Background Subcutaneous depot medroxyprogesterone acetate is an easy-to-use injectable contraceptive. A trained person can administer it, including women through self-injection. The objective of this systematic review and meta-analysis was to assess the effectiveness and safety of self-injection versus provider-administered subcutaneous depot medroxyprogesterone acetate for improving continuation of contraceptive use. Methods We searched for randomized controlled trials on November 1, 2020 in Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, Embase, Web of Science, Scopus, Open Grey, clinical trials registries, and reference lists of relevant studies. We did not impose any search restrictions. We included randomized trials comparing self- versus provider-administered subcutaneous depot medroxyprogesterone acetate. Two authors independently screened trials, extracted data, and assessed the risk of bias in the included studies. We used risk ratio and 95% confidence intervals for dichotomous outcomes. Results We identified 3 randomized trials (9 reports; 1264 participants). The risk of bias in the included studies was low except for performance bias and detection bias of participant-reported outcomes in unmasked trials. Self-administration, compared to provider-administration, increased continuation of contraceptive use (risk ratio 1.35; 95% confidence intervals 1.10–1.66); moderate-certainty evidence). Self-injection appears to be making more of an impact on continuation for younger women compared to women 25 years and older and on women living in low and middle income compared to high income countries. There was no subgroup difference by the type of care provider (community health worker vs. clinic-based provider). Conclusions Self-injection of subcutaneous depot medroxyprogesterone acetate probably improves continuation of contraceptive use. The effects on other outcomes remain uncertain because of the very low certainty of evidence.

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Background: Subcutaneous depot medroxyprogesterone acetate is an easy-to-use injectable contraceptive. A trained person can administer it, including women through self-injection. Objectives: to assess the effectiveness and safety of self-injection versus provider-administered subcutaneous depot medroxyprogesterone acetate for improving continuation of contraceptive use.Search strategy: We searched for randomized controlled trials on November 1, 2020 in Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, Embase, Web of Science, Scopus, Open Grey, clinical trials registries, and reference lists of relevant studies. We did not impose any search restrictions.Selection criteria: We included randomized trials comparing self- vs provider-administered subcutaneous depot medroxyprogesterone acetate.Data collection and analysis: Two authors independently screened trials, extracted data, and assessed the risk of bias in the included studies. We used risk ratio and 95% confidence intervals for dichotomous outcomes.Results: We identified 3 randomized trials (9 reports; 1264 participants). The risk of bias in the included studies was low except for performance bias and detection bias of participant-reported outcomes in unmasked trials. Self-administration, compared to provider-administration, increased continuation of contraceptive use (risk ratio 1.35; 95% confidence intervals 1.10 to 1.66); moderate-certainty evidence). Self-injection appears to be making more of an impact on continuation for younger women compared to women 25 years and older and on women living in low and middle income compared to high income countries. There was no subgroup difference by the type of care provider (community health worker vs clinic-based provider).Conclusions: Self-injection of subcutaneous depot medroxyprogesterone acetate probably improves continuation of contraceptive use. The effects on other outcomes remain uncertain because of the very low certainty of evidence.Registration number: CRD42018097388.

Nausea and vomiting during pregnancy are the most common conditions affecting pregnancy, occurring in about 80% of all pregnancies and commonly disappears by 16 to 18 weeks of gestation. Hyperemesis gravidarum is the most severe form of nausea and vomiting in pregnancy, it is accompanied by starvation, dehydration, acidosis, alkalosis from hydrochloric acid loss in the vomits, hypokalemia, weight loss and transient hepatic dysfunction [1]. Many hypotheses have been published to explain the etiology and pathophysiology of hyperemesis gravidarum including infections, gastrointestinal tract dysfunctions, endocrinal changes, anatomical, metabolic and immunological factors. However, no single theory is enough to give an adequate explanation for all the properties of hyperemesis gravidarum. Some studies done on patients with hyperemesis gravidarum indicated a relationship between Helicobacter pylori and hyperemesis gravidarum, in addition multiple gastrointestinal and extra digestive pathologies may be associated with Helicobacter pylori infection.

Objectives: About 30-80% of preterm deliveries following preterm premature rupture of fetal membranes (PPROM) are complicated by histological chorioamnionitis. To evaluate the accuracy of Interleukin-6 (IL-6) bedside test in detecting chorioamnionitis in women with PPROM. Material and methods: One hundred and ten (110) pregnant women with PPROM > 24 and < 34 weeks' gestation, admitted for conservative management were included in this study. Participants were examined on admission using sterile speculum examination for assessment of IL-6 in the cervico-vaginal secretions using the IL-6 bedside test. The IL-6 bedside test was repeated for all participants once termination of pregnancy (TOP) decided. After TOP, placenta, umbilical cord, and fetal membranes samples were examined for histologic detection of chorioamnionitis (gold standard). The histological results were compared with IL-6 bedside test results to evaluate the accuracy of IL-6 bedside test in detecting chorioamnionitis in women with PPROM. Results:The IL-6 bedside test had 98.6% sensitivity, 94.7% specificity, 97.3% positive predictive value (PPV), 97.3% negative predictive value (NPV) and 97.3% overall accuracy in detecting chorioamnionitis. The sensitivity, specificity, NPV and overall accuracy of IL-6 bedside test (98.6%, 94.7%, 97.3%, and 97.3%; respectively) were significantly higher than the clinical and laboratory parameters of chorioamnionitis (65.3%, 57.9%, 46.8%, and 62.7%; respectively) (p = 0.04, 0.02, 0.001 and 0.03; respectively). Conclusions:The IL-6 bedside test is an accurate, non-invasive bedside test with 98.6% sensitivity, 94.7% specificity, 97.3% PPV, 97.3% NPV, and 97.3% overall accuracy in detecting chorioamnionitis. The IL-6 bedside test had significantly higher sensitivity, specificity, NPV, and overall accuracy than the clinical and laboratory parameters of chorioamnionitis.