Understanding the impacts of child marriage on the health and well-being of adolescent girls and young women residing in urban areas in Egypt

Background Egypt has made progress in delaying age at marriage, but child marriage continues to be practiced in many places across the country. This study investigates the impacts of child marriage on the health and wellbeing of girls residing in urban Egypt using a multi-method approach. Methods The quantitative component leveraged data from the 2014 Egypt Demographic and Health Survey and focused on (1) reproductive health, (2) maternal health and (3) social outcomes among a subsample of ever-married urban women ages 20–24 (N = 1041). Simple and multivariable logistic regressions were used to estimate prevalence odds ratios and 95% confidence intervals for associations between child marriage and the three sets of outcomes. The qualitative component drew from 11 focus groups, 23 in-depth interviews, and 13 key informant interviews conducted in three urban sites in Egypt. The data was thematically analyzed using a combination of inductive and deductive coding. Results The prevalence of marriage under age 18 was 13.22%. Child marriage was significantly associated with ever use of contraception (Adjusted Odds Ratio (AOR) 2.95 95% CI 1.67–5.19), multiple births (AOR 12.93 95% CI 5.45–30.72), rapid repeat childbirth (AOR 2.20 95% CI 1.34–3.63), and pregnancy termination (AOR 1.89 95% CI 1.11–3.23). Many of these associations disappeared after adjusting for marriage duration. Girls married under age 18 had larger spousal age gaps (AOR 2.06; 95% CI 1.24–3.41) and higher odds of FGM (AOR 2.14; 95% CI 1.11–4.13). They were significantly more likely to report receiving no ANC care (AOR 0.39; 95% CI 0.19–0.80), and less likely to deliver through C-section (AOR: 0.53; 95% CI 0.34–0.83). Consequences emerging from the qualitative data centered around five themes: (1) Access to and use of sexual and reproductive health services; (2) exposure to FGM; (3) marriage and birth registration; (4) marital relations; and (5) relationship with in-laws. Conclusion Findings provide important insights into the practice of child marriage in urban areas in Egypt and illustrate a range of adverse consequences associated with the practice.

Therapeutic opportunities for improving the course of coronavirus disease and reducing the frequency of gestional complications

Research objective: to study the clinical efficacy of the proposed treatment complex in pregnant women with coronavirus disease (COVID-19).Materials and methods. 60 pregnant women with a moderate COVID-19 who were treated at the Kyiv City Center for Reproductive and Perinatal Medicine were examined and selected to assess the effectiveness of the proposed treatment. Pregnant women were divided into 2 clinical groups: the main group (n = 30) were prescribed treatment complex with progestin, the comparison group consisted of 30 pregnant women with COVID-19, who did not differ in age, sex, body mass index and received only standard drug therapy. Given the immunomodulatory effect, micronized progesterone was administered orally 200 mg three times a day immediately after hospitalization for 2 weeks, regardless of gestational age. Clinical manifestations, laboratory and instrumental indicators, duration of oxygen therapy and respiratory support, duration of hospital stay and intensive care were analyzed to assess the treatment complex.Results. Therapeutic complex with progesterone helps to reduce the severity of respiratory disorders in pregnant women with COVID-19, the general condition of pregnant women improves faster and inflammatory changes in the lungs regress. The positive dynamics of pulse oximetry indicators was noted. The frequency of the additional methods of respiratory support and transfer to the intensive care unit were lower, and a more rapid normalization of laboratory parameters was noted. Incidence of gestational complications (threats of pregnancy termination, placental insufficiency, fetal growth retardation and distress, oligohydramnios, premature birth and premature rupture of membranes) was lower against the background of treatment with progesterone, children status was better at birth. The need for oxygen therapy, the length of stay in the intensive care unit and the total length of hospitalization are significantly reduced when progesterone was prescribed for pregnant women with COVID-19.Conclusions. The use of progesterone in pregnant women with coronavirus disease has a stabilizing effect, has no negative side effects which is significantly expands the scope of the proposed therapy in pregnant women at different stages of gestation.

Mercy Procedure or a Nightmare? Attitude towards Pregnancy Termination among Polish University Students

Worldwide, there are about 121 million unintended pregnancies per year. The aim of the study was to assess the attitudes in different groups of students from 40 Polish universities towards pregnancy termination. In total, 9686 university students (20.1% male and 79.9% female) took part in our research. Questions about attitudes towards abortion in all possible circumstances were involved in the survey, which also included a socio-demographic questionnaire. Overall, 94.5% of women and 90.7% of men consider that abortion should be legal in the situation of a threat to the mother’s life, while only 52% of women and 38.7% of men accept it in the case of a hard financial situation for the mother. Most students stand for abortion in the situation of a threat to the mother’s life, in the case of rape, or in the case of a mortal fetus defect. Less than half of the students interviewed consider that abortion should be legal in the case of a hard financial situation for the mother or on the mother’s demand. People who declare a religious affiliation more often disagree with abortion, even in the hardest cases such as a danger to the mother’s life or a mortal fetus defect. The factor that influences the strongest on attitudes towards abortion is being an active Roman Catholic. The majority of students have a pro-choice attitude in respect of pregnancy termination.

Pregnancy associated atypical hemolytic uremic syndrome triggered by massive uterine bleeding after outpatient dilatation and evacuation

Background: Atypical Hemolytic Uremic Syndrome (aHUS) is a renal threatening multi-system disorder with significant hematologic findings of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia. Early recognition and institution of late complement inhibitors can interrupt a cycle of progressive hemolysis and renal injury. Methods: We present an informative case of aHUS triggered by pregnancy termination. Diagnostic, laboratory, and treatment measures are reviewed. Results: Clinical evidence demonstrates immediate improvement in hemolysis, platelet consumption, and acute kidney injury following initiation of eculizumab. Conclusion: Pregnancy is a recognized trigger of aHUS and its proper management requires early recognition and institution of late complement blockade. Genetic testing can be sent for genetic counseling purposes, but initiation of treatment should neither await these results nor be discontinued when high-risk polymorphisms are absent.

Progesterone induced blocking factor in health and disease

The foetus expressing paternal antigens ought to be “rejected” by the maternal immune system. However, the immunological relationship of the mother and the foetus does not follow the rules of transplantation immunology. Maternal immune functions are re-adjusted during pregnancy, to create a tolerant environment for the developing foetus. Progesterone and its downstream mediator; the progesterone induced blocking factor (PIBF) are important in this process. The mRNA transcribed from the PIBF1 gene contains 18 exons, and codes for a 90 kDa protein. The 90 kDa form is associated with the centrosome and plays a role in cell cycle regulation, while smaller isoforms produced by alternative spicing are secreted, and bind to the glycosylphosphatidylinositol (GPI) anchored PIBF receptor. Upon ligation, the former forms a heterodimer with the alpha chain of the interleukin-4 (IL-4) receptor and activates the Janus kinase/signal transducers and activators of transcription (Jak/STAT) pathway, via which, PIBF induces increased production of T helper2 (Th2) cytokines. PIBF regulates natural killer (NK) cytotoxicity, by inhibiting perforin release from the cytoplasmic granules of NK cells. During normal human pregnancy, the serum concentrations of PIBF increase with gestational age, and lower than normal serum levels predict spontaneous pregnancy termination. Depletion of PIBF during the peri-implantation period in mice, results in lower implantation and increased resorption rates, together with increased decidual and peripheral NK activity, downregulation of the genes implicated in T cell activation in CD4+ cells, and Th1 differentiation of the T cells. PIBF is expressed in rapidly proliferating immature cells as well as several tumours, and regulates invasion. The PIBF gene has been identified in the chromosomal region 13q21-q22—which is a common site for somatic deletions in a variety of malignant tumours. These data suggest that PIBF might be involved in tumorigenesis.

Outcomes and Risk Factors for Failed Trial of Labor After Cesarean Delivery (TOLAC) in Women with One Previous Cesarean Section: A Chinese Population-Based Study

Background To evaluate the outcomes and risk factors for trial of labor after cesarean delivery (TOLAC) failure in patients in China. Methods Consecutive patients who had a previous cesarean delivery (CD) and were scheduled for TOLAC were included from 2014 to 2020. Patients who successfully delivered were classified into the TOLAC success group. Patients who were scheduled for TOLAC and had a repeat CD due to medical issues were classified into the TOLAC failure group. Multiple logistic regression analyses were performed to examine the risk factors for TOLAC failure. Results In total, 720 women who had a previous CD and were scheduled for TOLAC were identified and included. The success rate of TOLAC was 84.17% (606/720). Seven patients were diagnosed with uterine rupture, none of whom underwent hysterectomy. Multiple logistic regression analysis showed that the gestational weeks at pregnancy termination (odds ratio [OR] = 3.046, 95% confidence interval [CI]: 0.962-9.642, P = 0.005) and induction of labor (OR = 2.843, 95% CI: 1.571-5.145, P = 0.001) were positively associated with TOLAC failure. In contrast, the thickness of the lower uterine segment (LUS) (OR = 0.215, 95% CI: 0.103-0.448, P = 0.001) was negatively related to TOLAC failure. Conclusions This study suggests that TOLAC is effective in decreasing CD rates in the Chinese population. The gestational weeks at pregnancy termination and induction of labor were positively associated with TOLAC failure. Our findings need to be confirmed in larger samples with patients of different ethnicities.

Methods of detection and isolation of trophoblast cells from trans-cervical specimens – a historical overview

Trophoblast cells can be detected and isolated from the cervical epithelial cells obtained via various techniques of trans-cervical samples collection such as a mucus aspiration, endocervical lavage, or standard cervical brushing in the early first trimester, even from the 5 weeks’ gestation. Isolated fetal cells can be used in the early prediction of fetal sex, prenatal diagnostics of the most common aneuploidies, and any other genetic abnormalities. Nevertheless, the collection of trophoblastic cells has limited efficacy compared to currently used methods of detection of free fetal DNA in maternal circulation or other protocols of invasive prenatal diagnostics available at later stages of pregnancy. In the past years, trans-cervical cell samples were collected mainly in women before planned pregnancy termination. The early trophoblastic cells isolation from women in ongoing pregnancies opens new perspectives for further studies focused on the elucidation of pathophysiology of numerous pregnancy-related complications.