Pregnancy Reverses Abdominoplasty Aesthetic Outcome: Myth or Misconception? A Cross-Sectional Study

Background The common recommendation for female abdominoplasty candidates is to conclude family planning before undergoing the procedure. However, there is no evidence demonstrating correlation between aesthetic outcome compromise, risk for fetal complications or risk for maternal complications when abdominoplasty is followed by pregnancy. Objectives The aim of this study was to evaluate maternal, fetal, and aesthetic outcomes among pregnant females with a history of abdominoplasty. Methods We conducted an online survey among women who became pregnant after having an abdominoplasty. Participants were recruited via social media groups related to abdominoplasty. The survey included demographic, aesthetic outcome and pregnancy related questions. We used a score from 1 (no effect) to 10 (worst effect) to assess abdominal aesthetic outcome compromise. Results Thirty-two participants completed the online survey, 15 (46.8%) of which reported their pregnancy was unplanned. Pregnancy related findings included five (15.6%) late premature births (between gestational week 35 and 37), one miscarriage and one emergency C-section. Compromised aesthetic outcomes following pregnancy included new abdominal stretch marks (50%, N=16), widened abdominoplasty scar (28%, N=9), abdominal skin excess (37.5%, N=12) and abdominal bulge (25.8%, N=8). A new hernia was reported by two participants (6.3%). The average abdominal aesthetic severity score was 2.7 (range 1-8), and only three scores were above 5 (9.3%). Two women (6.2%) underwent abdominoplasty revision, and eighteen (56.2%) stated they would recommend others to undergo abdominoplasty before pregnancy (56.3%). Conclusions Our survey shows there is room to reevaluate whether future pregnancy should be considered a relative contraindication for undergoing abdominoplasty.

MATERNAL AND FETAL OUTCOME IN RH NEGATIVE PREGNANCY

INTRODUCTION- When Rh negative maternal blood is exposed to Rh positive fetal blood (RBC) in maternal circulation, antibodies against Rh (D) may develop in the mother. These Rh (D) antibody, once produced, remains in the woman's circulation and poses the threat of hemolytic disease (due to destruction of fetal RBCs ) for subsequent Rh-positive fetuses and this event leads to alloimmunization. Coombs test is the most common method to detect alloimmunization done during pregnancy (ICT) and in postnatal period (DCT). Rhesus (Rh) isoimmunization is an important clinical entity in India and other developing countries, which is responsible for fetal anemia and hydrops fetalis, and if not treated, it can result in intrauterine fetal demise, thus timely diagnosis follow-up and management of Rh –ve pregnancy is must. MATERIAL AND METHODS- st th This is a retrospective observational study, done in a private hospital, Gwalior (M.P.), form 1 Jan. 2018 to 30 June 2020. 88 women with Rh-ve pregnancy were studied during this period, Data was recovered from labor room record, OT, PNC, post operative wards for maternal outcome a SNCU for neonatal outcome. RESULTS- In our study the most common age group was 21-25 years (62.5%), most of the patient were Primigravida(42.4%), most of them were unbooked (65.90%) and from Rural area (72.72%). The most common blood group Rh- was o-ve (53.40%). Only 2 patients had positive indirect coombs test. Most of the patients delivered normally, only (28.40%)Patients delivered by LSCS. Preeclampsia was the most common maternal complication found in Rh- Patient (12.5%). 96.59% of Neonates were live born. 2.27% were fresh still born and 1.13% were macerated still born. 24 babies were admitted in SNCU. The most common cause of admission was neonatal jaundice (66.66%). The most (76.13%) of the babies had serum bilirubin level between 10-15 mg/dl. CONCLUSION- We concluded that Rh isoimmunization leads to increased perinatal morbidity for perinatal morbidity. The obstetrician and maternity staff should be familiar to diagnosis and management of with Rhesus incompatibility and they should counsel the Rh negative patient about Importance of checking blood group and Rh type in pregnancy and should educated them about importance of Rh prophylaxis and Hemolytic diseases of fetus and newborn risks of present and future pregnancy. During past few decades there had been major advances in the medical treatment for Rh negative pregnancy.

Changing lives, dynamic plans: Prospective assessment of 12-month changes in pregnancy timing intentions and personal circumstances using data from HER Salt Lake

Objectives To explore the association between changes in personal circumstances and shifts in pregnancy intentions. Study design New start contraceptive clients, who desired to prevent pregnancy for at least one year enrolled in the survey arm of the HER Salt Lake Contraceptive Initiative (September 2015 –March 2017) and responded to the question “What are your future pregnancy plans?” at enrollment and 12-month follow-up. We estimated multivariable binary logistic fixed-effects regressions to examine the association between changes in personal circumstances and a change from never desiring a pregnancy at enrollment to considering one in the future at 12-month follow-up. Results The majority of the 2825 participants (2246, 79%) maintained their pregnancy timing intention over the 12-month study period. Multivariable analyses of the 208 participants who changed from never desiring a pregnancy to considering pregnancy in the future at 12-month follow-up indicated that entering cohabitation (aOR 3.14, 95% CI 1.30–7.58), increased household income (aOR 1.06, 95% CI 1.00–1.13), and changes from unemployment to full-time employment (aOR 5.94, 95% CI 1.29–27.36) are associated with increased the odds of desiring a future pregnancy after never wanting one a year prior. Conclusions Pregnancy intentions are dynamic over twelve months and covary with partner status, household income, and employment status. Pregnancy intentions are linked to changes in life circumstances. Health care providers need to frequently assess pregnancy intentions and resulting contraceptive or preconception needs.

Determinants of Intention To Use Maternity Waiting Homes in Tanzania: A Study Based on Women Using MWH in Dodoma, Iringa and Morogoro

Background Maternal mortality rate (MMR) in Tanzania is still persistently high. The data from Tanzania has revealed that maternal mortality ratio (MMR) has increased from 454 per 100,000 live births in 2010 to 556 per 100,000 live births by the year 2015. Establishment of Maternity Waiting Homes (MWH’s) in a few regions has been one of the efforts for trying to serve lives of pregnant women from pregnancy related complication. Methods The study adopted a cross-sectional study design and a convenience sampling technique for recruiting the respondents. Results The women aged 20–34 are 10 times more likely to use the MWHs in case of future pregnancy (OR = 10.906, p = 0.019) whereas those aged 35 to 49 are 54 times more likely to use MWHs in case of future pregnancy (OR = 54.629, p = 0.006) as compared to those aged 18 to 24 years old. Women who lived 3 to 6 hours of travel to MWH are 11 times more likely to use MWH in case of future pregnancy as compared to those living at the distance of 1 to 3 hours to the MWH (OR = 11.451, p = 0.032). Conclusion The results of this study have revealed some interesting findings in the issues of distance by traveling time and age of the respondent to be highly significant factors in predicting intention to use MWHs in case of future pregnancy.

Devising a fertility education guide relating to future pregnancy, childbirth and the formation of the family for high school students

High school sex education tends to focus on safe sex and preventing unwanted pregnancies. It is rarely mentioned that pregnancy is not a guaranteed outcome of unprotected sex. Some people will be unable to have children in the future and this is an eventuality that high school sex education should prepare students for. Dr Yuri Akizuki, Faculty of Life Sciences, Kumamoto University, Japan, is creating and developing an infertility prevention education programme for high school students. In doing so, her goal is to reduce the number of people who want to have children but cannot have them, and ensure that younger people have knowledge of fertility. When working in a gynecological clinic during her studies, Akizuki encountered stories from women who faced infertility and weren't equipped with important knowledge on the topic and this experience provided the inspiration for her current work. In the short term, Akizuki wants to ensure high school teachers are equipped with the skills and experience to teach and recognise the importance of fertility knowledge. In the long term, she hopes her work can help people to get pregnant later in life and even halt Japan's declining birth rate. It is necessary to ensure that local and national governments understand the importance of fertility knowledge in order that fertility education can be provided to high school students. Akizuki and her team hope that their guide can be used as an important aid to sex education in high schools.

Effects of HIV Status and History of Pregnancy Termination on Trends of Family Planning Knowledge among Women Living in Nine Fragile Countries

Background: To decrease the proportion of women in fragile or conflict-affected situations (FCS) that need, but are not using modern contraception, the global health community must better understand family planning (FP) knowledge gaps; and elucidate which subgroups of women are, and are not, effectively being reached with FP information. This study investigated whether women with notable sexual and reproductive health histories that put them at risk for future pregnancy complications, namely HIV+ women and women with history of terminated pregnancy (HTP), would possess more complete FP knowledge and/or recall being given FP information more readily than HIV- women and women with no HTP (NHTP), respectively. Methods: Knowledge of several contraceptive methods, and the prevalence of women who recalled being given FP information at a healthcare visit, or via TV, radio, or periodical were estimated across HIV, HTP, and country subgroups. HIV+ and HTP status were major predictors in multivariate logistic regressions analyzing the odds of knowing a specified method of contraception or of recalling being given FP information via the modes considered. Results: HIV+ as opposed to HIV- women showed significantly higher odds of knowing about the pill (p=0.001), IUD (p<0.001), injectables (p=0.005), male condoms (p<0.001), female condoms (p<0.001), and implants (p<0.001); but not female or male sterilization. HIV+ women demonstrated higher odds of recalling being given FP information at a health visit (p=0.001), whereas HTP women did not. HTP women showed higher odds (p<0.001) of knowing each modern method of FP with the exception of male sterilization and of recalling TV (p=0.01) and radio (p<0.001) FP messages. Conclusions: Notable findings were the higher FP awareness among HIV+ and HTP women, and the observation that HIV+ women were seemingly provided FP information more readily at healthcare visits than were HTP women, despite their similar risk profiles concerning future pregnancies. Subsequent studies may elucidate why these patterns were observed and indicate which other diagnostic groups are effectively being reached with FP education, and which are not. Understanding trends and predictors of FP knowledge can help practitioners better target FP counseling efforts in FCS toward knowledge gaps and their causes.

Tubal patency after Laparoscopic salpingostomy versus Methotrexate therapy in undisturbed tubal pregnancy

Future fertility after ectopic pregnancy is dependent on several factors, including age, history of infertility, history of previous EP, tubal rupture, and contralateral tubal lesion. Thus, it seems reasonable to assess tubal patency following a treatment of an ectopic pregnancy in those women who are willing to have future pregnancy. Aimed to: Compare between tubal patency after methotrexate & laparoscopic salpingostomy. The study included 72 patients equally divided in number into 2 main groups. First group: (36cases) Tubal ectopic pregnancy treated by MXT therapy single or multiple doses. Single dose regimen (MTX 1.0 mg/kg or 50 mg/m2 i.m or multiple dose regimen (MTX 1.0 mg/kg i.m days (0,2,4,6). Second group: - (36 cases) Tubal ectopic pregnancy treated by laparoscopic salpingostomy. After 3 months, we used laparoscopy with administration of methylene blue (MB) as a marker to detect the tubal patency. As regard to tubal patency, of 31 cases (86.1%) from 36 cases that treated by MTX were patent and 5 cases (13.9 %) were blocked. On the other side 21 cases (58.3 %) from 36 cases that treated by laparoscopic salpingostomy were patent and 15 cases (41.7 %) were blocked). Conclusions:Methotrexate is better than laparoscopic salpingostomy in treating undisturbed tubal pregnancy.

Clinical Aspects of Adolescent Endometriosis

Early diagnosis and long-term management of endometriosis is important in adolescent girls considering their potential for future pregnancy and need for preventing disease progression. However, symptoms and clinical findings of adolescent endometriosis may differ from those of typical adult endometriosis, making diagnosis difficult. In adolescents, menstrual pain may present as acyclic and unresponsive to commonly used medication. Typical imaging findings in adult endometriosis, such as ovarian endometriotic cysts and fibrotic scars, are less common in adolescents. Peritoneal lesions, characteristic of early-stage endometriosis, are commonly found in this age group. It should be noted that endometriosis may also be found in adolescents before menarche, because of premenarcheal endometriosis or congenital uterine anomaly and outflow obstruction; the latter requiring surgical correction. Although surgery is reported to be effective for pain, postsurgical recurrence rate is high, and the effect of hormonal treatment is controversial. The optimal timing for surgical intervention also remains to be determined. Here, we aim to identify the unique characteristics of endometriosis in adolescents to achieve early diagnosis and optimal management for this group of patients.

Effects of HIV status and history of pregnancy termination on trends of family planning knowledge among women living in nine fragile countries

Background: To decrease the proportion of women in fragile or conflict-affected situations (FCS) that need, but are not using modern contraception, the global health community must better understand family planning (FP) knowledge gaps; and elucidate which subgroups of women are, and are not, effectively being reached with FP information. This study investigated whether women with notable sexual and reproductive health histories that put them at risk for future pregnancy complications, namely HIV+ women and women with history of terminated pregnancy (HTP), would possess more complete FP knowledge and/or recall being given FP information more readily than HIV- women and women with no HTP (NHTP), respectively. Methods: Knowledge of several contraceptive methods, and the prevalence of women who recalled being given FP information at a healthcare visit, or via TV, radio, or periodical were estimated across HIV, HTP, and country subgroups. HIV+ and HTP status were major predictors in multivariate logistic regressions analyzing the odds of knowing a specified method of contraception or of recalling being given FP information via the modes considered. Results: HIV+ as opposed to HIV- women showed significantly higher odds of knowing about the pill (p=0.001), IUD (p<0.001), injectables (p=0.005), male condoms (p<0.001), female condoms (p<0.001), and implants (p<0.001); but not female or male sterilization. HIV+ women demonstrated higher odds of recalling being given FP information at a health visit (p=0.001), whereas HTP women did not. HTP women showed higher odds (p<0.001) of knowing each modern method of FP with the exception of male sterilization and of recalling TV (p=0.01) and radio (p<0.001) FP messages. Conclusions: Notable findings were the higher FP awareness among HIV+ and HTP women, and the observation that HIV+ women were seemingly provided FP information more readily at healthcare visits than were HTP women, despite their similar risk profiles concerning future pregnancies. Subsequent studies may elucidate why these patterns were observed and indicate which other diagnostic groups are effectively being reached with FP education, and which are not. Understanding trends and predictors of FP knowledge can help practitioners better target FP counseling efforts in FCS toward knowledge gaps and their causes.