Knowledge and Awareness of Parents Toward Thalassemia

Background: Thalassemias are the most common heritable blood disorders that represents a major public concern. Poor awareness and lack of knowledge lead to increase number of carrier that is a silent reservoir of the disease. To observe the knowledge and awareness level of parents of thalassemic children about the disease. Materials and methods: This descriptive cross-sectional study was conducted in the Thalassemia ward of Chattogram Maa Shishu-O-General Hospital, Chattogram from July 2013 to June, 2014. Parents of 70 thalassemia patients aged 2-18 years interviewed with a formulated questionnaire based on knowledge status and awareness level of parents towards thalassemia. Data were analyzed by both manually and by SPSS-18. Results: Majority of patients were from rural background (54.3%). Only 8.6% parents were consanguineous parents and majority of them completed only secondary education. 44.3% resolved it as inherited disorder. 52.9% resolved thalassemia cannot be cured. Only 24.3% regarded bone marrow transplantation as a measure of cure. More than half (55.7%) did not know how to prevent thalassemia. Only 37.1% knew about prenatal diagnosis. Carrier status of both father and mother were unknown in majority of patients (80%) and screening of sibs was not done at all in a significant number of patients (51.5%). Only 34.3% wanted to do prenatal diagnosis after conception and 65.7% parents were ready to accept therapeutic abortion if fetus would be diagnosed as thalassemia by prenatal diagnosis. Conclusion: Knowledge level and awareness of parents of thalassemic child regarding the disease is unsatisfactory. To reduce disease burden an awareness program regarding the disease and its prevention covering premarital screening, acceptance of prenatal diagnosis and therapeutic abortion is essential. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 12-15

Knowledge and Attitude of Midwives and Obstetricians Towards Therapeutic Abortion Law and its Ethical Pitfalls

Background: Despite the implementation of a safe motherhood program in many countries, unsafe abortion continues to be a matter of reproductive health. Thus, urgent efforts to make abortion legal and safe have been recommended in developing countries. The present study was done to determine the knowledge of midwives and obstetricians about the therapeutic abortion law as well as their attitude about the ethical pitfalls. Methods: In this descriptive knowledge and attitude study, a researcher-made questionnaire was used to gather data, after estimating the appropriate Cronbach’s Alpha coefficient. A total of 162 midwives and obstetricians working in public and private medical centers affiliated to Shahid Beheshti University of Medical Sciences in 2018 were included in the study by convenience sampling method. Results: According to the results, 9.3% of participants had a low level, 72.8% had a moderate level, and only 17.9% had a good level of knowledge. The total mean score of knowledge was 7.17±1.7. The mean score of knowledge in the group of obstetricians (7.60±1.74) was significantly higher than midwives (6.94±1.54), (t=2.29, p=0.024). There was a significant correlation between participants’ age and their knowledge (r=0.912, p=0.001). Also, 47.53% of the participants believed that the therapeutic abortion law has some pitfalls. The most frequent attitude was about the restriction of the therapeutic law up to 19 weeks for fetal indications. Conclusion: The level of participants’ knowledge was low to moderate. The findings indicated the need for training the professional standards related to prenatal genetic screening and therapeutic abortion.

Reproductive History and Pregnancy Incidence of Malian and Beninese Sex Workers Before and Suring Sex Work Practice

BACKGROUND: To reduce maternal mortality, access to family planning and reproductive health care services is a key strategy. Access to and use by marginalized populations pose a substantial challenge. Sex workers in sub-Saharan Africa are a good example. The objective of this study was to describe the reproductive history of female sex workers (FSWs) before and during sex work.METHODS: FSWs aged ≥18 years were recruited in Cotonou (Benin), and Bamako (Mali), to answer a face-to-face questionnaire inquiring on reproductive history. Descriptive analyses were carried out and comparisons made between countries using Pearson chi-square and between the periods before (BSW) and during sex work (DSW) practice within women in each country using McNemar chi-square. In addition, multiple imputations were used to estimate and compare the incidence rate of pregnancy BSW and DSW.RESULTS: Mean age was 26 years in Mali (n=322) and 35 years in Benin (n=330). More women had at least one pregnancy BSW compared to DSW in both Mali (62.1% vs 33.5%) and Benin (91.2% vs 32.7%). The pregnancies occurring DSW had lower livebirth rates (57.9% vs 74.7% - Mali, 17.6% vs 60.6% - Benin) and ended more often with a therapeutic abortion, DSW compared to BSW, especially in Benin (65.2% vs 25.6%). The level of complications associated with therapeutic abortion was high, both DSW (23%) and BSW (20%). The incidence rate of pregnancy was about twice lower DSW compared to BSW [incidence rate ratio (IRR): 0.49; 95% confidence interval (95%CI): 0.37-0.66 in Mali and IRR: 0.45; 95% CI: 0.32-0.63 in Benin].CONCLUSION: In both Benin and Mali, FSWs had more pregnancies during the period preceding sex work practice, about twice more than during sex work when considering the differences in incidence rates. Single mothers need to be supported to avoid sex work as a financial solution. On the other hand, the reproductive needs of FSWs need to be acknowledged to reduce maternal mortality within this marginalized population. It is of paramount importance that interventions remain focused on reproductive health and prevent unwanted pregnancies, answer contraceptive needs and provide safe therapeutic abortions.

Pulmonary hypertension in pregnancy

Pulmonary hypertension is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest as assessed by right heart catheterisation. Pulmonary hypertension in pregnancy is known to be associated with significantly high morbidity and mortality rate which ranges between 30% and 56%. So during pregnancy, efforts to be made to diagnose common medical ailments that can be complicated by pulmonary hypertension. Bedside 2D Echo and thoracic ultrasound are the strongly recommended in these patients to diagnose early and prevent the devastating complications. Relevant blood investigations need to be sent to diagnose the underlying etiology and to assess the prognosis. Cardiac catheterization is the gold standard investigation of choice for pulmonary hypertension. But it is 1 performed in very few cardiac centres in developing countries. In India diagnosis largely depends on echocardiography. It should be made clear to women at the time of their PAH diagnosis that pregnancy is not recommended due to the high maternal and fetal risks. If a woman with known PHT become pregnant, counselling should be given for therapeutic abortion. If they are willing for therapeutic abortion, it should be done before 22 weeks of gestation. All women with PHT should be initiated on PAH specific therapies (prostanoids, ccbs, phosphodiesterase inhibitors) except endothelin receptor blockers as it is teratogenic. Pregnancy in PAH is difficult to manage and needs mutidisciplanary team. Pregnancy is not recommended in women with PAH and appropriate counselling to be done to the mother and their relatives.

Centrality of Pregnancy and Prenatal Attachment in Pregnant Nulliparous After Recent Elective or Therapeutic Abortion

BackgroundThere are two types of voluntary interruption of pregnancy: elective and therapeutic abortion. These forms are different for many reasons, and it is reasonable to assume that they can have negative consequences that can last until a subsequent gestation. However, no study has analyzed the psychological experience of gestation after a previous abortion, distinguishing the two forms of voluntary interruption of pregnancy.ObjectiveThis study aims to explore the level of prenatal attachment and centrality of pregnancy in nulliparous low-risk pregnant women with a recently (<3 years) previous elective or therapeutic abortion.MethodsA total of 34 nulliparous pregnant women with a history of abortion (23 elective and 11 therapeutic abortion), aged from 27 to 48 years (mean = 37.17), were recruited in the maternity ward of a public hospital of the metropolitan area of Tuscany and Lombardy (Italy) during the third trimester of gestation. The participants filled out a battery of questionnaires aimed at assessing prenatal attachment and centrality of pregnancy.ResultsAnalyses of variance showed that women with a history of elective abortion reported a higher centrality of pregnancy than women with a past therapeutic abortion. On the contrary, women with a past therapeutic abortion reported higher prenatal attachment.ConclusionElective and therapeutic abortions are different experiences that impact the way women experience a subsequent pregnancy. Future research should further investigate the psychological experience of gestation after abortion.

The risk of cardiovascular disease in women after miscarriage, stillbirth, and therapeutic abortion: a protocol for a systematic review and meta-analysis

Background Cardiovascular disease (CVD) is the leading cause of death in women, responsible for approximately a third of all female deaths. Pregnancy complications are known to be associated with a greater risk of incident CVD in mothers. However, the relationships between pregnancy loss due to miscarriage, stillbirth, or therapeutic abortion, and future maternal cardiovascular health are under-researched. This study seeks to provide an up-to-date systematic review and meta-analysis of the relationship between these three forms of pregnancy loss and the subsequent development of CVD. Methods This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist (PRISMA) and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) Checklist. A systematic search will be undertaken using publications identified in MEDLINE (PubMed), Scopus, Web of Knowledge, the CINAHL Nursing Database, and the Cochrane Library. The eligibility of each publication will be determined by predefined selection criteria. The quality of the included studies will be rated using the Newcastle-Ottawa Scale. Pooled measures of association will be computed using random-effects model meta-analyses. Between-study heterogeneity will be assessed using the I2 statistic and the Cochrane χ2 statistic. Small study effects will be evaluated for meta-analyses with sufficient studies through the use of funnel plots and Egger’s test. Discussion The results of this systematic review will discuss the long-term risks of multiple types of cardiovascular disease in women who have experienced miscarriage, stillbirth, and/or therapeutic abortion. It will contribute to the growing field of cardio-obstetrics as the first to consider the full breadth of literature regarding the association between all forms of pregnancy loss and future maternal cardiovascular disease. Systematic review registration PROSPERO registration number [CRD42020167587]

A Survey on Leading Indications of Fetomaternal Therapeutic Abortions in Yazd: A Cross Sectional Study

Background: Congenital abnormalities are diseases that occur during fertilization of the egg or development of the fetus and lead to disability, illness or mortality. This study aimed to investigate the prevalence and the factors associated with fetomaternal abnormalities in therapeutic abortions. Methods: This cross-sectional study was performed on 391 mothers referred to Yazd legal medicine organization for pregnancy termination from March 2017 to March 2020. The data about their fetuses were extracted and recorded. Results:The most common fetal abnormalities observed in this study were central nervous system abnormalities (21.1%), subsequently chromosomal disorders (16.8%), hydropsfetalis, cystic hygroma (15.9%), syndromic disorders (10.1%), single-gene disorders (8.1%), dysmorphology (8.1%), musculoskeletal disorders (7.8%), and cardiovascular disorders (7.2%). Conclusion: The main maternal causes for therapeutic abortion were cardiovascular disease, kidney diseases and cancers, while the most common fetal disorders leading to therapeutic abortion were central nervous system disorders such as anencephaly.