Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

As vivências da maternidade e a concepção da interação mãe-bebê: interfaces entre as mães primíparas adultas e adolescentes / The motherhood experiences and the conception of mother-baby interaction: interfaces between primiparous adult mothers and adolescents / Las experiencias de la maternidad y el diseño de la interacción madre-hijo: interfaces entre las madres de adultos por primera vez y adolescentes

Objective: The study's purpose has been to further understand the interfaces of the experiences related to the first experience of both adolescent and adult mothers, then seeking to identify the creation of the mother-baby interaction. Methods: It is a descriptive-exploratory study with a qualitative approach, which counted with the participation of eleven primiparous mothers, from the Chapecó city, Santa Catarina State. Data collection was carried out through semi-structured questions, and the participants were identified by butterfly names. Data were analyzed using the Content Analysis. Results: The findings have shown profound changes in the way of life of the primiparous mothers, such as: physical changes, image concerns, greater responsibility, sadness, joy, fear, distancing from friends, sudden changes in lifestyle; and, for the adolescent mothers were found school abandonment and difficulties with child care. Conclusion: Bearing in mind the implications of motherhood, some adolescent mothers feel unprepared for maternity, because they are too young, although they believe that there is no differentiation between their feelings and those of an adult and primiparous mother

Objetivo: Compreender as interfaces das vivências relacionadas à primeira experiência de mães adolescentes e adultas, buscando identificar a construção da interação mãe-bebê. Método: Estudo exploratório, descritivo, qualitativo, com participação de onze mães primíparas, do município de Chapecó/ SC. Para a coleta de dados foi utilizado questões semiestruturadas e as participantes foram identificadas pelo nome de borboletas. Os dados foram analisados através da Análise de Conteúdo. Resultados: Mudanças profundas na forma de viver das mães primíparas, como: alterações físicas, preocupações com a imagem, maior responsabilidade, tristeza, alegria, medo, distanciamento de amigos, brusca alteração no modelo de vida, e para a adolescente mãe, também o abandono escolar e dificuldades com o cuidado da criança. Conclusão: No que tange às implicações da maternidade, algumas mães adolescentes sentem-se despreparadas para desempenhar a maternidade, por terem pouca idade, porém, acreditam não haver diferenciação entre seus sentimentos com os de uma mãe adulta e primípara

Objetivo: Comprender las interfaces de las vivencias relacionadas con la primera experiencia de madres adolescentes y adultas, buscando identificar la construcción de la interacción madre-bebé. Método: estudio exploratorio, descriptivo, cualitativo, con participación de once madres primíparas, del municipio de Chapecó SC. Para la recolección de datos se utilizaron cuestiones semiestructuradas y las participantes fueron identificadas por el nombre de mariposas. Los datos se analizaron a través del análisis de contenido. Resultados: cambios profundos en la forma de vivir de las madres primíparas, como: alteraciones físicas, preocupaciones con la imagen, mayor responsabilidad, tristeza, alegría, miedo, distanciamiento de amigos, brusca alteración en el modelo de vida, y para la adolescente madre, El abandono escolar y las dificultades con el cuidado del niño. Conclusión: En lo que se refiere a las implicaciones de la maternidad, algunas madres adolescentes se sienten despreparadas para desempeñar la maternidad, por tener poca edad, sin embargo, creen no haber diferenciación entre sus sentimientos con los de una madre adulta y primípara

Analysis of vitamin D-binding protein (VDBP) gene polymorphisms in Korean women with and without endometriosis / 대한생식의학회지

OBJECTIVE: Vitamin D-binding protein (VDBP) mediates various biological processes in humans. The goal of this study was to investigate whether VDBP gene polymorphisms could predispose Korean women to endometriosis. METHODS: We prospectively enrolled women with endometriosis (n = 16) and healthy controls (n = 16). Total serum 25-hydroxyl vitamin D (25(OH)D) concentrations were measured using an Elecsys vitamin D total kit. Levels of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using a vitamin D BP Quantikine ELISA kit. DNA was extracted using a DNeasy blood & tissue kit. Two single-nucleotide polymorphisms (SNPs; rs4588 and rs7041) in GC, the gene that codes for VDBP, were analyzed using a TaqMan SNP genotyping assay kit. The functional variant of VDBP was determined based on the results of the two SNPs. RESULTS: Gravidity and parity were significantly lower in the endometriosis patients than in the control group, but serum CA-125 levels and the erythrocyte sedimentation rate were significantly higher. Total serum 25(OH)D levels in the endometriosis patients were significantly lower than in the control group. However, serum bioavailable 25(OH)D, free 25(OH)D, and VDBP levels did not differ significantly between the endometriosis and control groups. The genotypes and allele frequencies of GC were similar in both groups. CONCLUSION: Korean women with endometriosis had lower total serum 25(OH)D concentrations than controls. Neither serum VDBP concentrations nor polymorphisms in the gene coding for VDBP were associated with endometriosis. Further studies are needed to investigate the pathophysiology and clinical implications of 25(OH)D and VDBP in endometriosis.

Differences in 25-hydroxy vitamin D and vitamin D-binding protein concentrations according to the severity of endometriosis / 대한생식의학회지

OBJECTIVE: To investigate serum 25-hydroxyl vitamin D (25(OH)D) and vitamin D-binding protein (VDBP) concentrations in women with endometriosis according to the severity of disease. METHODS: Women with mild endometriosis (n = 9) and advanced endometriosis (n = 7), as well as healthy controls (n = 16), were enrolled in this observational study. Serum total 25(OH)D concentrations were analyzed using the Elecsys vitamin D total kit with the Cobas e602 module. Concentrations of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using the Human Vitamin D BP Quantikine ELISA kit. Variables were tested for normality and homoscedasticity using the Shapiro-Wilk test and Leven F test, respectively. Correlation analysis was used to identify the variables related to total 25(OH)D and VDBP levels. To assess the effects of total 25(OH)D and VDBP levels in the three groups, multivariate generalized additive modeling (GAM) was performed. RESULTS: Gravidity and parity were significantly different across the three groups. Erythrocyte sedimentation rate (ESR) and CA-125 levels increased as a function of endometriosis severity, respectively (p= 0.051, p= 0.004). The correlation analysis showed that total 25(OH)D levels were positively correlated with gravidity (r = 0.59, p< 0.001) and parity (r = 0.51, p< 0.003). Multivariate GAM showed no significant relationship of total 25(OH)D levels with EMT severity after adjusting for gravidity and ESR. However, the coefficient of total 25(OH)D levels with gravidity was significant (1.87; 95% confidence interval, 0.12–3.63; p= 0.040). CONCLUSION: These results indicate that vitamin D and VDBP levels were not associated with the severity of endometriosis.

Laparoscopia en el tratamiento de endometriosis moderada y severa en mujeres infértiles / Laparoscopy in the treatment of moderate and severe endometriosis in infertile women

El objetivo de este estudio fue evaluar la eficacia de la laparoscopia en el tratamiento de endometriosis moderada y severa en mujeres infértiles. La investigación fue de tipo prospectivo realizado en el Hospital Central Dr. Urquinaona, Maracaibo, Venezuela, en el periodo de enero de 2012 a diciembre de 2017. Se incluyeron 118 pacientes con diagnóstico de endometriosis moderada a severa. El diagnóstico de endometriosis se planteó sobre los hallazgos encontrados durante la laparoscopia y la evaluación histopatológica de las muestras de las biopsias de tejido. El éxito del tratamiento y el porcentaje de embarazos se analizaron en todas las pacientes. Durante la laparoscopia secundaria en pacientes con endometriosis estadios III y IV, se encontró la resolución en 54,9 % y reaparición de la enfermedad en 45,1 % de los pacientes. El grupo de las pacientes con endometriosis estadio I y II tratadas y con terapia hormonal se descubrió regresión en 30,7 % y recurrencia en 69,2 % de las pacientes. La incidencia total de embarazos en pacientes con endometriosis estadio I y II sometidas a tratamiento médico fue del 23,8 % y 18,1 %, respectivamente. Las pacientes con endometriosis estadio III y IV presentaron una tasa de embarazo de 23,5 %. Se concluye que las pacientes con diagnóstico de endometriosis estadios III y IV deben ser tratadas con extirpación laparoscópica de los focos de endometriosis, seguido por tratamiento médico.

he aim of this study was to evaluate the efficacy of laparoscopy in the treatment of moderate and severe endometriosis in infertile women. The research was prospective in the Central Hospital Dr. Urquinaona, Maracaibo, Venezuela in the period from January 2012 to December 2017. We included 118 patients diagnosed with moderate to severe endometriosis. The diagnosis of endometriosis was raised on the findings found during laparoscopy and the histopathological evaluation of tissue biopsy samples. The success of the treatment and the percentage of pregnancies were analyzed in all patients. During secondary laparoscopy in patients with endometriosis stages III and IV, resolution was found in 54,9 % and reappearance of the disease in 45,1 % of patients. The group of patients with stage I and II endometriosis treated and with hormone therapy, regression was found in 30.7% and recurrence in 69,2 % of patients. The total incidence of pregnancies in patients with stage I and II endometriosis undergoing medical treatment was 23,8 % and 18,1 %, respectively. Patients with stage III and IV endometriosis had a pregnancy rate of 23,5 %. It is concluded that patients diagnosed with stage III and IV endometriosis should be treated with laparoscopic excision of the endometriosis foci, followed by medical treatment.

Determinantes sociodemográficos de la alta fecundidad en mujeres peruanas / Sociodemographic determinants of high fertility in peruvian women

RESUMEN Introducción: La fecundidad en Perú ha sido objeto de análisis desde diferentes perspectivas, a causa de la diversidad de contextos que influyen en el cambio de las pautas de reproducción en las mujeres. Objetivo: Determinar que variables sociodemográficas influyen sobre el hecho de que la mujer peruana tenga una alta fecundidad. Método y Material: Estudio de diseño transversal por encuestas, la recopilación de datos se obtuvo mediante la Encuesta Demográfica y de Salud Familiar del año 2016. Resultados: Se encontró que los factores que se asocian a una alta fecundidad son: falta de escolaridad en la mujer (RP: 3.01; IC 95%: 2.15-4.22; p<.001), haber tenido más de una unión (RP: 1.46; IC 95%: 1.41 -1.52; p<.001), que algún hijo haya fallecido (RP: 1.52; IC 95%: 1.47-1.57; p<.001), el uso actual de anticonceptivos (RP: 1.30; IC 95%: 1.15-1.47; p<.001), ser víctima de violencia (RP: 1.09; IC 95%: 1.05-1.12; p<.001). Conclusión: El comportamiento de la fecundidad en la mujer peruana se corresponde con los patrones culturales de reproducción actuales que incluyen tener pocos hijos a una mayor edad. En el plano socioeconómico, una mayor educación de la mujer es factores influyente.

ABSTRACT Introduction: Fertility in Peru has been the object of analysis from different perspectives, due to the diversity of contexts that influence the change of reproduction patterns in women. Objective: Determine which sociodemographic variables influence the fact that Peruvian women have a high fertility. Method and Material: It is a cross-sectional study, the data collection was obtained through the Demographic and Family Health Survey of 2016. Results: It was found that the factors associated with a high fertility are: lack of schooling in woman (RP: 3.01, 95% CI: 2.15-4.22, p <.001), more than one union (PR: 1.46, 95% CI: 1.41-1.52; p <.001), children mortality (PR: 1.52, 95% CI: 1.47-1.57, p <.001), current contraceptive use (PR: 1.30, 95% CI: 1.15-1.47, p <.001), to be a victim of violence (PR: 1.09; 95% CI: 1.05-1.12; p <.001). Conclusion: The fertility behavior of Peruvian women corresponds to the current cultural reproduction patterns that include having few children at an older age. In the socioeconomic level, greater education of women is an influential factor.

Further evidence of psychological factors underlying choice of elective cesarean delivery (ECD) by primigravidae

Objective: Requests for elective cesarean delivery (ECD) have increased in Iran. While some sociodemographic and fear-related factors have been linked with this choice, psychological factors such as self-esteem, stress, and health beliefs are under-researched. Methods: A total of 342 primigravidae (mean age = 25 years) completed questionnaires covering psychological dimensions such as self-esteem, perceived stress, marital relationship quality, perceived social support, and relevant health-related beliefs. Results: Of the sample, 214 (62.6%) chose to undergo ECD rather than vaginal delivery (VD). This choice was associated with lower self-esteem, greater perceived stress, belief in higher susceptibility to problematic birth and barriers to an easy birth, along with lower perceived severity of ECD, fewer perceived benefits from VD, lower self-efficacy and a lower feeling of preparedness. No differences were found for marital relationship quality or perceived social support. Conclusions: The pattern suggests that various psychological factors such as self-esteem, self-efficacy, and perceived stress underpin the decision by primigravidae to have an ECD.

A new biomarker for the early diagnosis of ovarian torsion: SCUBE-1 / 대한생식의학회지

OBJECTIVE: Prompt diagnosis and management are essential for saving the adnexal organs from infarction in cases of ovarian torsion (OT). This study aimed to determine the diagnostic significance of signal peptide, complement C1r/C1s, Uegf, and Bmp1 (CUB), and epidermal growth factor-like domain-containing protein-1 (SCUBE-1) levels in cases of OT, an emergent ischemic condition, and the relationship of SCUBE-1 with oxidative stress parameters. METHODS: This prospective study was conducted among 15 OT patients and 20 age- and gravidity-matched healthy women. SCUBE-1 serum concentrations were determined by using enzyme-linked immunosorbent assays. In addition, oxidative stress was evaluated by measuring the serum levels of advanced oxidation protein products (AOPP), ferric reducing ability of plasma (FRAP), and glutathione (GSH). RESULTS: The SCUBE-1 titers were significantly higher in the patients with OT than in the controls (p=0.008). In addition, serum FRAP and GSH levels were significantly lower in the OT patients than in the controls (p 0.05). Furthermore, there were no correlations between SCUBE-1 levels and age, gravidity, parity, cyst size, and AOPP, FRAP, or GSH levels (p>0.05). CONCLUSION: We believe that SCUBE-1 may be a promising biomarker for the early diagnosis of OT.

Reembarazo en la adolescencia: análisis de la población perteneciente a la Red del Hospital Padre Hurtado, entre los años 2005-2015 / Teenage pregnancy: analysis of the population belonging to the Padre Hurtado Hospital Network, between 2005-2015

OBJETIVO PRINCIPAL: Evaluar prevalencia de adolescentes multíparas >2, en la población atendida en Hospital Padre Hurtado. MATERIALES Y MÉTODO: Estudio de cohorte retrospectivo, con información extraída de la ficha electrónica de partos e intervenciones, realizados entre 2005-2015 HPH. Los datos fueron tabulados en Microsoft Excel y luego analizados en el paquete estadístico IBM SPSS versión 22. RESULTADOS: Se atendieron 62.656 partos y hubo 5.770 eventos gestacionales que requirieron alguna intervención, de éstas, 14.030 (20,5%) ocurrieron en pacientes menores de 20 años y 356 (0,52%) en menores de 15 años. El número de multíparas fue de 940 (10,3% de mujeres con embarazo adolescente). En el caso de primigestas <15 años, 68 presentaron más de un embarazo durante su adolescencia (19,3% de embarazadas). El período intergestacional tuvo una mediana en 3 años (rango 1 - 6 años). Cuando una adolescente <15 años se embaraza por primera vez, tiene un OR de 2,25 (IC 95%: 1.71-2.95; X2: 35,46; p<0,001) de volver a embarazarse durante su adolescencia, en relación a las adolescentes que se embarazan por primera vez después de los 15 años. En cuanto a intervenciones, al comparar ambos grupos, las menores de 15 años tienen un OR 2,75 de que al embarazarse, requieran cirugía. CONCLUSIÓN: La frecuencia de embarazo adolescente evaluada, es superior a la nacional y mundial. Cuando el primer embarazo ocurre <15 años, éstas tienen mayor riesgo de presentar un segundo embarazo durante la adolescencia. Una medida de prevención secundaria, es la utilización de MAC en el puerperio inmediato, idealmente LARCs.

OBJECTIVE: To evaluate the prevalence of multiparous adolescents, in the population that had their births at Hospital Padre Hurtado. METHODS: Retrospective cohort study, with information taken from the electronic database of the center, Birth data and Interventions, between 2005 and 2015. The data was tabulated in Microsoft Excel and the analysis was done with IBM SPSS 22 version. RESULTS: It occurred 62,656 deliveries and 5,770 pregnancies that ended in an intervention, from the total, 14,030 (20.5%) occurred in girls under 20 years and 356 (0.52%) under 15 years old (yo). The number of multiparous was 940 (10.3% of all of the adolescent pregnancies). For first time pregnants under 15 yo, 68 had a reiterative pregnancy among their adolescence (19.3% of pregnant <15 yo). The median time between pregnancies was 3 years (range 1- 6 years). When a girl <15 yo gets pregnant for the first time, she has an OR of 2.25 (IC 95%: 1.71-2.95; X2: 35,46; p<0,001) of getting pregnant again during adolescence compared to girls that get pregnant between 15-18 yo. About interventions, the group under 15yo had an OR 2.75 (in Chile all forms of abortions are illegal) compared with the group above 15 years, of requiring surgery when pregnant. CONCLUSIONS: The frequency of adolescent pregnancy analized, is above the national and international publications. Plus, if the pregnancy occurs under 15 yo, they have a greater chance of having another teenage pregnancy. An effective secondary prevention could be administration of contraception during immediate postpartum, ideally LARCs.

Cesarean section among primigravidae: cross section study - abba saudi arabia

Background: The Primary caesarean section [ CS] delivery worldwide rate is increasing due to public interest to avoid fetal complications and acceptance by most of the couple to complete their family with one or two children. This study was undertook to study selected cases of primary CSs in primigravid women, keeping the objectives to study the complications lead to cesarean section, maternal morbidity and mortality

Methods: Cross sectional survey conducted among Primigravidae in maternity and Pediatrics hospital -Abha - obstetrics and gynecology department between January 2016 and December 2016. Overall 170 cesarean section has been done out of 1167 births

Conclusion: Preeclampsia, eclampsia, placenta previa, intrauterine growth restriction, macrosomic fetus, malpresentation of the fetus, loss of fetal moment, fetal distress and labor dystocia are all indication of cesarean section. Our study revealed that cesarean section among Primigravidae still low in our area of the study

Frequency of pelvic pain and bleeding per vaginum in first trimester of pregnancy in a tertiary care hospital of Karachi

Objective: The objective of this study was to determine the frequency of pelvic pain and per vaginal bleeding, in the first trimester of pregnancy

Methods: A total of 150 pregnant women 18 to 35 years in first trimester were recruited in this crosssectional study, conducted from July 2015 to July 2016. Non-probability sampling technique was used to collect the data. The collected information from patients were entered in pre-designed proforma after taking informed consent. Data was analysed by using SPSS version 20

Results: The average age of the patients was 26.33 +/- 4.23 [range 18-35] years. Frequency of pelvic pain and per vaginal bleeding in first trimester of pregnancy was observed in 29.33% [44/150] and 12% [18/150] respectively. Stratification analysis was performed and it was observed that rate of pelvic pain and per vaginal bleeding was not statistically significant among different age groups. Rate of pelvic pain was significantly high in women with primigravida as compare to multigravida [p=0.003]

Conclusion: We found in our sample a significant number of women experiencing pelvic pain and vaginal bleeding in first trimester of their pregnancy. The practitioner must employ sound clinical and diagnostic skills in the management of the patient as early pregnancy complications can cause significant distress for some women and their partners

Impact of vaginal cylinder diameter on outcomes following brachytherapy for early stage endometrial cancer / 부인종양

OBJECTIVE: To examine the outcomes (tolerability, toxicity, and recurrence) of vaginal brachytherapy (VBT) among endometrial cancer (EC) patients treated with small cylinder size. METHODS: Patients with EC who received adjuvant VBT between September 2011 and December 2015 were reviewed. Patients were fitted with the largest vaginal cylinder they could comfortably accommodate, from 2.0–3.0 cm diameter. Small cylinders were defined as size 2.3 cm or less. Patient, tumor, or treatment characteristics were correlated with need for small cylinders. Treatment tolerability, measures of gastrointestinal (GI), genitourinary (GU), and vaginal toxicity, and rates of recurrence were analyzed. RESULTS: Three hundred four patients were included. Small cylinders were used in 51 patients (17%). Normal body mass index (BMI; p<0.001), nulligravidity (p<0.001), and shorter vaginal length (p<0.001) were associated with small cylinder size. There was no acute or late grade 3 toxicity. Rates of acute (grade 1–2) GI, GU, or vaginal symptoms were low (10%, 11%, and 19%, respectively). Small cylinder size was associated with increased likelihood of reporting acute GI (p<0.05) but not GU or vaginal symptoms. Small cylinder size was associated with higher risk of grade 1–2 vaginal stenosis (odds ratio [OR]=4.7; 95% confidence interval [CI]=1.5–14.7; p=0.007). There was no association between cylinder size and recurrence rate (p=0.55). CONCLUSION: VBT is generally very well tolerated, however, patients fitted with smaller cylinders (commonly nulligravid and low BMI) may have increased side effects. Further study to improve the dosimetry of VBT for patients requiring small cylinders may be worthwhile.

Relationship between age at last delivery and age at menopause: The Korea National Health and Nutrition Examination Survey

OBJECTIVE: We used data from the 2010 to 2012 Korean National Health and Nutrition Examination Surveys to investigate whether the age at menopause is related to age at last delivery. METHODS: This was a cross-sectional study of the data for 714 women who became menopausal within the 3 years preceding the Korean National Health and Nutrition Examination Survey. RESULTS: Smoking, exercise, drink, educational level, and income were adjusted in model 1, and the mean ages at menopause were 50.5±0.3, 51.2±0.2, 51.2±0.3, and 50.2±0.4 years for women with <25, ≥25 and <30, ≥30 and <35, ≥35 years age at last delivery, respectively (P=0.049). Smoking, exercise, drink, educational level, income, age at first delivery, age at last delivery, and gravidity were adjusted in model 2, and the respective mean ages at menopause were 50.5±0.5, 50.7±0.4, 50.3±0.4, and 49.2±0.5 years (P=0.03). In both models, older age at last delivery showed higher age at menopause compared with women with younger age at last delivery. CONCLUSION: Korean women with older age at last delivery were associated with younger age at menopause. Increased number of pregnancies was related to older age at menopause.

Factors associated with newborn screening compliance among mothers who gave birth in Quezon City lying-in clinics

BACKGROUND: Newborn screening (NBS) detects genetic and metabolic conditions that may be present in a newborn before clinical symptoms manifest. Early detection and treatment prevents catastrophic health outcomes. It was introduced into the public health delivery system with the enactment of the Newborn Screening Act of 2004. However, there still seems to be a trend of noncompliance.OBJECTIVE: The study sought to determine the prevalence of NBS compliance in Quezon City lying-in clinics (LICs) between 2010-2015 and the factors that are associated with compliance of mothers with NBS.METHODS: An analytic cross sectional study design was utilized. Records of 710 mothers who gave birth in Quezon City LICs were randomly selected. Multiple logistic regression was used to determine if the mothers' age, civil status, PhilHealth membership, gravidity, and parity were associated with NBS compliance.RESULTS: A 6-year prevalence of NBS compliance of 36.6% was found. PhilHealth members were more likely to comply with newborn screening (AOR=4.1; 95%CI: 2.9 - 6.0). Moreover, the odds of compliance among married mothers were higher than unmarried mothers (AOR=1.6; 95%CI: 1.1 - 2.3). Finally, primiparous mothers were more likely to comply than multiparous mothers (AOR=1.5; 95%CI: 1.0 - 2.1). Age and gravidity were not found to have statistical association with NBS compliance.CONCLUSION: The higher odds of compliance among PhilHealth members was expected since they can avail of NBS for free. Ninety-five percent of primiparous mothers included in the study were primigravid; they are more likely to go to prenatal checkups when NBS information is given, according to literature.

Staff nurses' competency and patients' satisfaction in an accredited maternity hospital: Basis for enhancement program

This paper centers on the staff nurses' level of competency and patients' level of satisfaction. Descriptive comparative design was utilized covering 32 staff nurses and 37 maternity patients from an accredited government maternity hospital. Purposive sampling was used to select the respondents. The questionnaires that were employed came from the Department of Health's Philippine Nurse Certification Program Self Assessment Tool for Level 3 Certification in Maternal and Child Nursing. The profile of staff nurses includes gender, length of experience, and educational attainment. On the other hand, gravidity, parity, and age are the patients' profile. Informed consent was given to all respondents. Statistical tools that were used includes: frequency and percentage, mean, standard deviation, independent sample t-Test, one way analysis of variance, and Pearson's correlation. The result concluded that there was no significant difference in the staff nurses' level of competency and patients' level of satisfaction when their profiles were considered. Moreover, it can be elucidated that there was no significant relationship between the level of competency and level of satisfaction. It can be interpreted that staff nurses are highly competent and patients are highly satisfied in terms of Client Care, Management and Leadership, and Research. However, there were statements with moderately competent results namely assess degree of laceration and actively participates in the collection of data research process to improve Maternal and Child Nursing practice in work setting with a mean of 2.50 and 2.28 respectively. The researcher suggests enhancement program in the form of the following trainings: internal external suturing in coordination with Association of Nursing Service Administrators of the Philippines and Research Process in coordination with Philippine Nursing Research Society.

Recurrent hydatidiform mole with NLRP7 mutation: The first confirmed case in the Philippines / Philippine Journal of Obstetrics and Gynecology

High gravidity hydatidiform mole (HM) without normal pregnancy is very rare. The challenge of managing such cases will dwell on the concern of having normal conception versus having another molar gestation and its neoplastic sequelae.Presented in this paper is a case of a 32-year-old, gravida 5 para 0 (0040) who was admitted for the management of her fifth molar pregnancy. She underwent suction curettage and administration of methotrexate chemoprophylaxis. Genetic testing was done, which revealed a homozygous mutation in NLRP7, the gene implicated in recurrent molar gestations. This paper discusses the proper approach to determine the cause of recurrent molar pregnancies, as well as the management and prognosis of such cases.

Creation of a scoring system to determine endometrial cancer risk using the International Endometrial Tumor Analysis (IETA) features / Philippine Journal of Obstetrics and Gynecology

GENERAL OBJECTIVE: To determine endometrial cancer risk among patients with abnormal uterine bleeding based on the International Endometrial Tumor Analysis (IETA) features.SPECIFIC OBJECTIVES: 1. To described the profile of patients with AUB suspected of having endometrial pathology; 2. To describe sonologic features of patients with AUB suspected of endometrial cancer using IETA features; and 3. To determine the association of a scoring system and endometrial cancer risk.METHODS: We prospectively studied 542 participants who came in the CWCU of CSMC with a diagnosis of AUB from July 1, 2016 to December 31, 2016. We excluded patients with endometrial thickness of less than 4 mm on gray-scale sonography, those with technical difficulties in assessing the endometrium such as in cases of very large myomas, absence of histopathological diagnosis, and those whose sampling was done as an office procedure. A total of 98 participants were included, 89 (90.8%) had benign pathologies and 9 (9.2%) were malignant. Patient characteristics including, age, gravidity, BMI, medical history, and endometrial assessment using IETA were tabulated with each characteristic given a score of 0-3 depending on the degree of risk factor. Percentages, Pearson Chi-square Test with corresponding P-value and ROC curve analysis were performed.RESULTS: The best predictors for endometrial cancer were age more than 50 years, nulligravid, BMI of more than 25, and presence of hypertension and diabetes mellitus. Sonographic features based on IETA showed an endometrial thickness of more than 20mm, irregular endometrial-myometrial junction, heterogenous endometrium, presence of multiple and large vessels on doppler analysis, contributed to endometrial cancer risk. These variables were used to create a scoring system with an area under the curve of 0.974 giving the best cut-off value of more than or equal to 9, with 100% sensitivity and 89% specificity.CONCLUSION: Among patients with abnormal uterine bleeding and endometrial thickness of more than 4mm, we can predict the risk for endometrial cancer and aid the clinician in decision making on who may be managed conservatively or aggressively based on the value obtained from the scoring system. The study, however, needs to be validated prior to use in clinical practice.

The role of sonography in the diagnosis of chronic puerperal uterine inversion: A case report / Philippine Journal of Obstetrics and Gynecology

Chronic puerperal uterine inversion is a rare and life-threatening obstetric emergency which requires emergent treatment. We present a case of a 27-year-old Gravida 2 Para 2 (2002) with chronic uterine inversion. A bleeding, 4 x 4 x 5 cm fleshy knob like mass protruding from the cervix, was seen during vaginal inspection. Two-dimensional transvaginal sonography and 3-dimensional imaging clinched the diagnosis of uterine inversion. The patient underwent Haultain's procedure and was discharged improved with resumption of normal menses. Postpartum transvaginal sonography revealed a normally positioned uterus.

Severe malaria in a pregnant woman successfully treated with Artemisinin-based Combination Therapy (ACT) / Philippine Journal of Obstetrics and Gynecology

Malaria is suspected in pregnant women with fever of unknown origin who come from areas with high transmission of the disease. Pregnant women are at greater risk of infection due to a weakened immune response and higher parasite burden because of placental sequestration. A 26-year-old Sudanese primigravid 23 6/7 weeks of gestation presented at our institution with mixed infection of malaria, with severe features (hypotension and anemia). Malaria was highly suspected due to her country of origin, which was highly endemic and has high transmission of the disease. Fetal surveillance to monitor fetal well-being was done since malaria is known to cause perinatal adverse outcomes. Intrauterine growth restriction, preterm labor and stillbirth are the most common perinatal morbidity from malaria. These are not present in the patient due to the prompt initiation of artemisinin-based combination therapy, which significantly decreased the parasite load, leading to successful outcome.

Preconceptional use of folic acid and knowledge about folic acid among low-income pregnant women in Korea

BACKGROUND/OBJECTIVES: Folic acid supplementation before pregnancy is known to significantly reduce the risk of having a baby with neural tube defects (NTDs). Therefore, it is important for women to be aware of the effects of folic acid supplementation before pregnancy. The purpose of this study was to investigate the awareness and preconceptional use of folic acid and to assess the current knowledge about folic acid among low-income pregnant women in Korea. SUBJECTS/METHODS: A questionnaire survey was conducted in 2012. Five hundred pregnant women were selected from the waiting list for the Nutriplus program implemented in public health centers using a multistage clustered probability sampling design. Data from 439 women were analyzed after excluding ones with incomplete answers. RESULTS: Among women who responded to the questionnaire, 65.6% had heard of folic acid before pregnancy, and 26.4% reported on the preconceptional use of folic acid. Women with a university degree or higher education were more likely to be aware of folic acid and to take folic acid in the preconception period. In a multivariate logistic regression, when age, education level, household income, employment status, gravidity, parity, and folic acid awareness were included in the model, folic acid awareness was a strong predictor of preconceptional folic acid use. As of interview, 85.4% and 77.7% of women were aware of the NTD-preventive role of folic acid and the appropriate time to take folic acid, respectively. The main sources of information on folic acid were healthcare professionals (41.2%), friends and family members (31.2%), and the media (26.5%). CONCLUSIONS: Our results suggest that public health strategies are needed to increase the preconceptional use of folic acid among Korean women.