Attitudes and Opinions of Young Gynecologists on Pregnancy Termination: Results of a Cross-Sectional Survey in Poland

Background: This paper aims to explore the attitudes and opinions of a group of Polish young gynecologists toward pregnancy termination. Method: An anonymous questionnaire was completed by physicians who participated in obligatory trainee courses held in 2019 in Warsaw. Results: The study group included 71 physicians with an average age of 29 years (SD 3.05). A considerable number of the physicians accepted terminations for medical reasons up to the end of pregnancy, especially in cases of lethal defects (46%) and a serious disease in the mother (34%). Only 6% of the group of gynecologists not performing terminations claimed that the procedure was contrary to their conscience, and 62% of them stated that such procedures were not performed at their hospital. Terminations would be performed by 90% of the respondents in cases of lethal defects of the fetus and by 80% if severe irreversible fetal defects were diagnosed. Conclusions: The main problem associated with the inaccessibility of pregnancy termination in Poland is not linked to individuals, meaning medical personnel and the possibility of invoking the conscience clause, but probably to the lack of approval for terminations granted by hospital supervisors. Adequate knowledge on pregnancy termination procedures, fetal defects, and diseases in the mother translated into the changes of opinions on pregnancy terminations

Wpływ L-karnityny i acetylo-L-karnityny na płodność mężczyzn

Podstawowe doniesienia ostatnich lat wskazują, że główne przyczyny męskiej niepłodności stanowią: stres oksydacyjny,apoptoza plemników oraz fragmentacja DNA. Około 80% przyczyn niepłodności wiąże się ze stresem oksydacyjnymi zmniejszonym poziomem zdolności antyoksydacyjnej plemników. Agarwal A. wprowadził w 2019 rokupojęcie Male Oxydative Stress Infertility (MOSI) jako dość powszechny mechanizm zaburzeń płodności męskiej.Laboratoryjnym wykładnikiem stresu oksydacyjnego jest przesunięcie punktu równowagi oksydo-redukcyjnej, ocenianegowieloma metodami. Obecnie najbardziej istotną klinicznie metodą wydaje się ORP (Oxidation-reductionpotential). L-karnityna (LC, L-carnitine) odgrywa główną rolę w transporcie i tworzeniu estrów długołańcuchowychkwasów tłuszczowych biorących udział w procesach energetycznych (β-oksydacji). Oksydacja lipidów stanowigłówne źródło energii dla plemników. Działalność antyoksydacyjna L-karnityny polega na wymiataniu wolnychrodników i pochodnych nadtlenku wodoru, a tym samym blokowaniu peroksydacji lipidów. Podaż L-karnitynyz acetylo-L-karnityną (ALC, acetylo-L-carnitine) stanowi optymalne zestawienie suplementów celem poprawy jakościnasienia. Badania Micica i wsp. oraz Busseto i wsp. wskazują, że po 3 i 6 miesiącach stosowania preparatuz L-karnityną i acetylo-L-karnityną poprawiły się zasadniczo: gęstość plemników, ruch postępowy, ruchliwość orazliczba żywych plemników. Indeks fragmentacji DNA plemników (DFI, DNA fragmentation index) obniżył się istotniejuż po 3 miesiącach terapii z dalszą tendencją spadkową po kolejnych 3 miesiącach. W związku z ograniczonymimożliwościami leczenia przyczynowego zaburzeń płodności męskiej słuszną alternatywą wydaje się substytucjazwiązków o działaniu antyoksydacyjnym u subpłodnych mężczyzn w wieku reprodukcyjnym z potwierdzonym stresemoksydacyjnym plemników

Beyond Contraception: The Medical Necessity of Hormonal Contraceptives for Optimal Health and Well-being of Women in the UAE

Introducing contraception as a method of treatment of many diseases is essential in order to optimize health and well-being of women in the UAE. The aim of the presented study was to analyze the non-contraceptive benefits and possible methods of using hormonal contraception in cultural context of the country. We reviewed articles concerning non-contraceptive use of contraception. Authors conducted their search in Pubmed/Medline, Scopus, Web of Science, EMBASE, CINAHL, National Library of Medicine, and Google Scholar. Hormonal contraceptives offer several health and wellness benefits that can improve the overall quality of life for women. These benefits encompass mood stabilization, reduction of premenstrual symptoms, acne relief, recurrent functional ovarian cysts, and luteal hemorrhagic cysts prevention, positive impact on bone mineral density, treatment of abnormal uterine bleeding, menstrual cycle abnormalities dysmenorrhea, ovarian and endometrial cancer prevention. It can also be used as a symptomatic method of treatment of PCOS and endometriosis. Moreover, it can guarantee appropriate birth spacing and can be prescribed for women with certain medical conditions where pregnancy poses significant risks to their health. Expanding access to hormonal contraceptives for non-contraceptive medical purposes requires a multi-faceted approach, including policy changes, regulatory reforms, insurance coverage adjustments, and educational initiatives for healthcare providers and the general publi

Tokophobia and anxiety in pregnant women during the SARS-CoV-2 pandemic in Poland - a prospective cross-sectional study

SARS-CoV-2 coronavirus emerged in the world at the end of 2019. The introduction of a number of restrictions had a significant effect on numerous aspects of human life with particular influence being exerted on pregnant women and their sense of security. The study aimed to assess the level of anxiety and its main determinants in women in the third trimester of pregnancy during the coronavirus pandemic. The study technique included the present purposely designed questionnaire, Labor Anxiety Questionnaire (KLPII), and the State-Trait Anxiety Inventory (STAI). The study was conducted in a group of 315 women in the third trimester of pregnancy. A total of 258 women (81.9%) completed the questionnaire in May 2020, and 57 of them (18.1%) completed it in October 2020. The overall analysis of the Labor Anxiety Questionnaire and the STAI inventory revealed a high level of anxiety, particularly situational anxiety, in pregnant women during the SARS-CoV-2 pandemic. The age and financial status of the women were the factors which contributed to the intensification of tokophobia. Women interviewed in October 2020 were characterized by higher tokophobia levels compared to the respondents included in May 2020. It seems justified to in-crease the vigilance in the diagnostics of possible mental disorders in the perinatal period during pandemic

Heterotopic pregnancy – how easily you can go wrong in diagnosing? A case study

Introduction: Heterotopic pregnancy is a rare, but potentially life-threatening pathology. The diagnosis of heterotopic pregnancy is still one of the biggest challenges in modern gynecology. The incidence of those pregnancies in natural conception is about 1:30000. Case presentation: We present an unusual case of a heterotopic pregnancy which was misdiagnosed in the first trimester as a dichorionic twin pregnancy. At 13 weeks of gestation, the patient presented with an acute abdomen, she was diagnosed with a heterotopic pregnancy, and therefore was operated on, with the excision of the ruptured fallopian tube and the ectopic pregnancy performed. Discussion: The presence of an intrauterine pregnancy does not rule out the presence of a coexisting ectopic pregnancy. Clinicians should always keep in mind that a heterotopic pregnancy may occur in a woman of reproductive age. Careful ultrasound scan of the uterus and appendages is a must in all women of reproductive age with clinical symptoms.Wstęp: Ciąża heterotopowa jest rzadką, jednak potencjalnie zagrażającą życiu jednostką kliniczną. Jej rozpoznanie pozostaje jednym z największych wyzwań współczesnej ginekologii. Częstość występowania ciąż heterotopowych wynosi około 1 : 30 000. Opis przypadku: W niniejszej pracy opisujemy rzadki przypadek ciąży heterotopowej, która w pierwszym trymestrze została mylnie rozpoznana jako ciąża bliźniacza dwukosmówkowa. W 13. tygodniu ciąży u pacjentki wystąpił zespół objawów ostrego brzucha i wówczas zostało postawione rozpoznanie ciąży heterotopowej oraz wdrożone leczenie operacyjne polegające na usunięciu pękniętego jajowodu i znajdującej się w nim ciąży pozamacicznej. Omówienie: Obecność ciąży wewnątrzmacicznej nie wyklucza współwystępowania równoległej ciąży pozamacicznej. U kobiet w wieku rozrodczym lekarze powinni zawsze brać pod uwagę możliwość wystąpienia ciąży pozamacicznej. Dokładne badanie ultrasonograficzne macicy i przydatków jest niezbędne u wszystkich pacjentek w wieku rozrodczym, u których występują objawy kliniczne

Psychosocial profile and reproductive decisions of women undergoing pregnancy termination for medical reasons : a cross-sectional study

Background: The study aims to define the profile of women who decide to exercise their right to terminate a pregnancy and their future reproductive plans. Methods: Patients found eligible for termination for medical reasons between 2014 and 2016 were asked to complete an anonymous survey consisting of sixty questions examining the determinants of the decision to terminate a pregnancy. In total, 150 completed surveys were returned (62.5%). Results: Environmental factors, such as age, education, place of residence, marital status and financial status did not affect the decision-making process. The majority of the respondents were females under 35 years of age (71.3%). In most cases, the pregnancies had been planned and long-awaited (62.7%). The study also indicated that 22.6% of the patients who had been against abortion changed their mind when they encountered problems themselves. In addition, 20% of them changed their views on the acceptability of abortion. Termination had an impact on the participants future reproductive plans. Eighteen percent of the patients said they were definitely not planning more pregnancies. The majority (84.09%) of these women said that the reason was the traumatic experiences related to their pregnancy. Conclusions: The personal experience of a pregnancy termination procedure changed women’s opinions about pregnancy termination and modified further reproductive plan

Emotional Complications in Midwives Participating in Pregnancy Termination Procedures—Polish Experience

Background: Ethically controversial medical procedures, such as the termination of pregnancy, are frequently associated with a discrepancy between personal attitude and values versus requirements related to a professional situation. The study aimed to assess emotional complications in midwives participating in pregnancy termination procedures. Methods: The study included 181 midwives working in state-governed healthcare facilities in central and eastern Poland. The Oldenburg Burnout Inventory (OLBI) and the present authors’ own questionnaire were used in the study. The results indicating the level of occupational burnout were presented in two scales: the exhaustion scale and the disengagement scale. Results: The study revealed that 48% of midwives had never participated in pregnancy termination procedures due to fetal defects. The level of occupational burnout described with the exhaustion factor (t = 2.06; p < 0.041) and disengagement factor (t = 2.96; p < 0.003) was significantly higher in the group of midwives participating in pregnancy termination procedures due to fetal defects than in the group of midwives who did not participate in pregnancy terminations. The most common factors contributing to burnout reported by midwives who participated in pregnancy terminations were: moral dilemmas (68%), seeing the aborted fetus (65%), anticipating the child’s death in case it was born with signs of life (59%) and the lack of professional psychological support for medical personnel (56%). Conclusions: Importantly, pregnancy termination should be performed by persons who find such procedures acceptable from the viewpoint of their value system. It is a protective factor in regards to work with women who undergo terminations. Moreover, developing a system of informational and psychological support for midwives participating in pregnancy termination procedures is also a significant aspect

The Influence of Abortion Law on the Frequency of Pregnancy Terminations—A Retrospective Comparative Study

Abortion law is one of the main factors influencing the number of abortions performed in a country. The study aimed to assess the influence of abortion law on the number of performed terminations with particular attention paid to pregnancy terminations due to fetal defects. The retrospective comparative analysis of statistical data included on the governmental websites of Poland and the UK was performed. The average of 190,733.1 terminations were performed in the United Kingdom in the years 2009–2018 with the average of 2820.9 due to fetal defects. At the same time the average of 858.6 terminations were performed in Poland with 820.7 due to fetal defects. Population size is the only significant predictor of the number of terminations in the United Kingdom. The increase in the number of deliveries and population in Poland was not linked to the increase in the overall number of terminations or terminations due to fetal defects. It might be due to the unavailability of pregnancy terminations in many places. The radicalization of abortion law exerts no influence on the decrease in the number of terminations due to fetal indications. The liberalization of abortion law promotes the increase in the number of terminations due to social indications

Peripartum Predictors of the Risk of Postpartum Depressive Disorder: Results of a Case-Control Study

Background: The study aimed at the identification of the risk factors present during delivery, which might be present in prophylactic programs concerning postpartum mood disorders. Material and Method: This was a retrospective comparative study. The study material included data retrieved from the medical records of patients hospitalized in the Teaching Department of Gynecology and Obstetrics of Professor Orłowski Hospital in Warsaw, in the years 2010–2017. The EPDS data of 604 patients were analyzed. The study group included 75 women who obtained at least 12 points in the EPDS and the control group was made up of 75 women who obtained no more than 5 points in the EPDS. Results: The women in whom we noted an increased risk of developing mood disorders had blood loss >1000 mL and had a significantly longer stage II and III of labor than the control group. Other risk factors were cesarean section, vaginal delivery with the curettage of the uterine cavity, slightly lower APGAR scores (0.4 pts), and lower birth weight (approximately 350 g) of the child. Women at a low risk of postpartum mood disorders more commonly underwent episiotomy during delivery (76%). Conclusions: Increased supervision and support should be offered to women who experienced the above-mentioned risk factors

Role of Social and Informational Support while Deciding on Pregnancy Termination for Medical Reasons

Background: Poland is a country with restrictive laws concerning abortion, which is only allowed if the mother’s life and health are in danger, in case of rape, and severe defects in the fetus. This paper specifies the forms of support expected by women considering termination from their family, people in their surroundings and professional medical personnel. Methods: Between June 2014 and May 2016 patients eligible to terminate a pregnancy for medical reasons were asked to complete an anonymous survey consisting of sixty questions to determine patient profile and forms of support expected from the society, family and professional medical personnel as well as to assess informational support provided. Results: Women do not take into consideration society’s opinion on pregnancy termination (95%). The majority of the respondents think that financial support from the state is not sufficient to provide for sick children (81%). Despite claiming to have a medium standard of life (75%), nearly half of the respondents (45%) say that they do not have the financial resources to take care of a sick child. The women have informed their partner (97%) and closest family members (82%) and a low percentage have informed friends (32%). Nearly one third (31%) have not talked to the attending gynecologist about their decision. Conclusions: The decision to terminate a pregnancy is made by mature women with a stable life situation—supported by their partner and close family. They do not expect systemic support, as they believe it is marginal, and only seek emotional support from their closest family. They appreciate support provided by professional medical personnel if it is personal