Sex hormones have been studied for more than a century.They affect almost all body systems and functions.FSH assists in converting androgens to estrogens; regulates bone mass, functioning of adipose tissue, energy metabolism, cholesterol synthesis; also, it has an impact on hepatocytes and tumor blood vessels.Estrogens are a family of hormones that consists of estrone, estradiol and estriol.The first two are biologically active estrogens in non-pregnant individuals, while the third one is produced in significant amounts during pregnancy.In non-pregnant females, estradiol circulates at higher concentrations, and it is more biologically active than estrone.Estrogens and progesterone spread their influence on the reproductive system, breasts, skin, adipose tissue, musculoskeletal, cardiovascular systems and brain functioning.Their levels fluctuate within lifespan, allowing clinicians and researchers to test them, monitor and predict different physiological events, conditions and disorders.Radioimmunoassays, enzyme immunoassays, enzyme-linked immunosorbent assays, and mass spectrometry are commonly used methods for measuring parent hormones and their metabolites.Serum samples provide a more accurate picture, while saliva and urine are more convenient, as they are painless and can be easily collected by patients and analyzed at home.There is great utilization of hormonal testing in clinical practice, and at the same time a big potential in monitoring hormone levels for disease diagnosis and prognosis, pregnancy outcomes predictions in assisted reproduction, building and using algorithms for labor predictions, first signs of transitions to menopause that could be useful for fertility preservation.
Background: American Indian/Alaska Native (AIAN) women have twice the risk compared to the general US population of adolescent obesity, pregnancy, and gestational diabetes.The purpose of this study was to explore the perspectives of adolescent AIAN girls who are at risk for gestational diabetes (GDM) on their awareness and understanding of GDM and reproductive health; and on an existing validated diabetes and preconception counseling (PC) education program for non-AIAN teen girls with diabetes.Methods: Five semi-structured focus group interviews with 13 AIAN females (age 15.5±1.8years) were conducted.Questions related to their awareness, understanding, and perceptions of risk for GDM.The moderator also showed video clips and booklet excerpts from the existing program to elicit feedback.Interviews were recorded and transcribed verbatim.Analysis included inductive coding and the constant comparison method.Results: Key themes were constructed: 1) Lack of awareness and knowledge of GDM; 2) Need for pregnancy planning and culturally responsive GDM and reproductive health resources; 3) Importance of using empowerment frameworks to promote positive reproductive health behaviors.Conclusions: The participants' lack of awareness and knowledge of GDM and their risk for developing GDM reveals the need for new health programming to mitigate risk for unplanned pregnancies and GDM, and to promote healthy pregnancy and birth outcomes.These findings have been used in conjunction with findings of focus groups of other key stakeholders to inform the development of a culturally tailored GDM risk reduction program for AIAN adolescents.
Background: Latinas are at a higher risk than Caucasians for both type 1 and type 2 diabetes (DM), as well as DM-associated reproductive health (RH) complications. Healthcare providers (HCPs) should deliver culturally-sensitive care to enhance the care relationship between Latinos and HCPs and to improve patient outcomes. This study explored an expert panel’s cultural understanding, experiences, barriers, and facilitators regarding RH and preconception counseling (PC) for adolescent Latinas with DM and their families. Methods: This study used open-ended questions with a focus group of 8 HCPs from the mid-Atlantic, Southwest, and Northwest regions of the United States in a teleconference format. Two researchers transcribed and reviewed the transcript for accuracy. Using content analysis, four members of the team identified themes. All researchers discussed themes and a 100% consensus was reached. For confirmation, a coding protocol was created based on the emerging themes. Results: Five themes related to cultural understanding and experiences were identified: 1) issues of identity; 2) acculturation; 3) stigma; 4) ambivalence toward birth control, RH education, and PC; and 5) cultural sensitivity vs. best practice. Four barriers were identified: 1) language; 2) religion; 3) access to healthcare, and 4) discomfort with discussion. Ten facilitators were identified: 1) the importance of support and support networks; 2) promoting trust among HCPs, daughters, and families; 3) assessing emotional development; 4) empowerment; 5) emphasizing safety; 6) communicating in patients’ preferred language; 7) discussing RH-related topics and PC using cultural sensitivity; 8) importance of being ready/temporality/planning for the future; 9) the importance of family-centered care; and 10) variation in educational tailoring and dissemination/ care delivery. Conclusions: Findings support the need for culturally sensitive and developmentally appropriate PC programs to empower adolescent Latinas with DM.
Background: Hysterosalpingogram is a useful investigation for evaluation of infertility.However the procedure is associated with variable degrees of pain and discomfort.Objective: The objectives of the study were to determine the intensity of pains experienced by women during the investigation, the management of the pains by providers and women's expectation and satisfaction with their pain management.Methodology: This was a prospective cohort study involving women who had Hysterosalpingography at radiologic centres in Calabar between July 2013 and June 2014.Structured self-administered questionnaire was used to collect data on demographic profile, pre and post procedure care, pain intensity, its management and women's satisfaction with their care.Data were analyzed using SPSS 16.Statistically significant level was set at <0.5.Results: The analysis was based on 93 returned completed questionnaire.The mean age was 33 ± 6.03 (SD).About half 51(54.8%) of the women had tertiary level of education and 49(52%) were nulliparous.The commonest indication for HSG was infertility 69(74.2%).Pain experienced was rated as severe (7-10) by 29(31.2%)women and moderate (4-6) by 35(37.6%).Pre-procedure analgesics were administered to 45(48.5%)women.Most women were satisfied with their pre 55(59%) and post 50(53.8%)procedure care.However, satisfaction was not significantly influenced by the severity of the pain experienced p=0.4.The study revealed that majority of the women experienced moderate to severe levels of pain and in most cases use of analgesics during HSG procedure was inadequate.Proper and adequate pain management should be integrated into the procedure.
Objectives: To evaluate whether an antenatal and immediate postpartum Edinburgh Postnatal Depression Scale score are predictive of future postpartum depression and observe the correlation in-between the scores and associated risk factors.Methods: Study Design A survey recruiting 345 women from March 2015 to February 2016 using Edinburgh Postnatal Depression Scale for same group of individuals: once before the delivery, during third trimester and twice postpartum in women seeking antenatal service in three major hospital of Jiamusi, Heilongjiang Province, China.We used cut-off score <12 as normal and >13 as risk of depression.The relation between EPDS scores across three stages were assessed using Spearman's correlation, chi-square test was used to examine association of socio-demographic variable and series of logistic regression to examine statistical significance between EPDS scores and associated risk factors.Results: A total of 167 women were studied with average age of 28.31±5.036years.Chi-square test showed that younger (p=0.029),unemployed (p=0.022),primiparous (p=0.039),less educated (p=0.040)women are more prone to perinatal depression.Further Spearman's Non-parametric correlation test showed that postpartum depression has positive correlation with both antepartum (χ 2 =3.977, df=1, p=0.018) and immediate postpartum (χ 2 =3.977, df=1, p=0.046).Binary logistic regression analysis showed that parity (Wald=4.754,p=0.029), and occupation (Wald=3.839,p=0.050) were independent risk factors for antepartum depression.Mode of birth (Wald=4.513,p=0.034), antepartum EPDS score (Wald=3.877,p=0.049) and immediate postpartum EPDS score (Wald=4.038,p=0.044) were independent risk factors for postpartum depression.Conclusions: 1) Higher EPDS score prenatally tends to persist postnatal indicating chances of developing postpartum depression in susceptible individuals.2) Early screening prenatally can guide clinician for active psychological support to susceptible cases thereby minimizing probability of postpartum depressions.
Introduction: Focused antenatal care (FANC), based on fewer goal-oriented visits, is the WHO's recommended care for pregnant women.The objectives of the study were to assess the acceptability of FANC and barriers to its implementation at the hospital.Methodology: This was a cross-sectional study conducted among antenatal clinic attendees between January and March 2011 at Obio Cottage Hospital, Port Harcourt Nigeria.Women were recruited by systematic sampling technique into the study.Questionnaires which sought demographic data, acceptability or rejection of fewer antenatal visits and reasons for decisions were administered to them.Data analysis was performed using Stata 10.Logistic regression analysis was performed to determine associations between demographic parameters and acceptance of FANC.Significance level was set at P<0.05.Results: The analysis was based on 456 out of 500 completed questionnaires.The mean age and parity of the women were 28.6±4.2 and 1±1 respectively.The mean number of preferred visits was 13.4±6.9visits, (IQR 9-18).Reduced visits were acceptable to 75% of the women.The main reason for accepting reduced visits was to save time 164 (40.6%).The main reasons for rejecting reduced visits were for better monitoring of pregnancy (35.1%) and early detection of problems (21.6%).The likelihood of accepting fewer visits increased with age.OR=1.04; 95% CI (1.09-1.10),P=0.01.Conclusion: Focused antenatal care was acceptable to most women in the clinic.The concern it would compromise monitoring of pregnancy should be addressed during health education.
Experience with prior use of contraception may contribute to low uptake rates of modern contraceptives.Objective: The objective of the study was to determine the pattern of current contraception among women with prior contraceptive use.Methods: This was a retrospective study at a tertiary hospital in northern Nigeria.Available client records from the family planning clinic from January 1st, 2000 to March 31st, 2014 were retrieved.Information was collected on demographics, reproductive and contraceptive history.Data was analyzed using SPSS version 15 with significance level at P<0.05.Results: Majority of clients were aged <35 years (71.7%);educated to secondary level (56.9%);Muslims (52.3%) and were spacing (76.2%).Only 2621 (43.8%) had used prior contraception and were more likely to be older, Christians, of higher parity, want no more children and use the intrauterine device (IUD) and implants for contraception (p<0.05).The commonest type of prior contraception was injectables (45.2) and current contraception was IUD.About 42.1% continued their prior contraception.Age, religion, number of living children and reason for contraception were significantly associated with client's choice to continue prior contraception, or to switch to a new form of contraception (p<0.05), while educational status was not (p>0.05).On logistic regression, religion was the only significant variable in the model (p<0.05).Concusion: The preferred form of current contraception among prior contraceptive users in our setting is the intrauterine device, and less Muslims are continuing with their prior choice.
Objective: This study assessed the performance of maternal and child health (MCH) services launched between 2009 and 2012, as a pilot program in two local government areas (LGAs) of Cross River State, Nigeria.Design: Interventions included: rebuilding existing staff capacity; regular supply of vaccines; improved work environment; enhancing community participation in promotion of MCH services; and strengthening the staff size by recruiting medical officers for supervision of activities and prompt response to complications.Methods: Through a 30 cluster sampling technique, a house-to-house survey approach was adopted to sample three categories of participants from 1,171 households at baseline and compare with performance of respondents from 1,299 households at end-line.Results: Results showed a 2.3% (from 11.2% to 8.9%) decrease in under-five mortality.Also, an 8% decrease in immunization rate was observed during the intervention year.There was significant improvement in the population of women who delivered babies at a health centre at baseline (30.7%) relative to the population who delivered during the intervention year (45.2%); showing a 15% impact attributable to the intervention programme.Results also show that the prevalence of diarrhea and malaria among under-fives reduced from 49% to 45% and 62.2% to 52.5% respectively.Primary health centre recorded the most increase in patronage from 21.9% at baseline to 40.7% at end-line.Conclusion: These results suggest the possibility of high rate of success for sustainable Development Goals (SDGs) pertaining to MCH in Nigeria if all stakeholders across the 774 LGAs provide the minimum inputs required to enhance the Primary Health Care (PHC) services.
Background: Since previous studies have shown that self-reports may not be as accurate as medical record data, this secondary analysis investigated the agreement between maternal self-report (SR) and medical record (MR) documentation of pregnancy outcomes (e.g., length of hospitalization, neonatal birth weight, complications) in women with type 1 diabetes (T1D).Methods: An online SR follow-up study to evaluate long-term reproductive-health outcomes was conducted with women who previously participated in randomized controlled trials (RCT) to test a preconception counseling (PC) intervention (READY-Girls) as adolescents and included a matched comparison group of women with T1D who did not receive the PC intervention as teens.Data were collected from SR surveys and MR review.Agreement between SR and MR entries was assessed using kappa coefficients and intra-class correlation coefficients (ICC).Results: Of the 101 women with T1D (51 RCT, 50 matched controls) who were recruited for long-term follow-up (98.0%Caucasian, age range 18-34 years, 82.0% had some college, T1D duration range 0-30 years), 18 (17.8%)reported ever being pregnant and for 8 (47.1%) of these women access to MR was obtained for 14 pregnancies.These women had a mean±SD age of 28.57±1.91 years at entry and duration of T1D of 19.75±5.45years.Perfect agreement (kappa=1.0)was observed between SR and MR for type of delivery and neonatal birth weight >9 pounds.Excellent agreement was observed for neonatal weight (ICC=.951).Lower levels of agreement were found between SR and MR for duration of post-delivery hospitalization [maternal (ICC=.269);neonatal (ICC=.657)]and maternal and neonatal complications (kappa=.639and kappa=.025,respectively).Conclusion: There was excellent agreement for several pregnancy outcomes in these women with T1D.Self-report of pregnancy outcomes should be verified by medical record data, especially time-related variables which could be more difficult to recall, suggesting that method of reporting for these types of variables may not be interchangeable.
The important role of women's health care decision making autonomy in enhancing the well-being of women and their families cannot be undervalued. As such, this study sought to examine the determinants of health Care decision making autonomy among mothers of children less than five years in Ghana using the 2014 Ghana Demographic and Health Survey dataset. In all, 5107 participants responded to the question while 5076 cases were used in the final analysis.
The national figure for skilled attendance at delivery in Nigeria is 38.1 percent, with some observed regional difference.In Anambra State for instance, 87.6 percent of deliveries are taken by skilled providers.However, the efficiency and effectiveness of skilled providers can be hampered by a lack of essential reproductive health drugs, commodities, supplies and equipment.Aim: Of this study is to assess reproductive health care services in Anambra State, Nigeria.Methodology: This is a descriptive study carried out in Anambra state of Nigeria in 2010.A stratified multi stage sampling method was used to select a total of 30 health facilities from both the public and private health facilities in Anambra state of Nigeria.A tertiary health facility in Anambra state was purposively selected and data was analysed using SPSS.Results: A majority (86.7%) of the facilities provided 24 hours services.All, except two of the facilities surveyed were open for services seven days of the week.Maternal health services such as antenatal care, delivery, and postnatal care were available in most of the health facilities studied (93% to 100%).The comprehensive emergency obstetrics care (26.7%) was the most common type of emergency obstetric care.Nurses constituted the most frequent cadre (57.4%) among the various categories of skilled health attendants, followed by medical non specialist doctors (31.1%).Seven facilities used partograph to monitor labour, while 11 health facilities provided adolescent reproductive health care services.HIV/AIDS counselling and STI services (ranging from 90% to 96%) were available in most of the health facilities studied.A majority of deliveries were conducted in the National teaching hospital (36.8%) followed by mission hospital (31.1%), while Mission hospitals reported the highest rate (13.2%) of Caesarean section performed in the health facilities.Obstetric haemorrhage constituted the commonest obstetric complication (88.7%) followed by prolonged/ obstructed labour (6.8%) found in the health facilities studied. Conclusion:The reproductive health services in Anambra state with specific reference to services coverage was found to be near adequate, although there is room for improvement.
BACKGROUND HIV antiretroviral-based intravaginal rings with and without co-formulated contraception hold promise for increasing HIV prevention options for women. Acceptance of and ability to correctly and consistently use this technology may create challenges for future ring-based microbicide trials in settings where this technology has not been introduced. We examined baseline factors associated with enrolling in a contraceptive intravaginal ring study in Kisumu, Kenya and describe notional acceptability (willingness to switch to a contraceptive ring based solely on information received about it). METHODS Demographic, psychosocial, and behavioral eligibility screening of women 18-34 years was undertaken. Testing for pregnancy, HIV, and other sexually transmitted infections (STIs) was also conducted. We compared enrollment status across groups of categorical predictors using prevalence ratios (PR) and 95% confidence interval (CI) estimates obtained from a log-binomial regression model. RESULTS Out of 692 women pre-screened April to November 2014, 463 completed screening, and 302 women were enrolled. Approximately 97% of pre-screened women were willing to switch from their current contraceptive method to use the intravaginal ring exclusively for the 6-month intervention period. Pregnancy, HIV, and STI prevalence were 1.7%, 14.5%, and 70.4% respectively for the 463 women screened. Women 18-24 (PR=1.47, CI 1.15-1.88) were more likely to be enrolled than those 30-34 years of age, as were married/cohabitating women (PR=1.62, CI 1.22-2.16) compared to those separated, divorced, or widowed. In adjusted analyses, sexual debut at less than 17 years of age, one lifetime sexual partner, abnormal vaginal bleeding in the past 12 months, condomless vaginal or anal sex in the past 3 months, and not having a sexual partner of unknown HIV status in the past 3 months were predictive of enrollment. CONCLUSION High notional acceptability suggests feasibility for contraceptive intravaginal ring use. Factors associated with ring use initiation and 6-month use will need to be assessed.
Maternal mortality ratio averages 230 per 100,000 live births in developing countries.Obstructed labour, which is a major cause results from prolonged, neglected labour.The partograph as recommended by the World Health Organization is a graphical tool used to monitor the progress of the first stage of labour, thereby preventing prolonged labour.The partograph has been in use in Ghana since 1989.The study was conducted to ascertain the proportion and correct use of the partograph in monitoring labours in 4 hospitals in a metropolitan area of Ghana.Partograph use for labour monitoring averaged 54% in this study.Midwives formed 90% of birth attendants.For the progress of labour, parameters were monitored to standard in 55-60% of cases.Parameters pertaining to fetal well being were correctly monitored in 30-50%.Maternal well being was monitored to standard in 40% of cases.Apgar scores at 1 and 5 minutes did not differ whether parameters were recorded to standard or not.We conclude from our study that almost half of labour cases were not monitored with the partograph.In those that were monitored with the partograph monitoring to standard was done in 40-60%.Birth attendants either lack the skill in charting the partograph to standard protocols or do not appreciate the use of the partograph in monitoring the progress of labour.In resourcelimited centres in the developing world the use of the partograph to monitor the progress of labour cannot be overemphasized.Skilled attendants at deliveries must therefore be given regular updates on the proper use of the partograph during labours.
Introduction: Lichen sclerosus (LS) is a site, gender and age specific disease that affects the vulvar region of menopausal women. The menopausal transition is characterized by physiologic changes that impact basic processes, such as weight, sleep and drug clearance. Our current pharmacopeia includes drugs that target basic metabolic processes such as cholesterol, sex steroidogenesis and the gut microbiome. Introduction of drugs engages complex pathways that govern bile salt metabolism and the provision of sex steroid substrate. We hypothesized that lichen sclerosus in the vulva may represent an off target effect of pharmaceutical alteration of sex steroid substrate in some women. We compared biometric and drug data in women with lichen sclerosus with an age matched control group without disease. Methods: 43 women with lichen sclerosus underwent chart review to determine BMI, Fitzpatrick level, and pharmaceutical burden. This data was compared to 106 randomly selected age matched controls. Logistic regression was adjusted for age, BMI and Fitzpatrick photo typing. The statistical software was R version 3.0.1. Cases were defined as those with diagnosis claims for lichen sclerosus and were obtained from electronic records in a single private practice. Results: Proton pump inhibitors were noted in 12/43 women (28%) cases and 15/106 (14%) controls: p=0.048, (confidence interval CI=-0.01 to 0.287), adjusted p value 0.33; Hormone therapy 5/43 cases (12%), 26/106 (25%) controls: p value 0.078, (CI=-0.25 to 0.002), adjusted p value 0.02. Antihypertensive medications 17/43 (40%) cases, 29/106 (27%) controls, p value 0.14, (CI=-0.047 to 0.29), adjusted p value 0.8. Statins 16/43 cases (37%), 28/106 controls (26%); p=0.19, (CI=-0.05 to 0.27), adjusted p value 0.89. Average age among cases was 63, average age in the control group was 61. Average BMI was 27.5 in the case group, 23.6 in the control group. Logistic regression analysis was adjusted for age, BMI and Fitzpatrick phototyping. Conclusions: Borderline statistical significance was seen with proton pump inhibitors and hormone replacement therapy (HRT). The significance seen with proton pump inhibitors went away with adjustment for Fitzpatrick, age and BMI. The significance seen with HRT withstood adjustment, with the control group featuring more women on hormone replacement therapy than the case group.
Abstract Background: Men's involvement in family planning is being seen as important in the enlightenment campaign for family planning especially in the rural areas. Objectives: This study
Causes of hematuria outside pregnancy are all implicated in hematuria occurring in pregnancy in addition to pregnancy-specific causes such as pre-eclampsia and placenta percreta. When no organic cause is found, hematuria is classed as Idiopathic. Most authorities believe idiopathic hematuria is due to peculiar changes in the urinary tract resulting from mechanical and hormonal factors related to pregnancy. Such hematuria usually begins in late second trimester through the third trimester and resolves after delivery. A case is presented of idiopathic hematuria in a 33-year old mother of 3 whose hematuria resolved at 34 weeks as abruptly as it had started at 18 weeks in pregnancy. Clinical features suggest the cause to be the Nutcracker phenomenon. The need for noninvasive investigations and conservative management is stressed as well as the rarity of such cases resolving before delivery.
Background Preconception counseling (PC) significantly and inexpensively reduces risks of reproductive-health complications for women with diabetes. Our validated technology-based preconception counseling intervention, READY-Girls, is tailored for female teens with type 1 (T1D) and type 2 (T2D) diabetes and targets decision-making regarding effective family planning and seeking PC. Our teen-focused research was instrumental in changing the American Diabetes Association's Practice Recommendations to specify that preconception counseling should “Start at puberty…”. This directive requires support from well-informed mothers of teens. Our goal is to provide both teen girls and their mothers with preconception counseling knowledge, and provide mothers with sex-communication training. Evaluation should focus on mother-daughter dyads. Purpose This feasibility study explored mother's and daughter's awareness and knowledge of diabetes and pregnancy, and preconception counseling; and compared mother-daughter responses using dyadic analyses. Methods A mixed-method design was conducted with 10 mothers of daughters with T1D. Mothers were given READY-Girls intervention and completed knowledge and support questionnaires. Their responses were compared to those of their daughter's who were participating in a large randomized, control intervention trial with READY-Girls. Results The major theme from one-on-one interviews was, “I know nothing about diabetes/pregnancy risks and PC”. Mother's and daughter's perceptions of having limited knowledge were confirmed by low knowledge scores. Mothers perceived giving higher levels of support compared to their daughter's perceptions of receiving support. Conclusion Mothers can play a vital role in initiating discussions regarding reproductive-health with their daughters and reinforcing preconception counseling. Mother-daughter team approach for starting preconception counseling at puberty in girls with diabetes is feasible. Mother-daughter dyadic analyses can be important to explore possible mediating and moderating roles of mother-daughter communication and support about reproductive health on the relationship between READY-Girls intervention and sustainable outcomes.
