This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ http://www.reproductive-health-journal.com The latest articles from Reproductive Health (ISSN 1742-4755) published by BioMed Central Background: To evaluate the effectiveness and safety of water aerobics during pregnancy. Methods: A randomized controlled trial carried out in 71 low-risk sedentary pregnant women, randomly allocated to water aerobics or no physical exercise. Maternal body composition and perinatal outcomes were evaluated. For statistical analysis Chi-square, Fisher's or Student's t-tests were applied. Risk ratios and their 95% CI were estimated for main outcomes. Body composition was evaluated across time using MANOVA or Friedman multiple analysis. Results: There were no significant differences between the groups regarding maternal weight gain, BMI or percentage of body fat during pregnancy. Incidence of preterm births (RR=0.84; 95%CI:0.28-2.53), vaginal births (RR=1.24; 95%CI:0.73-2.09), low birthweight (RR=1.30; 95%CI:0.61-2.79) and adequate weight for gestational age (RR=1.50; 95%CI:0.65-3.48) were also not significantly different between groups. There were no significant differences in systolic and diastolic blood pressure and heart rate between before and immediately after the water aerobics session measurements. Conclusion: Water aerobics for sedentary pregnant women proved to be safe and was not associated with any alteration in maternal body composition, type of delivery, preterm birth rate, neonatal well-being or weight. http://www.reproductive-health-journal.com/content/6/1/1 Sergio R Cavalcante, Jose G Cecatti, Rosa I Pereira, Erika P Baciuk, Ana L Bernardo and Carla Silveira Reproductive Health 2009, 6:1 2009-01-06 doi:10.1186/1742-4755-6-1 Reproductive Health 1742-4755 6 1 2009-01-06 Background: Maternal health services have a potentially critical role in the improvement of reproductive health. In order to get a better understanding of adolescent mothers' needs we compared health seeking practices of first time adolescent and adult mothers during pregnancy and early motherhood in Wakiso district, Uganda. Methods: This was a cross-sectional study conducted between May and August,2007 in Wakiso district. A total of 762 women (442 adolescents and 320 adult)were interviewed using a structured questionnaire. We calculated odds ratios with their 95% CI for antenatal and postnatal health care seeking, stigmatisation and violence experienced from parents comparing adolescents to adult first time mothers. STATA V.8 was used for data analysis. Results: Adolescent mothers were significantly more disadvantaged in terms of health care seeking for reproductive health services and faced more challenges during pregnancy and early motherhood compared to adult mothers. Adolescent mothers were more likely to have dropped out of school due to pregnancy (OR=3.61, 95% CI: 2.40-5.44), less likely to earn a salary (OR=0.43, 95%CI:0.24-0.76), and less likely to attend antenatal care compared to adult mothers (OR=1.52, 95%CI: 1.12-2.07). Adolescents were also more likely to experience violence from parents (OR=2.07, 95%CI: 1.39-3.08) and to be stigmatized by the community (CI=1.58, 95%CI: 1.09-2.59). In early motherhood, adolescent mothers were less likely to seek for second and third vaccine doses for their infants [Polio2 (OR=0.73, 95% CI: 0.55-0.98), Polio3 (OR=0.70: 95% CI: 0.51-0.95), DPT2 (OR=0.71, 95% CI: 0.53-0.96), DPT3 (OR=0.68, 95% CI: 0.50-0.92)] compared to adult mothers. These results are compelling and call for urgent adolescent focused interventions. Conclusion: Adolescents showed poorer health care seeking behaviour for themselves and their children, and experienced increased community stigmatization and violence, suggesting bigger challenges to the adolescent mothers in terms of social support.Adolescent friendly interventions such as pregnancy groups targeting to empower pregnant adolescents providing information on pregnancy, delivery and early childhood care need to be introduced and implemented. http://www.reproductive-health-journal.com/content/5/1/13 Lynn Atuyambe, Florence Mirembe, Nazarius M Tumwesigye, Annika Johansson, Edward K Kirumira and Elisabeth Faxelid Reproductive Health 2008, 5:13 2008-12-30 doi:10.1186/1742-4755-5-13 Reproductive Health 1742-4755 5 13 2008-12-30 Background: The percentage of mothers giving birth over the age of 35 increased in many western countries. The number of women remaining childless also increased, mostly due to aging oocytes. The method of oocyte donation offers the possibility for infertile older women to become pregnant. Gestation after oocyte-donation-IVF, however, is not without risks for the mother, especially at advanced age.Case presentationAn infertile woman went abroad for oocyte-donation-IVF, since this treatment is not offered in The Netherlands after the age of 45 years. The first oocyte donation treatment resulted in a multiple gestation, but was ended by induced abortion: the woman could not cope with the idea of being pregnant with twins. In the second pregnancy after oocyte donation, at the age of 50, she was mentally more stable. The pregnancy, again a multiple gestation, was uneventful until delivery. Immediately after delivery she had hypertension with nausea and vomiting. A few hours later she had an eclamptic fit. HELLP-syndrome was diagnosed. She died due to cerebral haemorrhage. Conclusions: In The Netherlands, the age limit for women receiving donor oocytes is 45 years and commercial oocyte donation is forbidden by law. In other countries there is no age limit, the reason why some women are going abroad to receive the treatment of their choice. Advanced age, IVF and twin pregnancy are all risk factors for pre-eclampsia, the leading cause of maternal death in The Netherlands. Patient autonomy is an important ethical principle, but doctors are also bound to the principle of 'not doing harm', and do have the right to refuse to give medical treatment such as IVF-treatment. The discussion whether women over the age of 50 should have children is still not closed. If the decision is made to offer this treatment to a woman at advanced age, the doctor should counsel them intensively about the risks before treatment is started. http://www.reproductive-health-journal.com/content/5/1/12 Joke M Schutte, Nico WE Schuitemaker, Eric AP Steegers and Jos van Roosmalen Reproductive Health 2008, 5:12 2008-12-30 doi:10.1186/1742-4755-5-12 Reproductive Health 1742-4755 5 12 2008-12-30 Background: The objective of this study was to assess young people's perceptions of being offered a chlamydia screening test in UK general practice. MethodThis is qualitative study that uses focus groups and individual interviews with young adults (age 16 -18) to assess their views. Results: These young adults were a difficult group to gain access to. Two focus groups, one in a school, the other in a general practice (family practice), and two individual interviews were undertaken (total sample 18). Respondents were unfamiliar with chlamydia, but broadly aware of sexually transmitted infections. General practice (family practice) was perceived as an acceptable place to deliver opportunistic screening, but tests should not be initiated practice receptionists. Novel delivery routes such as schools and "Pub" / Bar dispensing machines were discussed. Issues around stigma and confidentiality were also raised. Conclusions: Opportunistic Chlamydia screening in UK general practice (family practice) seems acceptable to young adults. While this is a difficult group to gain access to for research, attempts need to made to ensure acceptability to users of this programme. http://www.reproductive-health-journal.com/content/5/1/11 Joanne Heritage and Melvyn M Jones Reproductive Health 2008, 5:11 2008-12-19 doi:10.1186/1742-4755-5-11 Reproductive Health 1742-4755 5 11 2008-12-19 Background: To evaluate the association between water aerobics, maternal cardiovascular capacity during pregnancy, labor and neonatal outcomes. Methods: A randomized, controlled clinical trial was carried out in which 34 pregnant women were allocated to a water aerobics group and 37 to a control group. All women were submitted to submaximal ergometric tests on a treadmill at 19, 25 and 35 weeks of pregnancy and were followed up until delivery. Oxygen consumption (VO2 max), cardiac output (CO), physical fitness, skin temperature, data on labor and delivery, and neonate outcomes were evaluated. Frequency distributions of the baseline variables of both groups were initially performed and then analysis of the outcomes was carried out. Categorical data were compared using the chi-square test, and numerical using Student's t or Mann-Whitney tests. Wilk's Lambda or Friedman's analysis of repeat measurements were applied for comparison of physical capacity, cardiovascular outcomes and maternal temperature. Results: VO2 max and physical fitness were higher in both groups in the second trimester, returning to basal levels in the third trimester. In both groups, CO increased as pregnancy progressed and peak exercise temperature was higher than resting temperature, increasing further after five minutes of recovery and remaining at this level until 15 minutes after exercise completion. There was no difference between the two groups regarding duration (457.9 ± SD 249.6 vs 428.9 ± SD 203.2 minutes) or type of delivery. Labor analgesia was requested by significantly fewer women in the water aerobics group (27% vs 65%; RR = 0.42 95%CI 0.23–0.77). Neonatal results were similar in both groups. Conclusion: The regular practice of moderate water aerobics by sedentary and low risk pregnant women was not detrimental to the health of the mother or the child. There was no influence on maternal cardiovascular capacity, duration of labor or type of delivery; however, there were fewer requests for analgesia during labor in the water aerobics group. http://www.reproductive-health-journal.com/content/5/1/10 Erica P Baciuk, Rosa I Pereira, Jose G Cecatti, Angelica F Braga and Sergio R Cavalcante Reproductive Health 2008, 5:10 2008-11-21 doi:10.1186/1742-4755-5-10 Reproductive Health 1742-4755 5 10 2008-11-21 Surrogacy involves one woman (surrogate mother) carrying a child for another person/s (commissioning person/couple), based on a mutual agreement requiring the child to be handed over to the commissioning person/couple following birth. Reasons for seeking surrogacy include situations where a woman has non-functional or absent reproductive organs, or as a remedy for recurrent pregnancy loss. Additionally, surrogacy may find application in any medical context where pregnancy is contraindicated, or where a couple consisting of two males seek to become parents through oocyte donation. Gestational surrogacy is one of the main issues at the forefront of bioethics and the advanced reproductive technologies, representing an important challenge to medical law. This analysis reviews the history of surrogacy and clinical and legal issues pertaining to this branch of reproductive medicine. Interestingly, the Medical Council of Ireland does not acknowledge surrogacy in its current practice guidelines, nor is there specific legislation addressing surrogacy in Ireland at present. We therefore have developed a contract-based model for surrogacy in which, courts in Ireland may consider when confronted with a surrogacy dispute, and formulated a system to resolve any potential dispute arising from a surrogacy arrangement. While the 2005 report by the Commission on Assisted Human Reproduction (CAHR) is an expert opinion guiding the Oireachtas' development of specific legislation governing assisted human reproduction and surrogacy, our report represents independent scholarship on the contractual elements of surrogacy with particular focus on how Irish courts might decide on surrogacy matters in a modern day Ireland. This joint medico-legal collaborative also reviews the contract for services arrangement between the commissioning person/s and the surrogate, and the extent to which the contract may be enforced. http://www.reproductive-health-journal.com/content/5/1/9 Eric Scott Sills and Clifford M Healy Reproductive Health 2008, 5:9 2008-11-04 doi:10.1186/1742-4755-5-9 Reproductive Health 1742-4755 5 9 2008-11-04 Background: Experiences at sexual debut may be linked to reproductive health later in life. Additionally, young women with older sexual partners may be at greater risk for HIV and sexually transmitted infections. This study examines sexual debut with an older partner and subsequent reproductive health outcomes among 599 sexually experienced women aged 15–24 who utilized voluntary counseling and testing or reproductive health services in Port-au-Prince, Haiti. Methods: Logistic regression models, controlling for socioeconomic and demographic factors, examined whether age differences at first sex were significantly associated with STI diagnosis in the previous 12 months and family planning method use at last intercourse. Results: Sixty-five percent of women reported sexual initiation with a partner younger or less than 5 years older, 28% with a partner 5 to 10 years older, and 7% with a partner 10 or more years older. There was a trend towards decreased likelihood of recent use of family planning methods in women who had first sexual intercourse with a partner 5 to 9 years older compared to women with partners who were younger or less than 5 years older. Age differences were not linked to recent STI diagnosis. Conclusion: Programs focusing on delaying sexual debut should consider age and gender-based power differentials between younger women and older men. Future research should examine whether wide age differences at sexual debut are predictive of continued involvement in cross-generational relationships and risky sexual behaviors and explore the mechanisms by which cross-generational first sex and subsequent reproductive health may be connected. http://www.reproductive-health-journal.com/content/5/1/8 Anu Manchikanti Gómez, Ilene S Speizer, Heidi Reynolds, Nancy Murray and Harry Beauvais Reproductive Health 2008, 5:8 2008-10-31 doi:10.1186/1742-4755-5-8 Reproductive Health 1742-4755 5 8 2008-10-31 Background: Assisted reproductive technologies (ART) to treat infertility have been available for nearly three decades. There have been a number of systematic comparisons of the health and development of ART-conceived with spontaneously-conceived (SC) children. Data are equivocal, some finding no differences and others that there are more health and developmental problems in the ART group. It is agreed that perinatal mortality and morbidity are worse after assisted than spontaneous conception and the impact of the hormonally altered intrauterine environment on puberty and later fertility of offspring are unknown. To date however, there has been no investigation of the health and development of ART-conceived young adults, including from the world's few prospective cohorts of ART conceived children. Obtaining these data requires contact to be made with people at least twenty years after discharge from the treating service. Given the ethical difficulties of approaching families to participate in research up to two decades after cessation of treatment, the aim of this exploratory qualitative investigation was to assess the feasibility and acceptability of approaching mothers treated for infertility prior to 1988, and their recall of the health and development of their ART-conceived young adult children. Methods: Mothers treated for infertility at the Royal Women's Hospital Reproductive Biology Unit in Melbourne, Australia prior to 1988 were approached by a senior clinician and invited to participate in individual semi-structured interviews which could include their partners and/or young adult children if they wished. Recruitment continued until theoretic saturation had been reached. Results: Ten mothers, two of their husbands and five young adults participated in interviews, and the health and development of 15 ART-conceived young adults were described. The experience of conception, pregnancy, birth and the health and development of the children were recalled vividly and in detail. Families were pleased to have been approached and supported the need for systematic data collection. Mode of conception had been disclosed from childhood to all the offspring. Conclusion: With careful and sensitive recruitment strategies it is feasible and acceptable to contact women treated for infertility at least two decades ago and their families, to assess the health and development of ART-conceived young adults. http://www.reproductive-health-journal.com/content/5/1/7 Jane RW Fisher, Karin Hammarberg, HW Gordon Baker and John C McBain Reproductive Health 2008, 5:7 2008-10-28 doi:10.1186/1742-4755-5-7 Reproductive Health 1742-4755 5 7 2008-10-28 Background: To identify all the records within the Brazilian Hospital Information System (HIS) that contained information suggestive of severe maternal morbidity (near miss); to describe the diagnoses and procedures used; to identify variables associated with maternal death. Methods: A descriptive population study with data from the HIS and Mortality Information System (MIS) files of records of women during pregnancy, delivery and in the postpartum period in all the capital cities of the Brazilian states in 2002. Initially, records of women between 10 and 49 years of age were selected; next, those records with at least one criterion suggestive of near miss were selected. For the linkage of HIS with MIS and HIS with itself, a blocking strategy consisting of three independent steps was established. In the data analysis, near miss ratios were calculated with corresponding 95% confidence interval and the diagnoses and procedures were described; a multiple logistic regression model was adjusted. Primary and secondary diagnoses and the requested and performed procedures during hospitalization were the main outcome measures. Results: The overall maternal near miss ratio was 44.3/1,000 live births. Among the records indicating near miss, 154 maternal deaths were identified. The criteria of severity most frequently found were infection, preeclampsia and hemorrhage. Logistic regression analysis resulted in 12 variables, including four significant interactions. Conclusion: Although some limitations, the perspective of routinely using this information system for surveillance of near miss and implementing measures to avoid maternal death is promising. http://www.reproductive-health-journal.com/content/5/1/6 Maria H Sousa, Jose G Cecatti, Ellen E Hardy and Suzanne J Serruya Reproductive Health 2008, 5:6 2008-10-28 doi:10.1186/1742-4755-5-6 Reproductive Health 1742-4755 5 6 2008-10-28 Background: The purpose of the study was to evaluate inter- and intra-observer variability in sonographic measurements of the cross-sectional area of the umbilical cord and the diameters of its vessels in low-risk pregnancies of 12 to 40 weeks of gestation. Methods: A prospective cross sectional study was performed in 221 pregnant women at different gestational ages. Measurements were carried out also by a second observer to evaluate inter-observer variability and repeated once again by the first observer to assess intra-observer variability. The linear correlation between the measurements (Spearman's coefficient of correlation) and their reliability through the intraclass correlation coefficient (ICC), the Cronbach's alpha coefficient and the limits of agreement proposed by Bland and Altman were evaluated. Results: The results showed that inter-observer and intra-observer variability did not show any significant difference between examiners. A good linear correlation between the measurements and reliability was obtained, with values of R, ICC and Cronbach's alpha all above the standard limits. Conclusion: It is possible to conclude that inter- and intra-observer variability in the measurements of the umbilical cord and its vessels was small; their reliability and agreement were good. http://www.reproductive-health-journal.com/content/5/1/5 Cristiane Barbieri, Jose G Cecatti, Carla E Souza, Emilio F Marussi and Jose V Costa Reproductive Health 2008, 5:5 2008-10-15 doi:10.1186/1742-4755-5-5 Reproductive Health 1742-4755 5 5 2008-10-15