroid anomalies during pregnancy. Methods Based on the current literature, the task force members have developed the following recommendations and statements. These recommendations were adopted after a consensus by the members of the working group. Recommendations The following manuscript gives an insight into physiological and pathophysiological thyroid changes during pregnancy, recommendations for clinical and subclinical hypo- and hyperthyroidism, as well as fetal and neonatal diagnostic and management strategies.

Background Correct use of personal protective equipment is vital to minimise the risk of patients acquiring healthcare-associated infections. These measures are also important in preventing exposure to occupational infection. During the COVID-19 pandemic, the use of personal protective equipment was associated with anxiety, uncertainty and additional training requirements. This study investigated midwives’ experiences using personal protective equipment during the pandemic. Methods This systematic scoping review searched seven academic databases and grey literature. Data analysis was conducted using a thematic analysis framework. Results A total of 16 studies were included. Four themes were found: ‘fear and anxiety’, ‘personal protective equipment/resources’, ‘education and training needs’ and ‘communication’. Conclusions Management and administration inconsistences, logistical issues and lack of training on personal protective equipment led to midwives’ negative feedback. A gap has been identified in the exploration of midwives’ experiences as personal protective equipment end-users during the COVID-19 pandemic.

Constant electronic fetal monitoring has become a ubiquitous part of birth management in most high-income countries, both reflecting and creating the social context. This article uses a post-structuralist feminist critique to show that the use of the cardiotocograph in birth reinforces and reflects the logic of the separate sovereign self. This creates a rupture in the intrinsic relationality of the mother–fetus and the mother–midwife on a philosophical and physiological level. The cardiotocograph in labour privileges the medical model, constrains women through wires and the imperative to ‘keep the trace’, takes everyone’s attention and gives midwives tasks other than caring for the woman. It externalises the fetus and gives it selfhood separate from the mother, to the extent that it can seem like the machine is keeping the baby alive. This undermines women’s and midwives’ subjective knowledge, relegating women to organic containers. A reimagining of birth that centres relationality would start by acknowledging the nature of the self as semi-permeable and the being/doing, both/and nature of the mother–placenta–fetus in pregnancy and birth. Intermittent auscultation of the fetal heart in labour is better able to centre the mother–placenta–fetus relation and the midwife–mother relation.

This article discusses and evaluates the challenging and complex role of nurses and midwives in providing supportive care for couples after pregnancy loss. A planned pregnancy is usually a positive experience. However, some couples may experience pregnancy loss, which causes grief. While women may be severely affected, partners’ experiences are complicated by their role in caring for the grieving woman and their own experiences of grief. Nurses and midwives experience challenges when providing care, as pregnancy loss is emotional, entangling the joyous expectation of the start of life with the sorrow of a sudden end of life.

Background/Aims The use of electronic cigarettes for smoking cessation during pregnancy is supported by Public Health England and the Royal College of Midwives. However, their long-term effects remain largely unknown. The aim of this study was to explore midwives’ knowledge of and attitudes to electronic cigarette use in pregnancy, and whether this affected their recommendation for their use in smoking cessation. Methods An online survey was distributed to 122 qualified midwives in England. Participants were scored on their knowledge of and attitude to electronic cigarettes and their use in pregnancy. The study was cross-sectional and responses were subjected to analytical and descriptive statistical analysis. Results There was a significant indirect association between knowledge and attitude, where an increase in knowledge was associated with a more negative attitude (P≤0.001). There was a significant association between attitude, knowledge and personal practice. Categories identified from qualitative data were ‘not enough or no training/information/resources provided’ and ‘not enough research has been done’. Conclusions Midwives’ practice in supporting electronic cigarette use as a smoking cessation strategy is influenced by their knowledge and attitude, as well as by challenges in implementing recommendations in practice. This highlights the perceived need for more research on the potential risks and benefits, as well as more resources.

Background Understanding cultural context is crucial to providing respectful maternity care. This study’s aim was to explore pregnancy culture, beliefs and traditions among the Madurese tribe of Indonesia. Methods This qualitative study was conducted in the Sumenep district. In-depth interviews and focus group discussions were held with 67 key informants: pregnant women, their family members, traditional birth attendants, and community, religious and traditional/indigenous leaders. Results The practices included fourth-and seventh-month rituals, pregnancy massage and behavioural taboos and suggestions. Conclusions Most Madurese tribe practices are harmless. Healthcare providers must appreciate and integrate prevailing traditional beliefs and practices with other efforts to reduce maternal mortality.

Background/Aims Eclampsia is a major cause of maternal mortality worldwide. Simulation is an innovative pedagogical method to teach eclampsia management, while objective structured clinical examinations are effective in assessing midwifery students’ clinical skills. This study’s aim was to determine the impact of simulation and objective structured clinical examinations in teaching eclampsia management, and explore students’ satisfaction and self‑confidence. Methods This repeated measures study involved 31 second year midwifery students who participated in an objective structured clinical examination before and after a simulation on eclampsia management, and evaluated their experience using the National League for Nursing student satisfaction and self‑confidence learning scale. Results The mean post‑simulation score was significantly higher than pre‑simulation (PConclusions Joining simulation and objective structured clinical examinations is effective in teaching and assessing student midwives on the management of eclampsia.

Background/Aims A climate of trust in maternity may improve the experiences of staff and women accessing maternity services. The aim of this study was to explore how a climate of trust was promoted through creation of a regular virtual maternity multidisciplinary forum, known as a maternal medicine huddle, during the COVID-19 pandemic and what influence this had on the organisational culture of a local maternity system and the experiences of women receiving maternity care. Methods Through a critical feminist methodology, six participants were interviewed using a semi-structured interview schedule. Interviews were conducted through Miscrosoft Teams, with the six participants representing each of the six trusts in a selected local maternity and neonatal system. Results Developing trust for teamwork is valued, while at the same time interprofessional and interorganisation challenges are highlighted that can impact workplace culture. Conclusions The huddles have built a climate of trust, working to deliver safe, equitable care for those using maternity services and a supportive learning environment for those providing it.