Classification of caesarean section and normal vaginal deliveries using foetal heart rate signals and advanced machine learning algorithms.

BACKGROUND: Visual inspection of cardiotocography traces by obstetricians and midwives is the gold standard for monitoring the wellbeing of the foetus during antenatal care. However, inter- and intra-observer variability is high with only a 30% positive predictive value for the classification of pathological outcomes. This has a significant negative impact on the perinatal foetus and often results in cardio-pulmonary arrest, brain and vital organ damage, cerebral palsy, hearing, visual and cognitive defects and in severe cases, death. This paper shows that using machine learning and foetal heart rate signals provides direct information about the foetal state and helps to filter the subjective opinions of medical practitioners when used as a decision support tool. The primary aim is to provide a proof-of-concept that demonstrates how machine learning can be used to objectively determine when medical intervention, such as caesarean section, is required and help avoid preventable perinatal deaths. METHODS: This is evidenced using an open dataset that comprises 506 controls (normal virginal deliveries) and 46 cases (caesarean due to pH ≤ 7.20-acidosis, n = 18; pH > 7.20 and pH < 7.25-foetal deterioration, n = 4; or clinical decision without evidence of pathological outcome measures, n = 24). Several machine-learning algorithms are trained, and validated, using binary classifier performance measures. RESULTS: The findings show that deep learning classification achieves sensitivity = 94%, specificity = 91%, Area under the curve = 99%, F-score = 100%, and mean square error = 1%. CONCLUSIONS: The results demonstrate that machine learning significantly improves the efficiency for the detection of caesarean section and normal vaginal deliveries using foetal heart rate signals compared with obstetrician and midwife predictions and systems reported in previous studies.

Hormonal Contraceptives and Acne: A Retrospective Analysis of 2147 Patients.

INTRODUCTION: Although hormonal contraceptives may help acne or worsen it, there is limited evidence on the effects of many commonly prescribed agents. The present study evaluates patient-reported effect on acne from 2147 patients who were utilizing a hormonal contraceptive at the time of their initial consultation for acne.
METHODS: At the time of initial consultation for acne, each of 2147 consecutive patients using hormonal contraception provided her assessment of how her contraceptive had affected her acne. The Kruskal-Wallis test and logistic regression analysis were used to compare patient-reported outcomes by contraceptive type.
RESULTS: Depot injections, subdermal implants, and hormonal intrauterine devices worsened acne on average, and were inferior to the vaginal ring and combined oral contraceptives (COCs; P ≤ .001 for all pairwise comparisons), which improved acne on average. Within COC categories, a hierarchy emerged based on the progestin component, where drospirenone (most helpful) > norgestimate and desogestrel > levonorgestrel and norethindrone (P ≤ .035 for all pairwise comparisons). The presence of triphasic progestin dosage in COCs had a positive effect (P = .005), while variation in estrogen dose did not have a significant effect (P = .880).
CONCLUSIONS: Different hormonal contraceptives have significantly varied effects on acne, including among types of COC.

J Drugs Dermatol. 2016;15(6):670-674.

Coil or intrauterine device? Patient preferences for contraceptive terminology.

OBJECTIVE: To discover what terminology women prefer to use when referring to contraceptive methods and to investigate the understanding of and ideas associated with contraceptive names. DESIGN: A self-administered questionnaire was answered by 191 new patients at family planning clinics (FPCs). Women were asked if they understood the terms used by the fpa (Family Planning Association), if they knew of any alternatives and, if so, which they preferred. SETTING: Selected FPCs across the city of Manchester. RESULTS: Patients preferred to use familiar terms, e.g. pill, mini-pill, coil and morning-after pill. There was no difference in preference when the results were compared by age or educational level. A greater proportion of non-Caucasians than Caucasians preferred the precise (fpa) terms. Although precise terms were not widely known or understood, when used they were associated with more information than were the familiar terms. CONCLUSION: All FPC staff should evaluate the language used by individual patients and, where appropriate, introduce precise terminology to help patients to make informed, appropriate choices.

Diaphragm fitting.

When used with a spermicide, the diaphragm can be a more effective barrier contraceptive than the male condom. The diaphragm allows female-controlled contraception. It also provides moderate protection against sexually transmitted diseases and is less expensive than some contraceptive methods (e.g., oral contraceptive pills). However, diaphragm use is associated with more frequent urinary tract infections. Contraindications to use of a diaphragm include known hypersensitivity to latex (unless the wide seal rim diaphragm is used) or a history of toxic shock syndrome. A diaphragm is fitted properly if the posterior rim rests comfortably in the posterior fornix, the anterior rim rests snugly behind the pubic bone, and the cervix can be felt through the dome of the device. The diaphragm should not be left in the vagina for longer than 24 hours. When the diaphragm is the chosen method of contraception, patient education is key to compliance and effectiveness. An extended visit with the physician or a nurse may be required for a woman to learn proper insertion, removal, and care of the diaphragm.

Trends and determinants of contraceptive method choice in Kenya.

This study uses data from the 1989, 1993, and 1998 Kenya Demographic and Health Surveys to examine trends and determinants of contraceptive method choice in Kenya. The analysis, based on two-level multinomial regression models, shows that, over time, the use of modern contraceptive methods, especially long-term methods, is higher in urban than in rural areas, whereas the pattern is reversed for traditional methods. Use of barrier methods among unmarried women is steadily rising, but the levels remain disappointingly low, particularly in view of the HIV/AIDS epidemic in Kenya. One striking result from this analysis is the dramatic rise in the use of injectables. Of particular program relevance is the notably higher levels of use of injectables among rural women, women whose partners disapprove of family planning, uneducated women, and those less frequently exposed to family planning media messages, compared with their counterparts who have better access to services and greater exposure to family planning information.

Utilización de los métodos anticonceptivos de las usuarias del Hospital Materno Infantil San Pablo

Estudio descriptivo de los métodos utilizados por las mujeres que acuden al servicio de Planificación Familiar del Hospital Materno Infantil San Pablo. Describe los métodos anticonceptivos más utilizados, sus beneficios, riesgos y tratamientos

Mujer, frontera, inserción laboral y comportamiento reproductivo

Estudio descriptivo cuantitativo de la situación social ocupacional de las mujeres en la frontera Alberdi Formosa y los aspectos vinculados a su salud y comportamiento reproductivos

[Contraceptions in women with contra-indication to estrogen-progestins]. / Contraceptions chez des femmes ayant une contre-indication aux oestroprogestatifs.

Estrogen-progestin pill contra-indications can be related to a metabolic or vascular risk or to an estrogen-dependent disease. In the first case, a pregnane progestin (chlormadinone acetate or cyproterone acetate) can be used as a first choice, because of its good tolerance and absence of deleterious effects on these diseases. IUD use is limited due to the risk of infection and a decreased efficiency with corticosteroids. Diaphragm plus spermicides or condoms can be used in any case and are the only possibilities during the course or just after a deep vein thrombosis. In case of estrogen-dependent diseases, high-dose progestin is the treatment of the diseases in most of the cases and normethyl-testosterone derivatives or other progestin can be used.

Panorama retrospectivo de la planificación familiar en el Hospital Civil Alausi, 1992-1994

El presente es un estudio retrospectivo sobre la planificación familiar (PF) en el Hospital Civil de Alausi (HCA) en el período de enero 1992 a diciembre 1994. Encontramos que de la población de influencia, acudieron a solicitar este tipo de servicio el 10 por ciento de las mujeres en edad fértil. El método de mayor aceptación fue el dispositivo intrauterino (DIU) con el 46 por ciento, seguido de la ligadura con el 39.2 por ciento, dejando a los gestágenos orales (GO) y los otros métodos con poca aceptación. Las complicaciones y efectos adversos encontrados por los distintos métodos tienen una distribución distinta con otros estudios, de estos el fracaso con el subsecuente embarazo con el DIU fue el 4.3 por ciento y con los GO del 11.1 por ciento, frecuencia relativamente alta para la seguridad que ofrecen estos últimos frente a la complicación de embarazo . La ligadura mantiene buena aceptación y se realiza en estos hospitales con el método clásico de cirugía abierta...

Condón femenino: nuevo dispositivo de barrera

Es posible que próximamente las mujeres tengan su propio condón: un nuevo dispositivo anticonceptivo que también podría ofrecer protección contra las enfermedades de transmisión sexual (ETS). El "condón femenino" es una funda desechable de látex o plástico blando, que se coloca dentro de la vagina. Muchos de los métodos eficaces para el control de la natalidad son controlados por los mujeres, pero el principal método para la protección contra las ETS (el condón masculino) no lo está. En la estela de la pandemia del SIDA, el brindar a las mujeres el potencial de proteger su salud sexual tiene mayor urgencia que nunca

A comparison of satisfaction with types of diaphragms among women in a college population.

Since the 1940s diaphragms have been a popular contraceptive device used by women in the United States. This study compared three popular diaphragms and women's subjective comparisons of comfort, ease of insertion, and overall satisfaction. None of the three types, the wideseal, coil spring, or arcing spring, was found to be statistically more comfortable or easier to insert. For overall satisfaction, women were more pleased with the coil spring than the wideseal (p = .0416 at two to four weeks, p = .0759 at four to six months, and p = .0049 at one year). Women who used the arcing spring and wideseal were more pleased with the wideseal at two to four weeks (p = .0571). No significant difference was found at one year. The study results demonstrate that certain diaphragm styles may improve women's use of and satisfaction with the diaphragm.