46, XY DSD (Disorder of Sex Development) : Diagnosis dan Tatalaksananya.

Disorder of Sex Development (DSD) is a congenital disorder that occurs in the development of chromosomes, gonads, and internal or external genital organ. DSD of 46 XY is a condition where the children with XY genotype is not able to have complete virilization of external genital. Determination phase is an initial phase of reproductive system development. Disruption of this phase may potentially lead to DSD. Optimal care for children with Disorder of Sex Development requires a multidisciplinary team starting since neonatal period. Family and pregnancy history, complete physical examination and assessment of genital organ are the first step of ensuring the diagnose. Management of children with DSD are focusing on gender determination, hormone support therapy and surgical management. On the other hand, Children with XY genotype should be raised as a boy however if there is no responsive evidence in administration of androgen the children should be raised as a girl. Subsequent to prescribe the gender of the children, surgical management is a required treatment for removing unnecessary genital afterward. Keywords: Disorders of Sex Development, DSD, 46 XY DSD

The 12-year Experience - A Retrospective and Hospital-based Study of Gestational Trophoblastic Neoplasia in the Northwest of China

Purpose: To analyze clinical features of gestational trophoblastic neoplasia (GTN) patients who received initial treatments at the First Affiliated Hospital of Xi'an Jiaotong University.Methods: The patient record system was screened to extract clinical data including demographics, pregnancy history, diagnosis, staging, prognostic score, treatment. Student t test, x2 test, and Fischer’s exact test were used.Results: This study included 387 patients with GTN. Patients were divided into 2009-2014 and 2015-2020 groups, including 177 and 210 cases, respectively. Patients in 2015-2020 group had higher parity than those in 2009-2014 group (1.2±1.2 vs 0.9±1.2, P=0.030). Nullípara (73 [41.2%] vs 65 [31.0%]) and primípara (71 [40.1%] vs 84 [40.0%]) were more frequently seen in 2009-2014 group than those in 2015-2020 group, but multípara (61 [29.0%] vs 33 [18.7%]) was more common in 2015-2020 group (P=0.028). For patients in 2015-2020 group, more patients demonstrated 1 or more metastases (107 [51.0%] vs 63 [35.6%], P=0.014) than those in 2009-2014 group. Patients in 2015-2020 group had more distant invasions affecting more organs, including lungs (76 [36.2%] vs 52 [29.4%]) and lungs combining with other organs (31 [14.8%] vs 11 [6.2%]), than those in 2009-2014 group (P=0.003).Conclusions: Although patients diagnosed with GTN between 2015 to 2020 is associated with higher parity, more children, and more distant metastases, we cannot simply conclude that clinical features of GTN has changed over time.

1387 Audit of Pregnancy Status Documentation in Emergency Admissions to A Tertiary Colorectal Surgery Unit

Aim Documenting pregnancy status (PS) is an important component of the medical assessment of all females of reproductive age (FRA), defined as age 16-55 years old when admitted to hospital. This audit aims to determine the rate of documentation of PS amongst FRA admitted to a tertiary colorectal surgical unit via the surgical admissions unit (SAU) or transfer from other departments between 01/10/20 – 13/11/20. Method A complete documentation of PS comprises of results of urine or serum (β-hCG) and relevant gynaecological history (i.e., last menstrual period and any contraceptive use) clearly reported in the admission clerk-in. Patients with presenting complaint excluding abdominal pain, current pregnancy, history of hysterectomy or sterilisation procedures were excluded. Results During the audit duration, 29 FRA were admitted of which 13 (44.8%) were included for analysis. Of patients included, 4/9 (44.4%) and 1/4 (25.0%) admitted via SAU or transferred from other departments respectively had a past colorectal history. 4 (30.8%) had complete documentation of PS of which, 3 (75.0%) were patients transferred from other departments. Conclusions Low rates of documentation of PS especially amongst emergency admissions via SAU, is possibly associated with a narrow differential diagnosis influenced by pre-existing colorectal history. This audit did not look at PS documentation prior to any subsequent surgical intervention. A re-audit following the implementation of a guidance poster in SAU is currently underway.

RISK FACTOR OF ECTOPIC PREGNANCY BY USING LITERATURE REVIEW METHOD

Background: Ectopic pregnancy is a pregnancy outside the uterus, embryo could attached to thefallopian tube, ovary cervix or cervix. Around 85-90% incidence of ectopic pregnancy is found inmultigravid women. According to data from the Health Office, maternal mortality in 2017 tendsto increase in the last two years. Not only it is a major predictor of mortality and morbidity inpregnant women, but individuals with a history of ectopic pregnancy have a greater risk. Thepurpose of this research was to determine the risk factors that cause ectopic pregnancy by usingliterature studies review. Method:This study used a systematic review of articles that publishedbetween 2013-2020 in the Science Direct, Scopus and Google Scholar. 10 articles that meet theinclusion and exclusion criteria, included as a sample for further review. The results regarding torisk factors that caused ectopic pregnancy in each article were systematically synthesized. Results:Risk factors found to be significantly associated with the incidence of ectopic pregnancy in thearticle were age (2), infertility (2), IUD (3), PID (3), Ectopic Pregnancy History (5), Progestine Pills (2), History of Abortion (1), Smoking (3). Conclusions: age, infertility, IUD, PID, history of ectopic pregnancy, progestine pill, History of abortion, and smoking were risk factors that hadsignificant relationship with the incidence of ectopic pregnancy.

Determinan Kejadian Stunting pada Balita

Determinant of stunting incident in Saronggi Subdistrict, Sumenep Regency. The prevalence of stunting of toddlers in East Java is higher than the average prevalence at the national level of 32.8%. In 2020, the Health Office of East Java Province mentioned that the prevalence of stunting in SumenepRegency reached 170 toddlers spread across 14 villages. The highest prevalence of stunting was found in NongGunongSubdistrict which reached 6.02% and in SaronggiSubdistrict which reached 4.05%.This study aims to analyze the influence of maternal pregnancy history, nutritional status of children, parenting patterns, maternal knowledge and history of exclusive breastfeeding to stunting.This research is analytical research with case-control design. The samples used were 30 mothers with toddler cases and 30 mothers with control toddlers.Maternal pregnancy history, child nutrition status, parenting patterns, maternal knowledge and exclusive breastfeeding have a significant influence on stunting incidents in Saronggi Subdistrict, Sumenep Regency.Mothers must meet the intake of good nutrition, provide exclusive breastfeeding and good parenting patterns and health officials must improve health education programs, especially about stunting so that maternal knowledge can be improved and stunting problems can be addressed immediately.

Impact of being an adolescent mother on subsequent maternal health, parenting, and child development in Kenyan low-income and high adversity informal settlement context

Background Women who have experienced adolescent pregnancy and early motherhood are disproportionately affected in terms of their health and parenting capabilities, as well as their offspring’s health. Guided by Stress Process and Social Determinants of Health (SDH) Frameworks, which posit that multiple sources of stressors and structural determinants of adolescent pregnancy influence adolescent mothers’ subsequent health and quality of parenting (Xavier et al 2018, McLoyd 1998, Conger et al 2010, Gipson et al 2008). These dynamics then further impact offspring’s outcomes. Using an Integrated Stress-SDH Process for Health Disparities model and we test on whether early motherhood is associated with and subsequent maternal and child health from two informal settlements in Nairobi. Methods A cross-sectional design with 394 mothers of 2–16 years old children who sought maternal and child health services at Kariobangi and Kangemi public health centers between October 2015 to April 2016 were recruited. Participating mothers were asked questions related to their adolescent pregnancy history, their current health, wellbeing, and parenting practices, and their child’s health. Structural equation modeling (SEM) was utilized to examine hypothesized mediational pathways that adolescent pregnancy history has negative influences on women’s health and parenting during adulthood, which also influence their child’s health and development. Results Our study supports that women with a history of adolescent motherhood have poor physical and mental health outcomes as adults after adjusting for demographic confounders. SEM results partially support the Stress-SDH Process model that history of adolescent pregnancy had negative consequences on women’s adulthood health, which also negatively impacted offspring’s physical and mental health. Conclusion Consistent with the Stress Process and SDH literature, we found consistent cross-cultural literature that adolescent pregnancy set the stage for, subsequent poor maternal health and child outcomes. Although history of adolescent pregnancy and motherhood was not necessarily associated with negative parenting, consistent with parenting literature, negative parenting was associated with poor child mental health. Findings suggest importance of providing integrated care that address health and parenting needs to optimize offspring’s development in instances of early motherhood.

Prevalence of Pregnancy among Adolescent Livin with HIV in Muhoroni Sub County Kisumu County, Kenya

Background: HIV-infected pregnant and breastfeeding adolescents are a particularly vulnerable group that require special attention and enhanced support to achieve optimal maternal and infant outcomes. Aim: To find out the prevalence of pregnancy in adolescent living with HIV, review evidence about Antenatal Care (ANC) service delivery and outcomes for HIV-infected pregnant adolescents in Muhoroni Sub County. Setting: The project was conducted in Muhoroni Sub County, Kisumu County, Kenya Method: Questionnaire was used on the total 98 girls who were on care at the Referral center containing the adolescents’ center which was Masogo subcounty hospital and Muhoroni County Hospital within the sub-county to obtained the results. Result: Of the 98 girls 25 (25.5%) hard pregnancy history in which 10 (10.2%) hard knowledge on PMTCT, while only 4 (4.1%) were having knowledge on PNS and lastly all the pregnant girls were having knowledge on both ANC and Drug adherence and only 10 (10.2%) pregnancy were planned while 15 (15.3%) were unplanned in which 10 (10.2%) pregnancy were aborted and 11 (11.2%) were delivered safely while 4 (4.1%) of the girls were currently pregnant. Conclusion: Reasons for the poor outcome among adolescents in ANC and PNS need to be further explored and addressed, there is enough evidence that immediate action is needed to address the unique needs of this population. Such changes could include integration of adolescent-friendly services into PMTCT settings and PNS among the HIV*infected adolescents youths who are sexually active with enhanced retention and follow-up activities.

Termination of pregnancy data completeness and feasibility in population-based surveys: EN-INDEPTH study

Background Termination of pregnancy (TOP) is a common cause of maternal morbidity and mortality in low- and middle-income countries. Population-based surveys are the major data source for TOP data in LMICs but are known to have shortcomings that require improving. The EN-INDEPTH multi-country survey employed a full pregnancy history approach with roster and new questions on TOP and Menstrual Restoration. This mixed methods paper assesses the completeness of responses to questions eliciting TOP information from respondents and reports on practices, barriers, and facilitators to TOP reporting. Methods The EN-INDEPTH study was a population-based cross-sectional study. The Full Pregnancy History arm of the study surveyed 34,371 women of reproductive age between 2017 and 2018 in five Health and Demographic Surveillance System (HDSS) sites of the INDEPTH network: Bandim, Guinea-Bissau; Dabat, Ethiopia; IgangaMayuge, Uganda; Kintampo, Ghana; and Matlab, Bangladesh. Completeness and time spent in answering TOP questions were evaluated using simple tabulations and summary statistics. Exact binomial 95% confidence intervals were computed for TOP rates and ratios. Twenty-eight (28) focus group discussions were undertaken and analysed thematically. Results Completeness of responses regarding TOP was between 90.3 and 100.0% for all question types. The new questions elicited between 2.0% (1.0–3.4), 15.5% (13.9–17.3), and 11.5% (8.8–14.7) lifetime TOP cases over the roster questions from Dabat, Ethiopia; Matlab, Bangladesh; and Kintampo, Ghana, respectively. The median response time on the roster TOP questions was below 1.3 minutes in all sites. Qualitative results revealed that TOP was frequently stigmatised and perceived as immoral, inhumane, and shameful. Hence, it was kept secret rendering it difficult and uncomfortable to report. Miscarriages were perceived to be natural, being easier to report than TOP. Interviewer techniques, which were perceived to facilitate TOP disclosure, included cultural competence, knowledge of contextually appropriate terms for TOP, adaptation to interviewee’s individual circumstances, being non-judgmental, speaking a common language, and providing detailed informed consent. Conclusions Survey roster questions may under-represent true TOP rates, since the new questions elicited responses from women who had not disclosed TOP in the roster questions. Further research is recommended particularly into standardised training and approaches to improving interview context and techniques to facilitate TOP reporting in surveys.

Chance of live birth: a nationwide, registry-based cohort study

STUDY QUESTION Does the sequence of prior pregnancy events (pregnancy losses, live births, ectopic pregnancies, molar pregnancy and still birth), obstetric complications and maternal age affect chance of live birth in the next pregnancy and are prior events predictive for the outcome? SUMMARY ANSWER The sequence of pregnancy outcomes is significantly associated with chance of live birth; however, pregnancy history and age are insufficient to predict the outcome of an individual woman’s next pregnancy. WHAT IS KNOWN ALREADY Adverse pregnancy outcomes decrease the chance of live birth in the next pregnancy, whereas the impact of prior live births is less clear. STUDY DESIGN, SIZE, DURATION Nationwide, registry-based cohort study of 1 285 230 women with a total of 2 722 441 pregnancies from 1977 to 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS All women living in Denmark in the study period with at least one pregnancy in either the Danish Medical Birth Registry or the Danish National Patient Registry. Data were analysed using logistic regression with a robust covariance model to account for women with more than one pregnancy. Model discrimination and calibration were ascertained using 20% of the women in the cohort randomly selected as an internal validation set. MAIN RESULTS AND THE ROLE OF CHANCE Obstetric complications, still birth, ectopic pregnancies and pregnancy losses had a negative effect on the chance of live birth in the next pregnancy. Consecutive, identical pregnancy outcomes (pregnancy losses, live births or ectopic pregnancies) immediately preceding the next pregnancy had a larger impact than the total number of any outcome. Model discrimination was modest (C-index = 0.60, positive predictive value = 0.45), but the models were well calibrated. LIMITATIONS, REASONS FOR CAUTION While prior pregnancy outcomes and their sequence significantly influenced the chance of live birth, the discriminative abilities of the predictive models demonstrate clearly that pregnancy history and maternal age are insufficient to reliably predict the outcome of a given pregnancy. WIDER IMPLICATIONS OF THE FINDINGS Prior pregnancy history has a significant impact on the chance of live birth in the next pregnancy. However, the results emphasize that only taking age and number of losses into account does not predict if a pregnancy will end as a live birth or not. A better understanding of biological determinants for pregnancy outcomes is urgently needed. STUDY FUNDING/COMPETING INTEREST(S) The work was supported by the Novo Nordisk Foundation, Ole Kirk Foundation and Rigshospitalet’s Research Foundation. The authors have no financial relationships that could appear to have influenced the work. TRIAL REGISTRATION NUMBER N/A.