染色体多态性在生殖异常方面的临床效应

染色体多态性是染色体异染色质区域一种微小而恒定的变异,包括结构、带纹宽窄、着色强度等方面的变异,常发生于1、9、16号染色体,D、G组染色体,以及Y染色体。近年来,染色体多态性与生殖方面的关系日益受到人们的关注,本文将近期国内外相关研究综述如下。     

血清Hcy、IGFBP-1联合预测多囊卵巢综合征患者孕早期自然流产的价值

目的探讨血清同型半胱氨酸(Hcy)、胰岛素样生长因子结合蛋白-1(IGFBP-1)联合检测对多囊卵巢综合征患者孕早期自然流产的预测价值。方法选取2018年3月—2020年5月行促排卵治疗并成功临床妊娠的多囊卵巢综合征165例,检测血清Hcy、IGFBP-1水平。根据孕早期自然流产发生情况分为孕早期自然流产组与未自然流产组,比较两组妊娠前一次促排卵后血清Hcy、IGFBP-1水平;多囊卵巢综合征患者孕早期自然流产的危险因素采用多因素Logistic回归分析,并采用受试者工作特征(ROC)曲线分析血清Hcy、IGFBP-1水平单项及联合检测对多囊卵巢综合征患者孕早期自然流产的预测价值。结果患者妊娠前一次促排卵后血清Hcy水平低于入院时,血清IGFBP-1水平高于入院时(P<0.01);自然流产组妊娠前一次促排卵后血清Hcy水平高于未自然流产组,血清IGFBP-1水平低于未自然流产组(P<0.01)。孕早期自然流产的发生率为28.48%。年龄≥35岁、多囊卵巢综合征分型、空腹胰岛素水平偏高、空腹血糖水平偏高、血清睾酮水平偏高、血清叶酸水平偏低、妊娠前一次促排卵后血清Hcy水平偏高及血清IGFBP-1水平偏低均是多囊卵巢综合征患者孕早期自然流产的危险因素(P<0.01)。妊娠前一次促排卵后血清Hcy水平联合血清IGFBP-1水平预测多囊卵巢综合征患者孕早期自然流产的敏感度、ROC曲线下面积均高于单独预测(P<0.01)。结论多囊卵巢综合征孕早期自然流产患者血清Hcy水平偏高,IGFBP-1水平偏低,二者均与多囊卵巢综合征患者孕早期自然流产密切相关,并对多囊卵巢综合征患者孕早期自然流产的发生具有较好的预测价值,联合检测时的预测效能更高。     

Young Women's Experiences Obtaining Judicial Bypass for Abortion in Texas

Purpose

Like many states, Texas requires parental consent for adolescents under 18 to access abortion care. Adolescents who cannot obtain parental consent can try to obtain a judicial bypass of parental consent through the court system. Little is known about adolescents’ experiences with the judicial bypass process. Working with Jane's Due Process, an organization providing legal representation for adolescents, we explored adolescents’ experiences with the judicial bypass process.

2020 developments in the provision of early medical abortion by telemedicine in the UK

The COVID-19 pandemic has necessitated the rapid implementation of telemedical health services. In the United Kingdom, one service that has benefitted from this response is the provision of early medical abortion. England, Wales, and Scotland have all issued approval orders to this effect. These orders allow women to terminate pregnancies up to certain gestational limits, removing the need for them to contravene social distancing measures to access care. However, they are intended only as temporary measures for the duration of the pandemic response. In this paper, we chart these developments and further demonstrate the already acknowledged politicisation of abortion care. We focus on two key elements of the orders: (1) the addition of updated clinical guidance in the Scottish order that suggests an extended gestational limit, and (2) sunset clauses in the English and Welsh orders, as well as an indication of similar intentions in Scotland. In discussing these two issues, we suggest that the refusal of UK governments to introduce telemedical provision of early medical abortion previously has not been based on health concerns. Further, we question whether it would be appropriate for the approval orders to be lifted following the pandemic, suggesting that to do so would represent regressive and harmful policy.     

Self-managed abortion: A systematic scoping review

Self-managed abortion, when a person performs their own abortion without clinical supervision, is a model of abortion care used across a range of settings. To provide a comprehensive synthesis of the available literature on self-managed abortion, we conducted a systematic search for peer-reviewed research in April 2019 in PubMed, Embase, Web of Science, Popline, PsycINFO, Google Scholar, Scielo, and Redalyc. We included studies that had a research question focused on self-managed abortion; and were published in English or Spanish. The combined search returned 7167 studies; after screening, 99 studies were included in the analysis. Included studies reported on methods, procurement, characteristics of those who self-managed, effectiveness, safety, reasons for self-managed abortion, and emotional and physical experiences. Numerous abortion methods were reported, most frequently abortion with pills and herbs. Studies reporting on self-managed medication abortion reported high-levels of effectiveness. We identify gaps in the research, and make recommendations to address those gaps.     

2017–19 governmental decisions to allow home use of misoprostol for early medical abortion in the UK

Home use of misoprostol for early medical abortion has long been an established practice in several countries. It is a safe, effective, and dignified means of obtaining a legal abortion, with a low risk of complications. In the UK, however, the practice has only recently been permitted. Prior to the change, women were required to attend a clinic to be observed taking the drug, before being discharged to go home and see through the process. The requirement to attend a clinic was a result of political rather than medical reasoning; a desire not to provoke pro-life groups. It also highlighted an inconsistency whereby misoprostol was prescribed for home use to women who had suffered an incomplete miscarriage. Failure to permit home use of misoprostol for early medical abortion has caused women to suffer trauma when experiencing the effects of the drug when returning home from clinics, in addition to acting as an obstacle to access for women living in remote areas with no nearby clinic. Through an overview of recent developments in UK abortion policy, I demonstrate the lack of good, medical reasons for the delayed change. Further, I suggest appropriate future steps to be taken by policymakers.     

Misoprostol as an adjunct to overnight osmotic dilators prior to second trimester dilation and evacuation: A systematic review and meta-analysis,

ObjectiveTo understand effect of adjunct misoprostol on cervical preparation with overnight osmotic dilators for dilation and evacuation after 16 weeks gestation.MethodsWe searched on-line reference databases using search terms for second trimester, abortion, misoprostol, and dilators. Randomized controlled trials of cervical preparation for second trimester D&E using overnight osmotic dilators comparing adjunct misoprostol to placebo were included. Weighted mean with standard deviation (SD) and pooled binary outcomes were compared.ResultsAmong 84 articles identified, three met inclusion criteria (n = 457 subjects) adjunct misoprostol did not significantly decrease mean procedure times (8.5 ± 4.6 vs 9.6 ± 5.8 min, p = 0.78) or manual dilation (18% vs 28%, p = 0.23) when compared to placebo. There was no difference in total complications (p = 0.61), major complications (p = 0.44), or cervical lacerations (p = 0.87).ConclusionCurrent limited evidence suggests adjunct misoprostol with osmotic dilators after 16 weeks does not affect procedure time or need for manual dilation.ImplicationsFurther research is needed to determine the effect of adjunct misoprostol on major complications and blood loss.     

South African abortion attitudes from 2007-2016: the roles of religiosity and attitudes toward sexuality and gender equality

ABSTRACT

Abortion is legal in South Africa, but negative abortion attitudes remain common and are poorly understood. We used nationally representative South African Social Attitudes Survey data to analyze abortion attitudes in the case of fetal anomaly and in the case of poverty from 2007 to 2016 (n = 20,711; ages = 16+). We measured correlations between abortion attitudes and these important predictors: religiosity, attitudes about premarital sex, attitudes about preferential hiring and promotion of women, and attitudes toward family gender roles. Abortion acceptability for poverty increased over time (b = 0.05, p < .001), but not for fetal anomaly (b = ?0.008, p = .284). Highly religious South Africans reported lower abortion acceptability in both cases (Odds Ratio (OR)_anomaly = 0.85, p = .015; OR_poverty = 0.84, p = .02). Premarital sex acceptability strongly and positively predicted abortion acceptability (OR_anomaly = 2.63, p < .001; OR_poverty = 2.46, p < .001). Attitudes about preferential hiring and promotion of women were not associated with abortion attitudes, but favorable attitudes about working mothers were positively associated with abortion acceptability for fetal anomaly ((OR_anomaly = 1.09, p = .01; OR_poverty = 1.02, p = .641)). Results suggest negative abortion attitudes remain common in South Africa and are closely tied to religiosity, traditional ideologies about sexuality, and gender role expectations about motherhood.     

The Irish Journey: Removing the shackles of abortion restrictions in Ireland

In May 2018, the Irish electorate voted to remove from the Constitution one of the most restrictive abortion bans in the world. This referendum followed 35 years of legal cases, human rights advocacy, feminist activism and governmental and parliamentary processes. The reframing of abortion as an issue of women's health rather than foetal rights was crucial to the success of law reform efforts. The new law, enacted in 2018, provides for access to abortion on a woman's request up to 12 weeks of pregnancy and in situations of risk to the life or of serious harm to the health of the pregnant woman and fatal foetal anomaly thereafter. Abortion is now broadly accessible in Ireland; however, continued advocacy is needed to ensure that the state meets international human rights standards and that access to abortion care and abortion rights is fully secured within the law.