Clinical and statistical assessment of the reproductive health of fertilized women in the Tyumen region and the risks of miscarriage in Western Siberia

Introduction. Loss of pregnancy remains an extremely acute public health problem today. Live birth accounts for only 30% of gestational outcomes, all other pregnancies that occur end in reproductive losses: 30% – implantation, 30% – postimplantation, 10% – spontaneous miscarriages. In conditions of declining birth rates, reducing reproductive losses is the most important element of the state’s demographic policy.Аim. Тo assess the reproductive health of women of fertile age in the Tyumen region, registered in antenatal clinics and other medical institutions in connection with pregnancy, as well as the risks associated with an increase in the frequency of diseases endemic for the West Siberian region.Materials and methods. The study used data from federal statistical observation. Statistical analysis of the data was carried out using the statistical program Statistica (version 13.0). Quantitative features are described by absolute and relative (percent) indicators. The difference is considered significant at p < 0.05. Results. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. The incidence of HIV and hepatitis C among pregnant women for five years and for each of the given nosologies exceeds 1% of the number of patients admitted under the supervision of health care facilities. At the same time, since 2018, the incidence of ectopic pregnancy associated with HIV has significantly increased (p >< 000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. >< 0.05.Results. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. The incidence of HIV and hepatitis C among pregnant women for five years and for each of the given nosologies exceeds 1% of the number of patients admitted under the supervision of health care facilities. At the same time, since 2018, the incidence of ectopic pregnancy associated with HIV has significantly increased (p < 000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. >< 000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p < 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control.Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate.

FIRST TRIMESTER MEDICAL ABORTION PRACTICE IN NORTH EAST INDIA

Objectives: This study is to compare the efficacy of Mifepristone combined with Misoprostol (Prostaglandin) administered through vaginal and sublingual route in termination of pregnancy of ≤63 days. Methods: Randomized comparative study comprised of 140 pregnant women of ≤63 days gestational age was conducted at Zoram Medical College, Mizoram. Women in group A received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol sublingually 36–48 h later, whereas women in group B received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol vaginally 36–48 h later. A 2nd dose of 400 μg Misoprostol was given through the same route if abortion process does not start within 4 h. All women who aborted were seen at follow-up and ultrasound pelvis done to confirm complete expulsion of products of conceptions. Results: The total number of primigravida was 34 (24.3%) and multigravida was 106 (75.7%). Complete abortion was seen in 91.4% and 94.28% of per sublingual and per vaginal route group, respectively (p = 0.51). Failure of abortion was 8.57% and 5.71%, respectively, in per oral and per vaginal route (p = 0.51). Conclusion: Sublingual and per vaginal misoprostol after pre-treatment with mifepristone are both an effective method for termination of pregnancy for gestational age of 63 days or less, but the tolerance for sublingual misoprostol was poorer.

An audit of MTP in women with high-risk pregnancy

Background: The women who have been pregnant more than four times are fewer than 18or over 35-years-old, or have at least one medical issue before or during pregnancy, the pregnancy is considered high-risk. Increased maternal and foetal mortality and morbidity are linked to these risk factors. MTP in itself is a blind and risky procedure and performing it in High Risk Pregnancy (HRP) is a challenge for obstetrics and gynecology personnel. When performed with all pre, intra and post-op precautions, results are good and patient-friendly. Aims and Objectives: Aims of the study were to calculate the number, high-risk factors, method used, and its outcome of MTP in HRP. Materials and Methods: The present study was a retrospective observational study done at QMH, KGMU, Lucknow performed on subjects admitted for MTP from January 2018 to December 2018. Total admitted patients seeking MTP were 450 out of which 93 belonged to High-Risk Group who underwent surgical and medical abortion accordingly. All precautions and norms defined by Govt. of India were taken care of. Cases were evaluated on the basis of high-risk factors- Age, parity, obstetrical and medical illnesses, and interval since last delivery. Results: Out of 93 high-risk cases, 88 cases were of 1st trimester and 5 were of 2nd trimester abortion. Six cases required suction evacuation while seven cases were managed medically using medical abortion kit. Contraception was given to all subjects according to their needs. Seventy-one women were of more than 35 yrs, while two were teenagers. 21 women were grand multipara. Women of obstetrical risk were 17 while the rest were having medical illnesses. Conclusion: This study concludes that there are a large number of high-risk groups for MTP again showing unmet need and lack of specialized counseling of HR patients according to their mental and physical condition. Early recognition of pregnancy and timely intervention can be lifesaving in these women and proper contraceptive counseling is required to prevent future pregnancies.

Immediate IUD insertion after second trimester abortion: implications for service delivery

Background The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrauterine device (IUD) after medical abortion (MA) at 17-20 gestational weeks showed that immediate insertion resulted in higher IUD use at 6 weeks postabortion, but that expulsion rates were significantly higher than for delayed insertion. This study aims to explore barriers, facilitators, and context-specific factors relevant to the implementation of immediate IUD provision after second trimester medical abortion. Methods We performed a qualitative study alongside the RCT in which we conducted in-depth interviews with 14 staff providing healthcare to study participants and 24 study participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the impact of context and supplementary trial activities on service provision. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text. Results Contraceptive counselling at the abortion facility by a study nurse improved knowledge, corrected misconceptions, and increased demand for the IUD postabortion. Women expressed a clear preference for immediate insertion. Convenience, protection from pregnancy and privacy issues were paramount and women expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to provide contraception as allocated during the trial. Conclusions Women and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure timely insertion postabortion, continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence.

A qualitative study of abortion care providers’ perspectives on telemedicine medical abortion provision in the context of COVID-19

BackgroundTelemedicine for medical abortion care was rapidly introduced in Great Britain in response to the COVID-19 pandemic. A growing body of literature demonstrates that telemedicine abortion care is safe, effective and highly acceptable to patients. Less is known about the perspectives of abortion care providers (ACPs).MethodsQualitative research within the telemedicine abortion service in Lothian (Edinburgh and surrounding region), UK. We conducted qualitative in-depth interviews with ACPs between May and July 2020 (doctors, n=6; nurses, n=10) and analysed the data thematically.ResultsWe present three themes from our qualitative analysis: (1) Selective use of ultrasound – the move away from routine ultrasound for determination of gestational age was generally viewed positively. Initial anxiety about non-detection of ectopic pregnancy and later gestations was expressed by some ACPs, but concerns were addressed through clinical practice and support structures within the clinic. (2) Identifying safeguarding issues – in the absence of visual cues some ACPs reported concerns about their ability to identify safeguarding issues, specifically domestic violence. Conversely it was acknowledged that teleconsultations may improve detection of this in some situations. (3) Provision of information during the consultation – telephone consultations were considered more focused than in-person consultations and formed only part of the overall ‘package’ of information provided to patients, supplemented by online and written information.ConclusionsACPs providing telemedicine abortion care value this option for patients and believe it should remain beyond the COVID-19 pandemic. Safeguarding patients and the selective use of ultrasound can be initially challenging; however, with experience, staff confidence improves.

Danggui-Yimucao Herb Pair Can Protect Mice From the Immune Imbalance Caused by Medical Abortion and Stabilize the Level of Serum Metabolites

Unintended pregnancy is a situation that every woman may encounter, and medical abortion is the first choice for women, but abortion often brings many sequelae. Angelica sinensis Radix (Danggui) and Leonuri Herba (Yimucao) are widely used in the treatment of gynecological diseases, which can regulate menstrual disorders, amenorrhea, dysmenorrhea, and promote blood circulation and remove blood stasis, but the mechanism for the treatment of abortion is not clear. We determined the ability of Danggui and Yimucao herb pair (DY) to regulate the Th1/Th2 paradigm by detecting the level of progesterone in the serum and the expression of T-bet and GATA-3 in the spleen and uterus. Then, we detected the level of metabolites in the serum and enriched multiple metabolic pathways. The arachidonic acid pathway can directly regulate the differentiation of Th1/Th2 cells. This may be one of the potential mechanisms of DY in the treatment of abortion.