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Pre conceptional counseling

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https://www.readbyqxmd.com/read/29032069/woman-s-pre-conception-evaluation-genetic-and-fetal-risk-considerations-for-counselling-and-informed-choice
#1
REVIEW
R Douglas Wilson
OBJECTIVE: To inform reproductive and other health care providers about genetic and fetal risk information to consider during a woman/couples' pre-conception evaluation, including considerations for genetic risk assessment, genetic screening, or testing to allow for improved counselling and informed choice. OPTIONS: This genetic information can be used for patient education, planning, and possible pre-conception and/or prenatal testing. OUTCOMES: This information may allow improved risk assessment for pre-conception counselling for individual patients and their families...
October 11, 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/28980182/combined-advanced-parental-age-has-an-additive-negative-effect-on-live-birth-rates-data-from-4057-first-ivf-icsi-cycles
#2
Nicole O McPherson, Deirdre Zander-Fox, Andrew D Vincent, Michelle Lane
PURPOSE: The purpose of this study is to determine if there is an additive effect of combined advanced maternal and paternal age on pregnancy and live birth rates. METHODS: Retrospective data analysis of 4057 first cycles at a fertility centre between 2009 and 2013 was compiled. Donor, preimplantation genetic screening and double embryo transfer cycles were excluded. Main outcomes measured were clinical pregnancy, viable pregnancy, live birth and term birth. RESULTS: Logistic regression indicated strong negative associations for maternal ages exceeding 27 years with clinical pregnancies (p < 0...
October 4, 2017: Journal of Assisted Reproduction and Genetics
https://www.readbyqxmd.com/read/28946059/pregabalin-as-adjunct-in-a-multimodal-pain-therapy-after-traumatic-foot-amputation-a-case-report-of-a-4-year-old-girl
#3
Stephanie Wössner, Kirsten Weber, Anna C Steinbeck, Markus Oberhauser, Matthias Feuerecker
BACKGROUND AND PURPOSE: The purpose of this case report is to describe a multimodal pain therapeutic concept including the adjunct use of pregabalin in a 4.5 year-old child after forefoot amputation. Phantom limb pain and sensation is a complex pain syndrome that is difficult to treat and prevent. 70-75% of all children develop such a pain syndrome after amputation. We describe here a paediatric patient who underwent forefoot amputation following traumatic foot injury and received multimodal pain therapy including pregabalin...
September 22, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/28894986/fertility-intentions-pregnancy-and-use-of-prep-and-art-for-safer-conception-among-east-african-hiv-serodiscordant-couples
#4
Renee Heffron, Kerry Thomson, Connie Celum, Jessica Haberer, Kenneth Ngure, Nelly Mugo, Elizabeth Bukusi, Elly Katabira, Josephine Odoyo, Nulu Bulya, Stephen Asiimwe, Edna Tindimwebwa, Jared M Baeten
African HIV serodiscordant couples often desire pregnancy, despite sexual HIV transmission risk during pregnancy attempts. Pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) reduce HIV risk and can be leveraged for safer conception but how well these strategies are used for safer conception is not known. We conducted an open-label demonstration project of the integrated delivery of PrEP and ART among 1013 HIV serodiscordant couples from Kenya and Uganda followed quarterly for 2 years. We evaluated fertility intentions, pregnancy incidence, the use of PrEP and ART during peri-conception, and peri-conception HIV incidence...
September 11, 2017: AIDS and Behavior
https://www.readbyqxmd.com/read/28819946/inflammatory-bowel-disease-and-pregnancy
#5
Anna Małgorzata Maliszewska, Aleksandra Warska, Krzysztof Cendrowski, Włodzimierz Sawicki
Inflammatory bowel disease (IBD) comprising Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) may appear at any age. As such, IBD commonly affects young patients in their reproductive age. Rate of voluntary childlessness among women with IBD far exceed that of the general population, as patients with IBD fear not only the effect of pregnancy on the course of inflammatory bowel disease, but also the increased risk of the offspring developing the disease, adverse pregnancy outcomes, the effect IBD treatment may have on the health and development of the infant or the risk of relapse during pregnancy and the influence of lactation on child development and disease course...
2017: Ginekologia Polska
https://www.readbyqxmd.com/read/28819945/adolescent-pregnancies-complications-birth-outcomes-and-the-possible-solutions
#6
Tayfur Çift, Engin Korkmazer, Muzaffer Temur, Berk Bulut, Bariş Korkmaz, Onur Ozdenoğlu, Cem Akaltun, Emin Üstünyurt
OBJECTIVES: In this study we aim to evaluate antenatal, perinatal and postnatal outcomes and complications of adolescent pregnancies, as well as to discuss the social and psychological consequences of these pregnancies. MATERIAL AND METHODS: We compare a total of 243 pregnant women at age 14-18 years to a vast control group at age 19-36 who all delivered at Bursa Yüksek Ihtisas Training and Research Hospital between years 2005-2014. RESULTS: Antenatal care (folic acid supplementation, pre-conception counseling) was significantly higher in adolescent pregnancy group...
2017: Ginekologia Polska
https://www.readbyqxmd.com/read/28751846/consensus-document-of-the-italian-association-of-hospital-cardiologists-anmco-italian-society-of-pediatric-cardiology-sicp-and-italian-society-of-gynaecologists-and-obstetrics-sigo-pregnancy-and-congenital-heart-diseases
#7
Innocenzo Bianca, Giovanna Geraci, Michele Massimo Gulizia, Gabriele Egidy Assenza, Chiara Barone, Marcello Campisi, Annalisa Alaimo, Rachele Adorisio, Francesca Comoglio, Silvia Favilli, Gabriella Agnoletti, Maria Gabriella Carmina, Massimo Chessa, Berardo Sarubbi, Maurizio Mongiovì, Maria Giovanna Russo, Sebastiano Bianca, Giuseppe Canzone, Marco Bonvicini, Elsa Viora, Marco Poli
The success of cardiac surgery over the past 50 years has increased numbers and median age of survivors with congenital heart disease (CHD). Adults now represent two-thirds of patients with CHD; in the USA alone the number is estimated to exceed 1 million. In this population, many affected women reach reproductive age and wish to have children. While in many CHD patients pregnancy can be accomplished successfully, some special situations with complex anatomy, iatrogenic or residual pathology are associated with an increased risk of severe maternal and fetal complications...
May 2017: European Heart Journal Supplements: Journal of the European Society of Cardiology
https://www.readbyqxmd.com/read/28718898/exposure-to-biologic-therapies-during-conception-and-pregnancy-a-systematic-review
#8
E M Pottinger, R T Woolf, L S Exton, A D Burden, C Nelson-Piercy, C H Smith
Biologic therapies are effective treatments for psoriasis and are often used in women of childbearing age. To evaluate the safety of biologic therapy in conception and/or pregnancy, we have performed a systematic review of Pubmed, MEDLINE, EMBASE and Cochrane databases for multivariable adjusted studies of women exposed to biologic therapy relevant to the treatment of psoriasis during conception and/or pregnancy. We identified four population-based cohort studies involving 1300 women exposed to TNF-α inhibitors (TNFi) 3 months prior to or during the first 3 months of pregnancy...
July 18, 2017: British Journal of Dermatology
https://www.readbyqxmd.com/read/28680462/congenital-heart-disease-and-pregnancy-a-contemporary-approach-to-counselling-pre-pregnancy-investigations-and-the-impact-of-pregnancy-on-heart-function
#9
REVIEW
Matthew Cauldwell, Michael Gatzoulis, Philip Steer
Cardiac disease in pregnancy is a challenging clinical problem. The number of women pursuing pregnancy and the underlying complexity of their cardiac disease is increasing, such that heart disease is now the leading cause of maternal mortality in developed countries. Women with congenital heart disease make up the majority of these cases and although maternal mortality is infrequent, a good outcome is only achieved though meticulous multidisciplinary care, beginning with pre-pregnancy counselling. All women with congenital heart disease should be assessed and be referred for pre-conception counselling prior to pregnancy and should receive thorough clinical assessment prior to pregnancy...
June 2017: Obstetric Medicine
https://www.readbyqxmd.com/read/28643569/iron-overload-directly-affecting-the-ovaries-in-a-patient-with-diamond-blackfan-anaemia-a-case-report
#10
Mariano Mascarenhas, Victoria Rawnsley, Adam Balen
Iron is a 'one-way' element and the primary point of regulation of body iron stores is at the level of intestinal iron absorption. Repeated blood transfusions for congenital anaemias bypass this regulatory checkpoint and inevitably lead to iron overload in the long-term. Iron overload causes multi-organ dysfunction of the heart, liver, pancreas and joints. It also causes reproductive toxicity primarily through its damaging effect on the anterior pituitary leading to hypogonadotrophic hypogonadism. Another less understood mechanism of reproductive toxicity is direct gonadal damage of excess free iron...
June 23, 2017: Human Fertility: Journal of the British Fertility Society
https://www.readbyqxmd.com/read/28606654/management-of-marfan-syndrome-during-pregnancy-a-real-world-experience-from-a-joint-cardiac-obstetric-service
#11
Joanna C E-S Lim, Matthew Cauldwell, Roshni R Patel, Anselm Uebing, Ruth A Curry, Mark R Johnson, Michael A Gatzoulis, Lorna Swan
BACKGROUND: Pregnancy in Marfan Syndrome (MFS) is associated with increased maternal risk of cardiovascular events. Given the maternal and genetic risks, pre-conception counselling is essential to facilitate informed choices. Multidisciplinary antenatal care with regular imaging is mandatory and best delivered through a Joint Cardiac Obstetric Service (JCOS). The aim of this study was to compare the care delivered in a JCOS against recognised international standards (European Society of Cardiology (ESC))...
September 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28521194/preconception-care-for-women-with-type-2-diabetes-mellitus-a-mixed-methods-study-of-provider-knowledge-and-practice
#12
J Klein, J A Boyle, R Kirkham, C Connors, C Whitbread, J Oats, F Barzi, D McIntyre, I Lee, M Luey, J Shaw, A D H Brown, L J Maple-Brown
AIMS: Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. METHODS: Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews...
July 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28420934/preconception-management-of-thyroid-disorders
#13
Bharti Kalra, Yashdeep Gupta, Sanjay Kalra
Thyroid function is closely interlinked with pregnancy. Maternal and foetal outcomes can be improved if optimal thyroid function is achieved, and maintained prior to conception. This needs a systematic approach which includes rational screening, appropriate management, and pragmatic counseling. This review describes pre-conception management of thyroid disorders, and completes an earlier article on preconception management of other endocrine diseases.
April 2017: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/28418987/the-roles-of-behavioral-and-social-science-research-in-the-fight-against-hiv-aids-a-functional-framework
#14
Paul Gaist, Michael J Stirratt
Landmark advances have been made in HIV/AIDS prevention and treatment. These include proof-of-concept and public health implementation of preexposure prophylaxis and "treatment as prevention" to reduce HIV transmission as well as definitive evidence of the clinical gain from early antiretroviral treatment initiation. Significant progress has been made in understanding and addressing the social contexts and behavioral factors that impact HIV prevention, care, and treatment interventions. These include facilitating uptake of testing and counseling, developing technology-based interventions that increase viral suppression, reducing HIV/AIDS-related stigma, and addressing other sociobehavioral and structural barriers to care and treatment...
August 1, 2017: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/28361508/delivering-safer-conception-services-to-hiv-serodiscordant-couples-in-kenya-perspectives-from-healthcare-providers-and-hiv-serodiscordant-couples
#15
Kenneth Ngure, Grace Kimemia, Kristin Dew, Njambi Njuguna, Nelly Mugo, Connie Celum, Jared M Baeten, Renee Heffron
INTRODUCTION: For HIV serodiscordant couples in resource-limited settings, pregnancy is common despite the risk of sexual and/or perinatal HIV transmission. Some safer conception strategies to reduce HIV transmission during pregnancy attempts are available but often not used for reasons including knowledge, accessibility, preference and others. We sought to understand Kenyan health providers' and HIV serodiscordant couples' perspectives and experiences with safer conception. METHODS: Between August 2015 and March 2016, we conducted key informant interviews (KIIs) with health providers from public and private HIV care and fertility clinics and in-depth interviews (IDIs) and focus group discussions (FGDs) with HIV serodiscordant couples participating in an open-label study of integrated pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) for HIV prevention (the Partners Demonstration Project)...
March 8, 2017: Journal of the International AIDS Society
https://www.readbyqxmd.com/read/28361507/client-uptake-of-safer-conception-strategies-implementation-outcomes-from-the-sakh-umndeni-safer-conception-clinic-in-south-africa
#16
Sheree R Schwartz, Jean Bassett, Charles B Holmes, Nompumelelo Yende, Rebecca Phofa, Ian Sanne, Annelies Van Rie
INTRODUCTION: Implementation of safer conception services for HIV-affected couples within primary healthcare clinics in resource-limited settings remains limited. We review service utilization and safer conception strategy uptake during the first three years of Sakh'umndeni, which is a safer conception clinic in South Africa. METHODS: Sakh'umndeni is located at Witkoppen Health and Welfare Centre, a high-volume primary healthcare clinic in northern Johannesburg...
March 8, 2017: Journal of the International AIDS Society
https://www.readbyqxmd.com/read/28361503/offering-pre-exposure-prophylaxis-for-hiv-prevention-to-pregnant-and-postpartum-women-a-clinical-approach
#17
REVIEW
Dominika L Seidman, Shannon Weber, Deborah Cohan
INTRODUCTION: HIV prevention during pregnancy and lactation is critical for both maternal and child health. Pregnancy provides a critical opportunity for clinicians to elicit women's vulnerabilities to HIV and offer HIV testing, treatment and referral and/or comprehensive HIV prevention options for the current pregnancy, the postpartum period and safer conception options for future pregnancies. In this commentary, we review the safety of oral pre-exposure prophylaxis with tenofovir/emtricitabine in pregnant and lactating women and suggest opportunities to identify pregnant and postpartum women at substantial risk of HIV...
March 8, 2017: Journal of the International AIDS Society
https://www.readbyqxmd.com/read/28314442/-adult-congenital-heart-disease-medical-and-psychosocial-issues
#18
Magalie Ladouceur, Florence Pontnau, Laurence Iserin
The population of adults with congenital heart disease (ACHD) is continuously increasing with now a higher prevalence than that of the pediatric population. This concerns above all complex congenital heart diseases. Heart failure is the primary cause of death followed by arrhythmia, which is very common in ACHD. A specialized follow-up by dedicated centers is significantly associated with an improvement of survival of ACHD patients compared to non-expert follow-up. Extracardiac disorders (liver, kidney, respiratory) are frequent and require an accurate and specific management...
May 2017: La Presse Médicale
https://www.readbyqxmd.com/read/28294527/peripartum-type-b-aortic-dissection-in-patients-with-marfan-syndrome-who-underwent-aortic-root-replacement-a-case-series-study
#19
S Sayama, N Takeda, T Iriyama, R Inuzuka, S Maemura, D Fujita, H Yamauchi, K Nawata, M Bougaki, H Hyodo, R Shitara, T Nakayama, A Komatsu, T Nagamatsu, Y Osuga, T Fujii
OBJECTIVE: To investigate pregnancy outcomes, especially the risk of pregnancy-related aortic dissection (AD), in patients with Marfan syndrome (MFS) after prophylactic aortic root replacement (ARR). DESIGN: Retrospective case series study. SETTING: Tertiary perinatal care centre at a university hospital. POPULATION: Pregnant women fulfilling the revised Ghent nosology (2010) criteria for MFS who were managed at our institute...
March 11, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28277140/interactive-case-based-learning-improves-resident-knowledge-and-confidence-in-reproductive-endocrinology-and-infertility
#20
Kara N Goldman, Ashley W Tiegs, Kristen Uquillas, Margaret Nachtigall, M Elizabeth Fino, Abigail F Winkel, Veronica Lerner
Resident physicians' scores on the REI section of the CREOG exam are traditionally low, and nearly 40% of house staff nation-wide perceive their REI knowledge to be poor. We aimed to assess whether an interactive case-based group-learning curriculum would narrow the REI knowledge gap by improving understanding and retention of core REI concepts under the time constraints affecting residents. A three-hour case-based workshop was developed to address four primary CREOG objectives. A multiple-choice test was administered immediately before and after the intervention and 7 weeks post-workshop, to evaluate both knowledge and confidence...
February 21, 2017: Gynecological Endocrinology
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