Female sexual function before and during the severe acute respiratory syndrome coronavirus-2 pandemic: a systematic review and Meta-analysis of longitudinal studies.

PurposeTo compare the female sexual function before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic using the Female Sexual Function Index (FSFI).MethodsRelevant studies were retrieved by online databases and manual searching reporting FSFI scores before and during the SARS-CoV-2 pandemic. The methodological quality of reviewed articles was evaluated using the Newcastle-Ottawa Scale, and heterogeneity with the I2 statistic. The standardized mean differences (SMDs) with their 95% confidence intervals (CIs) were calculated by random-effect meta-analyses.ResultsFour studies met the inclusion criteria reporting 1002 sexually active non-pregnant women comparing results of the 19-item FSFI. The meta-analysis of the overall FSFI score showed an SMD (95% CI) of -1.16 (-1.97 to -0.35), comparing the pandemic with the pre-pandemic scores. In addition, SMD scores for the FSFI domains were also significantly lower during the pandemic for arousal -0.80 (-1.13 to -0.48), orgasm -0.66 (-1.07 to -0.25), satisfaction -0.59 (-0.97 to -0.22), and pain -0.35 (-0.54 to -0.16), whereas there were not significant differences for desire and lubrication domains. There was a low risk of bias and the sensitivity analysis suggests that results are robust.ConclusionThe available studies showed a lower overall FSFI score during the pandemic, suggesting an increased risk of female sexual dysfunction compared to prepandemic results. Also, there were increased risks of sexual arousal, orgasm, satisfaction, and pain disorders. However, there were no alterations in the desire and the lubrication domains. Limitations are related to the heterogeneity populations, and pandemic confounding and aggravating factors.

Personalized Model to Predict Small for Gestational Age at Delivery Using Fetal Biometrics, Maternal Characteristics, and Pregnancy Biomarkers: A Retrospective Cohort Study of Births Assisted at a Spanish Hospital.

Small for gestational age (SGA) is defined as a newborn with a birth weight for gestational age < 10th percentile. Routine third-trimester ultrasound screening for fetal growth assessment has detection rates (DR) from 50 to 80%. For this reason, the addition of other markers is being studied, such as maternal characteristics, biochemical values, and biophysical models, in order to create personalized combinations that can increase the predictive capacity of the ultrasound. With this purpose, this retrospective cohort study of 12,912 cases aims to compare the potential value of third-trimester screening, based on estimated weight percentile (EPW), by universal ultrasound at 35−37 weeks of gestation, with a combined model integrating maternal characteristics and biochemical markers (PAPP-A and ß-HCG) for the prediction of SGA newborns. We observed that DR improved from 58.9% with the EW alone to 63.5% with the predictive model. Moreover, the AUC for the multivariate model was 0.882 (0.873−0.891 95% C.I.), showing a statistically significant difference with EPW alone (AUC 0.864 (95% C.I.: 0.854−0.873)). Although the improvements were modest, contingent detection models appear to be more sensitive than third-trimester ultrasound alone at predicting SGA at delivery.

Leukocyte telomere length in women with and without polycystic ovary syndrome: a systematic review and meta-analysis.

AIM: To study the telomere length and the telomerase activity in women with and without polycystic ovary syndrome (PCOS). METHODS: Relevant studies were searched from PubMed, Embase, and LILACS online databases and manual screening. The mean differences (MDs) or standardized MDs (SMDs) with their 95% confidence intervals (CIs) were calculated. The methodological quality of included studies was evaluated with the Newcastle-Ottawa Scale (NOS), and heterogeneity with the I2 and Tau2 statistics. RESULTS: Six studies including 2109 non-pregnant women with (n = 1155) or without (n = 954) PCOS assessed leukocyte telomere length. There was a non-significant leukocyte telomere length difference (SMD = 0.25, 95% CI: -0.01, 0.51, p = .06, I2 = 81%, Tau2 = 0.08) comparing PCOS patients with the control group. Studied PCOS women were younger (MD = -1.39, 95% CI: -2.47, -0.31 years, I2 = 83%), and had higher body mass index (BMI; MD = 3.66, 95% CI: 2.11, 5.20 kg/m2, I2 = 94%). There were significantly higher testosterone (SMD = 0.88, 95% CI: 0.65, 1.10) and luteinizing hormone levels (SMD = 0.60, 95% CI: 0.12, 1.08) in women with PCOS as compared to controls. There was a low risk of bias and there were not sufficient studies to meta-analyze other cell types. CONCLUSIONS: Leukocyte telomere length did not differ between women with and without PCOS. Further studies with large sample sizes and including other outcomes are warranted to further substantiate the reported evidence.

Obstetric and perinatal outcomes of pregnancies with COVID 19: a systematic review and meta-analysis.

OBJECTIVE: This meta-analysis aimed at comparing obstetric and perinatal outcomes in laboratory-tested pregnant women for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection before delivering. METHOD: We performed a comprehensive systematic review of electronic databases for studies reporting pregnant women with and without SARS-CoV-2 infection, as determined by polymerase chain reaction (PCR) before delivery, during the pandemic period published up to June 25, 2021. Results are reported as mean difference (MD) or odds ratio (OR) and their 95% confidence interval (CI). RESULTS: Seventeen observational studies with low to moderate risk of bias, reported on 2,769 pregnant women with a positive SARS-CoV-2 PCR test and 13,807 with a negative test. Pregnant women with a positive PCR test delivered at an earlier gestational age (MD -0.19; 95% CI -0.36 to -0.02 weeks), smoked less (OR 0.75; 95% CI 0.61-0.94) and were associated with higher odds for preeclampsia (OR 1.30; 95% CI 1.09-1.54), NICU admissions (OR 2.37; 95% CI 1.18-4.76), stillbirths (OR 2.70; 95% CI, 1.38-5.29), and perinatal mortality (OR 3.23; 95% CI 1.23-8.52). There were no significant differences between positive and negative tested women in terms of nulliparity, multiple pregnancies, gestational diabetes, route of delivery, labor induction, preterm birth, infant birth weight, 5 min Apgar scores < 7, small-for-gestational-age infants and fetal malformations. Eleven studies included neonatal PCR SARS-CoV-2 testing which was performed on 129 infants, of which 20 were positive. CONCLUSION: Positive SARS-CoV-2 tested pregnant women had higher odds for preeclampsia/hypertensive disorders of pregnancy, NICU admissions, stillbirths and perinatal mortality.

Women's knowledge about the genitourinary syndrome of menopause: adherence to its treatments in the COVID-19 era in a sample of them: COMEM-GSM study.

OBJECTIVE: To study knowledge regarding genitourinary syndrome of menopause (GSM) and the treatments for it and to analyze treatment adherence during the COVID-19 confinement. METHODS: Multi-center observational study including women between 35 and 75 years. An extension study of treatment adherence was conducted during the coronavirus pandemic between March and April 2020. RESULTS: A sample of 2355 women were included. Vaginal dryness was the most frequently identified symptom (74.3%). Lubricants were the best-known treatments (69.6%), followed by local estrogens (25.7%); 66% of the women did not speak to their gynecologist about sexuality. Comparative analyses were conducted according to age, menopausal status, type of menopause, place of residence, type of health care received and level of education. During the coronavirus confinement period, adherence to treatments for vulvovaginal atrophy was poor in 72.5% asked (n = 204). Reduced sexual activity (p > 0.001) and coronavirus diagnosis (p = 0.003) were significantly associated with poorer treatment compliance. CONCLUSIONS: There is great lack of knowledge of the treatments used for GSM. Most women do not talk to their gynecologist about sexuality. Adherence to treatments during the coronavirus confinement has been worryingly low.

Reduced Growth in Non-Small for Gestational Age Fetuses from 35 Weeks of Gestation to Birth and Perinatal Outcomes.

OBJECTIVE: This study aimed to assess reduced fetal growth between 35 weeks of gestation and birth in non-small for gestational age fetuses associated with adverse perinatal outcomes (APOs). MATERIAL AND METHOD: It is a retrospective cohort study of 9,164 non-small for gestational age fetuses estimated by ultrasound at 35 weeks. The difference between the birth weight percentile and the estimated percentile weight (EPW) at 35 weeks of gestation was calculated, and we studied the relationship of this difference with the appearance of APO. APOs were defined as cesarean or instrumental delivery rates for nonreassuring fetal status, 5-min Apgar score <7, arterial cord blood pH <7.10, and stillbirth. Fetuses that exhibited a percentile decrease between both moments were classified into 6 categories according to the amount of percentile decrease (0.01-10.0, 10.01-20.0, 20.01-30.0, 30.01-40.0, 40.01-50.0, and >50.0 percentiles). It was evaluated whether the appearance of APO was related to the amount of this percentile decrease. Relative risk (RR) was calculated in these subgroups to predict APOs in general and for each APO in particular. Receiver operating characteristic and area under curves (AUC) for the difference in the percentile was calculated, used as a continuous parameter in the entire study population. RESULTS: The median gestational age at delivery in uncomplicated pregnancies was 40.0 (39.1-40.7) and in pregnancies with APOs 40.3 (49.4-41.0), p < 0.001. The prevalence of APOs was greater in the group of fetuses with a decrease in percentile (7.6%) compared to those with increased percentile (4.8%) (p < 0.001). The RR was 1.63 (95% CI: 1.365-1.944, p < 0.001). Although the differences were significant in all decreased percentile groups, RRs were significantly higher when decreased growth values were >40 points (RR: 2.036, 95% CI: 1.581-2.623, p < 0.001). The estimated value of the AUC for percentile decrease was 0.58 (0.56-0.61, p < 0.001). CONCLUSION: Fetuses with a decrease in the EPW between the ultrasound at 35 weeks of gestation and birth have a higher risk of APOs, being double in fetuses with a decrease of >40 percentile points.

Prediction of Late-Onset Small for Gestational Age and Fetal Growth Restriction by Fetal Biometry at 35 Weeks and Impact of Ultrasound-Delivery Interval: Comparison of Six Fetal Growth Standards.

Small-for-gestational-age (SGA) infants have been associated with increased risk of adverse perinatal outcomes (APOs). In this work, we assess the predictive ability of the ultrasound-estimated percentile weight (EPW) at 35 weeks of gestational age to predict late-onset SGA and APOs, according to six growth standards, and whether the ultrasound-delivery interval influences the detection rate. To this purpose, we analyze a retrospective cohort study of 9585 singleton pregnancies. EPWs at 35 weeks were calculated to the customized Miguel Servet University Hospital (MSUH) and Figueras standards and the non-customized MSUH, Fetal Medicine Foundation (FMF), INTERGROWTH-21st, and WHO standards. As results of our analysis, for a 10% false positive rate, the detection rates for SGA ranged between 48.9% with the customized Figueras standard (AUC 0.82) and 60.8% with the non-customized FMF standard (AUC 0.87). Detection rates to predict SGA by ultrasound-delivery interval (1-6 weeks) show higher detection rates as intervals decrease. APOs detection rates ranged from 27.0% with FMF to 7.9% with the Figueras standard. In conclusion, the ability of EPW to predict SGA at 35 weeks is good for all standards, and slightly better for non-customized standards. The APO detection rate is significantly greater for non-customized standards.

Prediction of Large for Gestational Age by Ultrasound at 35 Weeks and Impact of Ultrasound-Delivery Interval: Comparison of 6 Standards.

OBJECTIVE: The aim of the study was to assess the predictive ability of the ultrasound estimated percentile weight (EPW) at 35 weeks to predict large for gestational age (LGA) at term delivery according to 6 growth standards, including population, population-customized, and international references. The secondary objectives were to determine its predictive ability to detect adverse perinatal outcomes (APOs) and whether the ultrasound-delivery interval influences the detection rate of LGA newborns. METHODS: This was a retrospective cohort study of 9,585 singleton pregnancies. Maternal clinical characteristics, fetal ultrasound data obtained at 35 weeks, and pregnancy and perinatal outcomes were used to calculate EPWs to predict LGAs at delivery according to the customized and the non-customized (NC) Miguel Servet University Hospital (MSUH), the customized Figueras, the NC Fetal Medicine Foundation (FMF), the NC INTERGROWTH-21st, and the NC World Health Organization (WHO) standards. RESULTS: For a 10% false-positive rate, detection rates for total LGAs at delivery ranged from 31.2% with the WHO (area under the curve [AUC] 0.77; 95% confidence interval [CI], 0.76-0.79) to 56.5% with the FMF standard (AUC 0.85; 95% CI, 0.84-0.86). Detection rates and values of AUCs to predict LGAs by ultrasound-delivery interval (range 1-6 weeks) show higher detection rates as the interval decreases. APO detection rates ranged from 2.5% with the WHO to 12.6% with the Figueras standard. CONCLUSION: The predictive ability of ultrasound estimated fetal weight at 35 weeks to detect LGA infants is significantly greater for FMF and MSUH NC standards. In contrast, the APO detection rate is significantly greater for customized standards. The shorter ultrasound-delivery interval relates to better prediction rates.

Detection of Adverse Perinatal Outcomes at Term Delivery Using Ultrasound Estimated Percentile Weight at 35 Weeks of Gestation: Comparison of Five Fetal Growth Standards.

OBJECTIVE: To assess the predictive ability of the ultrasound estimated percentile weight (EPW) at 35 weeks of pregnancy to predict adverse perinatal outcomes (APOs) at term delivery according to 5 fetal growth standards, including population, population-customized, and international references. METHODS: This was a retrospective cohort study of 9,585 singleton pregnancies. Maternal clinical characteristics, fetal ultrasound data obtained at 35 weeks and pregnancy and perinatal outcomes were used to calculate EPWs to predict APOs according to: the customized and noncustomized (NC) Miguel Servet University Hospital (MSUH), the customized Figueras, the NC INTERGROWTH-21st, and the NC World Health Organization (WHO) international standards. APOs were defined as the occurrence of cesarean or instrumental delivery for nonreassuring fetal status, 5-min Apgar score < 7, arterial cord blood pH <7.10, or stillbirth. The predictive ability of EPW for APOs was analyzed using the area under the curve (AUC), and sensitivities were calculated for different false-positive rates (FPRs). RESULTS: For a 10% FPR, detection rates for total APOs ranged between 12.7% with the customized MSUH (AUC 0.52; 95% CI 0.50-0.55) and 14.4% with the NC MSUH standard (AUC 0.55; 95% CI 0.53-0.57) for EPW by ultrasound; and from 22.0% with the customized MSUH standard (AUC 0.60; 95% CI 0.58-0.63) to 27.8% with the NC WHO (AUC 0.65; 95% CI 0.63-0.68) for EPW at delivery. CONCLUSIONS: The predictive capacity of the EPW for APOS is limited and similar, by both ultrasound and at delivery, for the 5 growth standards, without significant differences between customized and NC standards.

Restricción del ductus arterioso fetal en gestante de tercer trimestre por consumo de paracetamol / Fetal Ductus Arteriosus Restriction in the Final Third of Pregnancy Due To Acetaminophen Consumption

Se presenta el caso de una paciente que desde la semana 20 de gestación fue diagnosticada de cólico renal con la necesidad de varios ingresos y colocación de catéter doble J por parte de Urología. La paciente recibió tratamiento con paracetamol intravenoso y oral. Los controles ecográficos obstétricos -a los largo de la gestación- fueron normales hasta que en la semana 32, cuando ingresó de nuevo por cuadro sospechoso de cólico renal tratado con Paracetamol. Se objetivan en ecografía con hallazgos compatibles con restricción precoz del ductus arterioso. Se indicó la suspensión del paracetamol y los cambios se redujeron en las 48 horas posteriores y casi desaparecieron por completo una semana tras la retirada de la medicación. La gestación llegó a término y el recién nacido presentó un ecocardiograma posnatal normal. Recomendamos la restricción de los analgésicos no opiáceos en el tercer trimestre y el seguimiento con Doppler del conducto arterioso en los casos en que se requiriera usarlos(AU)

A case is reported of a pregnant woman who was diagnosed with renal colic at 20 weeks of gestation. She needed various admissions in hospital and double J stent placement by Urology Service and she was treated with acetaminophen by both intravenous and oral ways. Obstetric ultrasound scans were normal throughout gestation until week 32, when she was admitted to hospital again for suspected renal colic. She was treated with acetaminophen. In that moment, ultrasound findings are consisted with early ductus arteriosus constriction. Acetaminophen was decided to be stopped and changes reduced in the first 48 hours and they almost disappeared after one week of medication withdrawal. Pregnancy came to term and the child was born normal. Restricting non-opioid analgesics was recommended in the third quarter, as well as following up with ductus arteriosus doppler in cases in which it is required to use them(AU)

Restricción del ductus arterioso fetal en gestante de tercer trimestre por consumo de paracetamol / Fetal Ductus Arteriosus Restriction in the Final Third of Pregnancy Due To Acetaminophen Consumption

Se presenta el caso de una paciente que desde la semana 20 de gestación fue diagnosticada de cólico renal con la necesidad de varios ingresos y colocación de catéter doble J por parte de Urología. La paciente recibió tratamiento con paracetamol intravenoso y oral. Los controles ecográficos obstétricos -a los largo de la gestación- fueron normales hasta que en la semana 32, cuando ingresó de nuevo por cuadro sospechoso de cólico renal tratado con Paracetamol. Se objetivan en ecografía con hallazgos compatibles con restricción precoz del ductus arterioso. Se indicó la suspensión del paracetamol y los cambios se redujeron en las 48 horas posteriores y casi desaparecieron por completo una semana tras la retirada de la medicación. La gestación llegó a término y el recién nacido presentó un ecocardiograma posnatal normal. Recomendamos la restricción de los analgésicos no opiáceos en el tercer trimestre y el seguimiento con Doppler del conducto arterioso en los casos en que se requiriera usarlos(AU)

A case is reported of a pregnant woman who was diagnosed with renal colic at 20 weeks of gestation. She needed various admissions in hospital and double J stent placement by Urology Service and she was treated with acetaminophen by both intravenous and oral ways. Obstetric ultrasound scans were normal throughout gestation until week 32, when she was admitted to hospital again for suspected renal colic. She was treated with acetaminophen. In that moment, ultrasound findings are consisted with early ductus arteriosus constriction. Acetaminophen was decided to be stopped and changes reduced in the first 48 hours and they almost disappeared after one week of medication withdrawal. Pregnancy came to term and the child was born normal. Restricting non-opioid analgesics was recommended in the third quarter, as well as following up with ductus arteriosus doppler in cases in which it is required to use them(AU)

Restricción del ductus arterioso fetal en gestante del tercer trimestre por consumo de paracetamol / Fetal ductus arteriosus constriction in the final third of pregnancy due to paracetamol comsumption

El ductus arterioso es una derivación que conecta la arteria pulmonar con el arco aórtico el que permite la descarga del ventrículo derecho sin pasar por la alta resistencia de los pulmones. La permeabilidad del conducto arterioso se mantiene durante la gestación por las prostaglandinas producidas especialmente PGE2, que circulan a nivel local, especialmente PGE2, y la baja saturación de oxígeno fetal. Se trata de una paciente que desde la semana 20 de gestación es diagnosticada de cólico renal con la necesidad de varios ingresos y colocación de catéter doble J por parte de Urología y la cual recibió tratamiento con paracetamol intravenoso y oral. Los controles ecográficos obstétricos a los largo de la gestación fueron normales hasta que en semana 32, cuando ingresa de nuevo por cuadro sospechoso de cólico renal tratado con Paracetamol, se objetivan en ecografía hallazgos compatibles con restricción precoz del ductus arterioso. Se indicó suspender el paracetamol y los cambios se redujeron en las 48 horas posteriores y casi desaparecieron por completo una semana tras la retirada de la medicación. La gestación llegó a término y el recién nacido presentó un ecocardiograma postnatal normal. Recomendamos la restricción de los analgésicos no opiáceos en el tercer trimestre y el seguimiento con Doppler del conducto arterioso en los casos en que se requiriera usarlos(AU)

Ductus arteriosus is a derivation that connects the pulmonary artery with the aortic arch and allows the discharge from the right ventricle without passing the high resistance of lungs. Permeability of the ductus arteriosus is kept during gestation because of the production of prostaglandins, particularly PGE2, which circulates locally, and the low fetal oxygen saturation. Here is a pregnant woman who, since her 20th week of gestation was diagnosed as a renal colic case. She required several admissions to hospital and placement of double J stent in the urology service and she was treated with intravenous and oral paracetamol. Obstetric ultrasound scans throughout gestation were normal until week 32, when she was admitted to hospital again for suspected renal colic and treated again with paracetamol. At that moment, findings compatible with early ductus arteriosus constriction were observed in ultrasound. It was then decided to stop the paracetamol treatment, the changes declined in the following 48 hours and they almost disappeared completely after one week after the medication withdrawal. It was finally a term pregnancy and the postnatal echocardiogram of the newborn was normal. Restricting non-opioid analgesics in the third pregnancy trimester and the follow up of the ductus arteriosus with Doppler technique when required(AU)