Objective: Endometrial polyps are one of the most often diagnosed gynecological pathologic findings, affecting women from reproductive age to advanced menopause. In women of childbearing age, they can cause infertility, although a clear cause-and-effect relationship is not always evident. In postmenopausal women, endometrial polyps may manifest primarily with abnormal uterine bleeding (AUB). They are usually benign lesions, and the malignant transformation, especially in menopausal women, occurs infrequently increasing with age. The ultrasound suspicion of an endometrial polyp requires a better definition of its size, position, and nature through hysteroscopy. Hysteroscopy performed as an outpatient procedure, in addition to diagnosis may be followed by the simultaneous removal of the polyp (see & treat approach). If this is not possible in an outpatient setting, polypectomy can be performed in the operating theatre by means of resectoscopy or mechanical hysteroscopic tissue removal (mHTR) system. This critical study about the management of endometrial polyps, intends to examine what is still being discussed in this regard. Mechanism: A narrative review was conducted analyzing the available literature regarding the management of endometrial polyps in infertile childbearing age and pre and postmenopausal women. Findings in Brief: There is no agreement that all endometrial polyps should be removed. Polyps <10 mm can be monitored over time. In infertile women, polypectomy is recommended because it is a possible impediment to fertilization, or for Assisted Reproductive Technology (ART) procedures, however not all studies are of agreement. For patients with polyps symptomatic of AUB, polypectomy must always be recommended. Conclusions: Following an endometrial polyp diagnosis by hysteroscopy, the decision to operate should be considered for infertile women or for those with large or symptomatic menopausal polyps. Due to the lack of clear guidelines, the decision can be postponed by adopting careful surveillance in some cases.
{"title":"Critical Aspects of Endometrial Polyp Clinical Management: A Narrative Review","authors":"Oronzo Ruggiero Ceci, Mario Franchini","doi":"10.31083/j.ceog5009188","DOIUrl":"https://doi.org/10.31083/j.ceog5009188","url":null,"abstract":"Objective: Endometrial polyps are one of the most often diagnosed gynecological pathologic findings, affecting women from reproductive age to advanced menopause. In women of childbearing age, they can cause infertility, although a clear cause-and-effect relationship is not always evident. In postmenopausal women, endometrial polyps may manifest primarily with abnormal uterine bleeding (AUB). They are usually benign lesions, and the malignant transformation, especially in menopausal women, occurs infrequently increasing with age. The ultrasound suspicion of an endometrial polyp requires a better definition of its size, position, and nature through hysteroscopy. Hysteroscopy performed as an outpatient procedure, in addition to diagnosis may be followed by the simultaneous removal of the polyp (see & treat approach). If this is not possible in an outpatient setting, polypectomy can be performed in the operating theatre by means of resectoscopy or mechanical hysteroscopic tissue removal (mHTR) system. This critical study about the management of endometrial polyps, intends to examine what is still being discussed in this regard. Mechanism: A narrative review was conducted analyzing the available literature regarding the management of endometrial polyps in infertile childbearing age and pre and postmenopausal women. Findings in Brief: There is no agreement that all endometrial polyps should be removed. Polyps <10 mm can be monitored over time. In infertile women, polypectomy is recommended because it is a possible impediment to fertilization, or for Assisted Reproductive Technology (ART) procedures, however not all studies are of agreement. For patients with polyps symptomatic of AUB, polypectomy must always be recommended. Conclusions: Following an endometrial polyp diagnosis by hysteroscopy, the decision to operate should be considered for infertile women or for those with large or symptomatic menopausal polyps. Due to the lack of clear guidelines, the decision can be postponed by adopting careful surveillance in some cases.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135107866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
IMR Press is a leading publisher of open access peer-reviewed biomedical and life sciences journals. We aim to facilitate the dissemination of high-quality research in the area of biomedical science. With a long tradition and wide readership, IMR Press is dedicated to making positive contributions to academics, corporate libraries as well as to readers and authors. All the editors in IMR Press will provide the best service for researchers, allowing them to have a easy and smooth publication experience and helping maximize the impact and visibility of their research.
{"title":"Toward Better Care of Rare Ovarian Tumors","authors":"Yasuhiko Ebina","doi":"10.31083/j.ceog5009186","DOIUrl":"https://doi.org/10.31083/j.ceog5009186","url":null,"abstract":"IMR Press is a leading publisher of open access peer-reviewed biomedical and life sciences journals. We aim to facilitate the dissemination of high-quality research in the area of biomedical science. With a long tradition and wide readership, IMR Press is dedicated to making positive contributions to academics, corporate libraries as well as to readers and authors. All the editors in IMR Press will provide the best service for researchers, allowing them to have a easy and smooth publication experience and helping maximize the impact and visibility of their research.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135107082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Whether gonadotropin-releasing hormone agonist (GnRH-a) pituitary suppression improves clinical outcomes in non-endometriosis patients undergoing frozen embryo transfer remains controversial. The objective of this study is to investigate whether GnRHa combined with hormone replacement treatment (HRT) compared to HRT alone can improve the clinical outcomes of frozen-thawed embryo transfer in patients without endometriosis. Methods: This is a retrospective cohort study. This study involved 2178 frozen-thawed embryo transfer (FET) cycles of non-endometriosis patients between January 2018 and December 2019, of these cycles, 1535 were GnRHa-HRT combined cycles and 643 were HRT alone cycles. The primary outcomes were the clinical pregnancy and live birth rates. SPSS software (version 23.0, IBM Corp., Chicago, IL, USA) was used for data analysis. Results: Single-factor analysis showed that the live birth and implantation rates -were higher in the GnRHa-HRT group than those in the HRT group (p < 0.05). The mid-to-late-term miscarriage rate in the GnRHa-HRT group was lower than that in the HRT group (p < 0.05). The rates of human chorionic gonadotropin (HCG) positivity, clinical pregnancy, early abortion, multiple pregnancy, and preterm delivery between the two groups were comparable. Multivariate logistic regression analysis showed that rate of the live birth in the GnRHa-HRT group was higher than in the HRT group (p = 0.009), and there was no significant difference in the clinical pregnancy rate between the two groups (p = 0.103). Conclusions: This large-scale retrospective study revealed that non-endometriosis women in FET cycles may benefit from the GnRHa downregulation due to increasing the live birth rate.
背景:促性腺激素释放激素激动剂(GnRH-a)垂体抑制是否能改善非子宫内膜异位症冷冻胚胎移植患者的临床预后仍存在争议。本研究的目的是探讨GnRHa联合激素替代治疗(HRT)与单独HRT相比，是否可以改善无子宫内膜异位症患者冻融胚胎移植的临床结果。方法:回顾性队列研究。本研究涉及2018年1月至2019年12月期间非子宫内膜异位症患者的2178个冷冻解冻胚胎移植(FET)周期，其中1535个周期为GnRHa-HRT联合周期，643个周期为HRT单独周期。主要结局为临床妊娠率和活产率。采用SPSS软件(version 23.0, IBM Corp.， Chicago, IL, USA)进行数据分析。结果:单因素分析显示，GnRHa-HRT组的活产率和着床率均高于HRT组(p <0.05)。gnha -HRT组中晚期流产率低于HRT组(p <0.05)。两组间的人绒毛膜促性腺激素(HCG)阳性、临床妊娠、早流产、多胎妊娠和早产率具有可比性。多因素logistic回归分析显示，GnRHa-HRT组活产率高于HRT组(p = 0.009)，两组临床妊娠率差异无统计学意义(p = 0.103)。结论:这项大规模回顾性研究显示，FET周期的非子宫内膜异位症女性可能因活产率增加而受益于GnRHa下调。
{"title":"Gonadotropin-Releasing Hormone Agonist Combined with Hormone Replacement Therapy Protocol Improves the Live Birth Rate in Frozen-Thawed Embryo Transfer Cycles for Patients without Endometriosis","authors":"Yu Wang, Huixia Xie, Ping Shen, Qun Lv","doi":"10.31083/j.ceog5008171","DOIUrl":"https://doi.org/10.31083/j.ceog5008171","url":null,"abstract":"Background: Whether gonadotropin-releasing hormone agonist (GnRH-a) pituitary suppression improves clinical outcomes in non-endometriosis patients undergoing frozen embryo transfer remains controversial. The objective of this study is to investigate whether GnRHa combined with hormone replacement treatment (HRT) compared to HRT alone can improve the clinical outcomes of frozen-thawed embryo transfer in patients without endometriosis. Methods: This is a retrospective cohort study. This study involved 2178 frozen-thawed embryo transfer (FET) cycles of non-endometriosis patients between January 2018 and December 2019, of these cycles, 1535 were GnRHa-HRT combined cycles and 643 were HRT alone cycles. The primary outcomes were the clinical pregnancy and live birth rates. SPSS software (version 23.0, IBM Corp., Chicago, IL, USA) was used for data analysis. Results: Single-factor analysis showed that the live birth and implantation rates -were higher in the GnRHa-HRT group than those in the HRT group (p < 0.05). The mid-to-late-term miscarriage rate in the GnRHa-HRT group was lower than that in the HRT group (p < 0.05). The rates of human chorionic gonadotropin (HCG) positivity, clinical pregnancy, early abortion, multiple pregnancy, and preterm delivery between the two groups were comparable. Multivariate logistic regression analysis showed that rate of the live birth in the GnRHa-HRT group was higher than in the HRT group (p = 0.009), and there was no significant difference in the clinical pregnancy rate between the two groups (p = 0.103). Conclusions: This large-scale retrospective study revealed that non-endometriosis women in FET cycles may benefit from the GnRHa downregulation due to increasing the live birth rate.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135114731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Intrapartum cesarean delivery has been the focus of many researchers. We derived and validated a model to predict cesarean for low-risk Chinese nulliparous undergoing induction of labor. Methods: We developed a risk model for cesarean by including variables in univariate and multivariable logistic regression using the development set (3841 pregnant women). The performance of the model was assessed for the receiver operating characteristic (ROC) curve, calibration and decision curve analysis (DCA). Additionally, we validated the model externally using an independent dataset (3421 pregnant women). Results: Multivariable logistic regression analysis showed that age, height, body mass index (BMI), weight change during pregnancy, gestational age, premature rupture of membranes (PROM), meconium-stained amniotic fluid and neonatal sex were independent factors affecting cesarean outcome. Two models were established, depending on whether the sex of the fetus was included. The area under the ROC curve of two models were 0.755 and 0.748, respectively. We verified externally, and the area under the ROC curve of two models were 0.758 and 0.758, respectively. The calibration plots demonstrated a good correlation. DCA demonstrated that two models had clinical application value. The online web servers were constructed based on the nomograms for convenient clinical use. Conclusions: These two models can be used as useful tools to assess the risk of cesarean for low-risk Chinese nulliparous undergoing induction of labor.
{"title":"Development and Validation of Models to Predict Cesarean Delivery among Low-Risk Nulliparous Women at Term: A Retrospective Study in China","authors":"Fangcan Sun, Fangfang Wu, Huiyun Chen, Qianqian Shen, Youguo Chen, Minhong Shen, Bing Han","doi":"10.31083/j.ceog5008166","DOIUrl":"https://doi.org/10.31083/j.ceog5008166","url":null,"abstract":"Background: Intrapartum cesarean delivery has been the focus of many researchers. We derived and validated a model to predict cesarean for low-risk Chinese nulliparous undergoing induction of labor. Methods: We developed a risk model for cesarean by including variables in univariate and multivariable logistic regression using the development set (3841 pregnant women). The performance of the model was assessed for the receiver operating characteristic (ROC) curve, calibration and decision curve analysis (DCA). Additionally, we validated the model externally using an independent dataset (3421 pregnant women). Results: Multivariable logistic regression analysis showed that age, height, body mass index (BMI), weight change during pregnancy, gestational age, premature rupture of membranes (PROM), meconium-stained amniotic fluid and neonatal sex were independent factors affecting cesarean outcome. Two models were established, depending on whether the sex of the fetus was included. The area under the ROC curve of two models were 0.755 and 0.748, respectively. We verified externally, and the area under the ROC curve of two models were 0.758 and 0.758, respectively. The calibration plots demonstrated a good correlation. DCA demonstrated that two models had clinical application value. The online web servers were constructed based on the nomograms for convenient clinical use. Conclusions: These two models can be used as useful tools to assess the risk of cesarean for low-risk Chinese nulliparous undergoing induction of labor.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135697717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Min Zhao, Meng-Jiao Zhang, Lian-Ju He, Chun-Mei Zuo, Song-Rui Ding, Allison Rabkin Golden, Le Cai
Background: Cervical cancer is the fourth most common cancer in women, with an estimated 600,000 new cases and 340,000 deaths worldwide in 2020. However, there remains limited understanding of the association between individual socioeconomic status, clinical characteristics, and health-related quality of life (HRQoL) of women with cervical precancerous lesions. This study investigates socioeconomic and clinical variations in HRQoL of women with cervical precancerous lesions and cervical cancer in Yunnan Province, China. Methods: The present study employed a cross-sectional survey design. An EuroQol Five Dimensions Five Level (EQ-5D-5L) questionnaire was used to assess HRQoL of 400 patients with cervical precancerous lesions and cervical cancer in Yunnan Province, China, from 2019 to 2020. Analysis of variance (ANOVA) and independent samples t-tests were performed to identify the independent variables associated with EQ-5D-5L utility scores and visual analogue scale (VAS) scores. Predictors of utility scores were confirmed using a Tobit regression model. Results: The mean EQ-5D-5L utility scores of cervical precancerous lesions and cervical cancer patients was 0.939 (standard deviation (SD), 0.104), and the mean VAS score was 80.84 (SD, 16.551). Patients aged 40–59 years (β = –0.037, p = 0.005), patients who were not aware of the human papillomavirus (HPV) vaccine (β = –0.032, p = 0.004), and patients who underwent radical hysterectomy (β = –0.036, p = 0.006) had significantly lower utility scores, whereas having high monthly household income (β = 0.023, p = 0.033) was significantly associated with higher EQ-5D-5L utility scores. Age (p = 0.023) was statistically significant in differences in patients’ VAS scores. Anxiety/depression was the most frequently reported issue (35.75%) among participants. Conclusions: Future cervical cancer prevention and treatment guidelines should focus on low-income women, women aged 40–59 years, and those lacking knowledge about cervical cancer prevention.
背景:宫颈癌是女性中第四大常见癌症，预计2020年全球将有60万新病例和34万例死亡。然而，对于宫颈癌前病变妇女的个体社会经济地位、临床特征和健康相关生活质量(HRQoL)之间的关系，人们的理解仍然有限。本研究调查了中国云南省宫颈癌前病变和宫颈癌妇女HRQoL的社会经济和临床变化。方法:本研究采用横断面调查设计。采用EuroQol五维度五水平(EQ-5D-5L)问卷对2019 - 2020年云南省400例宫颈癌前病变和宫颈癌患者的HRQoL进行评估。采用方差分析(ANOVA)和独立样本t检验来确定与EQ-5D-5L效用评分和视觉模拟量表(VAS)评分相关的自变量。使用Tobit回归模型确认效用得分的预测因子。结果:宫颈癌前病变与宫颈癌患者EQ-5D-5L效用评分均值为0.939(标准差为0.104)，VAS评分均值为80.84(标准差为16.551)。40-59岁患者(β = -0.037, p = 0.005)、未接种人乳头瘤病毒(HPV)疫苗的患者(β = -0.032, p = 0.004)和接受根治性子宫切除术的患者(β = -0.036, p = 0.006)效用得分显著降低，而家庭月收入高(β = 0.023, p = 0.033)与EQ-5D-5L效用得分显著升高相关。患者VAS评分的年龄差异有统计学意义(p = 0.023)。焦虑/抑郁是参与者中最常报告的问题(35.75%)。结论:今后宫颈癌防治指南应重点关注低收入妇女、40 ~ 59岁妇女和缺乏宫颈癌预防知识的妇女。
{"title":"Health-Related Quality of Life with Cervical Cancer and Precancer: A Cross-Sectional Study in Yunnan Province, China","authors":"Min Zhao, Meng-Jiao Zhang, Lian-Ju He, Chun-Mei Zuo, Song-Rui Ding, Allison Rabkin Golden, Le Cai","doi":"10.31083/j.ceog5008161","DOIUrl":"https://doi.org/10.31083/j.ceog5008161","url":null,"abstract":"Background: Cervical cancer is the fourth most common cancer in women, with an estimated 600,000 new cases and 340,000 deaths worldwide in 2020. However, there remains limited understanding of the association between individual socioeconomic status, clinical characteristics, and health-related quality of life (HRQoL) of women with cervical precancerous lesions. This study investigates socioeconomic and clinical variations in HRQoL of women with cervical precancerous lesions and cervical cancer in Yunnan Province, China. Methods: The present study employed a cross-sectional survey design. An EuroQol Five Dimensions Five Level (EQ-5D-5L) questionnaire was used to assess HRQoL of 400 patients with cervical precancerous lesions and cervical cancer in Yunnan Province, China, from 2019 to 2020. Analysis of variance (ANOVA) and independent samples t-tests were performed to identify the independent variables associated with EQ-5D-5L utility scores and visual analogue scale (VAS) scores. Predictors of utility scores were confirmed using a Tobit regression model. Results: The mean EQ-5D-5L utility scores of cervical precancerous lesions and cervical cancer patients was 0.939 (standard deviation (SD), 0.104), and the mean VAS score was 80.84 (SD, 16.551). Patients aged 40–59 years (β = –0.037, p = 0.005), patients who were not aware of the human papillomavirus (HPV) vaccine (β = –0.032, p = 0.004), and patients who underwent radical hysterectomy (β = –0.036, p = 0.006) had significantly lower utility scores, whereas having high monthly household income (β = 0.023, p = 0.033) was significantly associated with higher EQ-5D-5L utility scores. Age (p = 0.023) was statistically significant in differences in patients’ VAS scores. Anxiety/depression was the most frequently reported issue (35.75%) among participants. Conclusions: Future cervical cancer prevention and treatment guidelines should focus on low-income women, women aged 40–59 years, and those lacking knowledge about cervical cancer prevention.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135064469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Forslund, K. Landin-Wilhelmsen, E. Krantz, Penelope Trimpou, Johanna Schmidt, M. Brännström, E. Dahlgren
Background: Several studies have shown that younger women with polycystic ovary syndrome (PCOS) have decreased Health-Related Quality of Life (HRQoL) compared with women in general. Method: In this study periand postmenopausal women previously diagnosed with PCOS (n = 27) were compared with randomly selected, age-matched controls (n = 94). Mean age of the study participants was 52 years. Structured interviews and Short Form (SF)-36 questionnaires were used. Results: No differences in SF-36 scores were found, median for the physical summary score was 54 vs. 57, for women with PCOS and controls, respectively; and 53 vs. 53 for the mental summary score, with no differences in any of the eight dimensions of HRQoL. There were no significant difference in prevalence of depression and/or anxiety. The use of drugs for mood disorders was 22% in both groups. Conclusion: PCOS women of periand postmenopausal ages had similar HRQoL compared with age-matched controls.
{"title":"Health-Related Quality of Life in perimenopausal women with PCOS","authors":"M. Forslund, K. Landin-Wilhelmsen, E. Krantz, Penelope Trimpou, Johanna Schmidt, M. Brännström, E. Dahlgren","doi":"10.31083/j.ceog4902052","DOIUrl":"https://doi.org/10.31083/j.ceog4902052","url":null,"abstract":"Background: Several studies have shown that younger women with polycystic ovary syndrome (PCOS) have decreased Health-Related Quality of Life (HRQoL) compared with women in general. Method: In this study periand postmenopausal women previously diagnosed with PCOS (n = 27) were compared with randomly selected, age-matched controls (n = 94). Mean age of the study participants was 52 years. Structured interviews and Short Form (SF)-36 questionnaires were used. Results: No differences in SF-36 scores were found, median for the physical summary score was 54 vs. 57, for women with PCOS and controls, respectively; and 53 vs. 53 for the mental summary score, with no differences in any of the eight dimensions of HRQoL. There were no significant difference in prevalence of depression and/or anxiety. The use of drugs for mood disorders was 22% in both groups. Conclusion: PCOS women of periand postmenopausal ages had similar HRQoL compared with age-matched controls.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2022-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46853084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Escura Sancho, L. Ribera-Torres, C. Castelo-Branco, S. Anglès-Acedo
Objective: Globally, the prevalence of urinary incontinence (UI) in women is estimated to be in the range of 25% to 45%. Different types of UI exist, being the most frequent ones stress UI, urgency UI and mixed UI. Being affected by UI is associated with a higher risk of sexual inactivity, regardless of its type. Mechanism: It is estimated that 5–38% patients with UI are sexually inactive due to UI, whereas 25–38% sexually active women would restrict their sexual activity due to UI. The prevalence of sexual dysfunction within sexually active women with UI is 23–56%. Findings in brief: In patients with UI, the most frequent sexual dysfunctions are dyspareunia (44%), female sexual interest/arousal disorder (34%) and orgasmic disorder (11%). Therefore, UI has a negative impact on the sexual function of sexually active women with UI. Coital incontinence is defined as the complaint of involuntary loss of urine during or after intercourse. UI with penetration represents any complaint of involuntary loss of urine with vaginal stimulation (either with a sexual toy, manually or with penetration). Orgasmic UI refers to any complaint of involuntary loss of urine occurring at orgasm, regardless of the sexual behaviour that has triggered it. Due to the high prevalence of coital UI (50–60%) in the female population and its strongly negative impact on women’s sexuality, patients should be specifically asked for coital UI in the gynecologic visits. Conclusions: UI affects between one in four and one in two women and had a negative impact on quality of life. Not only UI has an impact on female sexuality, but also different treatments which are offered to treat it can play a role. The reduction of sexual problems with pelvic floor muscle training in women with stress UI has been proved, being the rate of sexual activity doubled. A significant improvement of the overactive bladder associated to urgency UI and female sexual function has been described after the pharmacological treatment or botulinum toxin. Finally, significant improvement of the sexual function has also been found after midurethral slings for stress UI, as well as for coital UI.
{"title":"Impact of Urinary Incontinence on Women’s Sexuality","authors":"S. Escura Sancho, L. Ribera-Torres, C. Castelo-Branco, S. Anglès-Acedo","doi":"10.31083/j.ceog4902049","DOIUrl":"https://doi.org/10.31083/j.ceog4902049","url":null,"abstract":"Objective: Globally, the prevalence of urinary incontinence (UI) in women is estimated to be in the range of 25% to 45%. Different types of UI exist, being the most frequent ones stress UI, urgency UI and mixed UI. Being affected by UI is associated with a higher risk of sexual inactivity, regardless of its type. Mechanism: It is estimated that 5–38% patients with UI are sexually inactive due to UI, whereas 25–38% sexually active women would restrict their sexual activity due to UI. The prevalence of sexual dysfunction within sexually active women with UI is 23–56%. Findings in brief: In patients with UI, the most frequent sexual dysfunctions are dyspareunia (44%), female sexual interest/arousal disorder (34%) and orgasmic disorder (11%). Therefore, UI has a negative impact on the sexual function of sexually active women with UI. Coital incontinence is defined as the complaint of involuntary loss of urine during or after intercourse. UI with penetration represents any complaint of involuntary loss of urine with vaginal stimulation (either with a sexual toy, manually or with penetration). Orgasmic UI refers to any complaint of involuntary loss of urine occurring at orgasm, regardless of the sexual behaviour that has triggered it. Due to the high prevalence of coital UI (50–60%) in the female population and its strongly negative impact on women’s sexuality, patients should be specifically asked for coital UI in the gynecologic visits. Conclusions: UI affects between one in four and one in two women and had a negative impact on quality of life. Not only UI has an impact on female sexuality, but also different treatments which are offered to treat it can play a role. The reduction of sexual problems with pelvic floor muscle training in women with stress UI has been proved, being the rate of sexual activity doubled. A significant improvement of the overactive bladder associated to urgency UI and female sexual function has been described after the pharmacological treatment or botulinum toxin. Finally, significant improvement of the sexual function has also been found after midurethral slings for stress UI, as well as for coital UI.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41857248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seongmin Kim, K. Min, Sanghoon Lee, J. Hong, J. Song, Jae Kwan Lee, N. Lee
Background: Given that borderline ovarian tumors (BOTs) are usually found in young, fertile women without a history of childbirth, fertility preservation should be considered in the treatment plan. This retrospective study aimed to evaluate the safety of ovarian cystectomy in patients with BOTs. Methods: Patients with BOTs treated between August 2007 and August 2016 at our institution were divided into two groups according to the type of surgery: the cystectomy group and the oophorectomy group with or without salpingectomy, and differences in surgical outcomes were compared. The cumulative disease recurrence was also compared using Kaplan–Meier curves. Results: Of the 162 patients enrolled, 128 (79.0%) underwent an oophorectomy with or without salpingectomy and 34 (21.0%) underwent an ovarian cystectomy. The patients in the cystectomy group were younger than those in the oophorectomy group (29.2 years vs. 46.5 years, p< 0.001), and the proportion of patients who underwent minimally invasive surgery was higher in the cystectomy group than in the oophorectomy group (88.2% vs. 46.9%, p < 0.001). During the mean follow-up period of 44 months, six patients (3.70%) developed disease recurrence (five [3.9%] and one [2.9%] in the oophorectomy and cystectomy groups, respectively). The two-year disease-free survival rate was 97.1% and 97.6% in the cystectomy and oophorectomy groups, respectively, and did not differ between the groups (p = 0.818). Discussion: Ovarian cystectomy can be considered a safe and effective option for young women with BOTs who wish to preserve their fertility.
{"title":"Is ovarian cystectomy feasible for patients with borderline ovarian tumors? A retrospective study and review of the literature","authors":"Seongmin Kim, K. Min, Sanghoon Lee, J. Hong, J. Song, Jae Kwan Lee, N. Lee","doi":"10.31083/j.ceog4902051","DOIUrl":"https://doi.org/10.31083/j.ceog4902051","url":null,"abstract":"Background: Given that borderline ovarian tumors (BOTs) are usually found in young, fertile women without a history of childbirth, fertility preservation should be considered in the treatment plan. This retrospective study aimed to evaluate the safety of ovarian cystectomy in patients with BOTs. Methods: Patients with BOTs treated between August 2007 and August 2016 at our institution were divided into two groups according to the type of surgery: the cystectomy group and the oophorectomy group with or without salpingectomy, and differences in surgical outcomes were compared. The cumulative disease recurrence was also compared using Kaplan–Meier curves. Results: Of the 162 patients enrolled, 128 (79.0%) underwent an oophorectomy with or without salpingectomy and 34 (21.0%) underwent an ovarian cystectomy. The patients in the cystectomy group were younger than those in the oophorectomy group (29.2 years vs. 46.5 years, p< 0.001), and the proportion of patients who underwent minimally invasive surgery was higher in the cystectomy group than in the oophorectomy group (88.2% vs. 46.9%, p < 0.001). During the mean follow-up period of 44 months, six patients (3.70%) developed disease recurrence (five [3.9%] and one [2.9%] in the oophorectomy and cystectomy groups, respectively). The two-year disease-free survival rate was 97.1% and 97.6% in the cystectomy and oophorectomy groups, respectively, and did not differ between the groups (p = 0.818). Discussion: Ovarian cystectomy can be considered a safe and effective option for young women with BOTs who wish to preserve their fertility.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47396689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kanczuk, N. Lightfoot, Y. Ohashi, J. Chong, H. Mace, David W. Hoppe, E. O’Loughlin
Background: The incidence of postoperative nausea and vomiting (PONV) when intrathecal morphine (ITM) is used for caesarean delivery (CD) is up to 80% without antiemetic prophylaxis. Prophylactic antiemetics can reduce this rate by 50%, except for dexamethasone that did not show to be effective in this context. Combinations showed divergent results. We investigated the incidence of PONV when different combinations of antiemetics were used for CD in parturients receiving ITM.Methods: Retrospective, single centre cohort study of patients undergoing elective CD with ITM between January 2016 and October 2017. The primary outcome was the incidence of PONV requiring treatment in the first 24 hours following CD. Interactions were sought using multivariate modelling for predictors of PONV following surgery. Results: Overall, 598 women were included in the study. The rate of PONV requiring treatment was 29.1%. The rate of PONV decreased with increasing numbers of prophylactic medications (p < 0.001). Women who did not experience PONV received a greater number of antiemetics in the operating room (p < 0.001). There was a dose response relationship between ITM dose and PONV rate (p < 0.001). Dexamethasone, either alone or in combination with other agents was not protective against PONV when compared with other drug combinations (p = 0.08). Conclusions: We have demonstrated an inverse relationship between the number of prophylactic antiemetics given and the rates of PONV after caesarean delivery in the context of intrathecal morphine use. Dexamethasone use, either alone or in conjunction with other drugs did not offer advantages over other combinations where dexamethasone was avoided.
{"title":"The effect of intraoperative antiemetics on postoperative nausea and vomiting in patients receiving intrathecal morphine for elective caesarean deliveries","authors":"M. Kanczuk, N. Lightfoot, Y. Ohashi, J. Chong, H. Mace, David W. Hoppe, E. O’Loughlin","doi":"10.31083/j.ceog4902050","DOIUrl":"https://doi.org/10.31083/j.ceog4902050","url":null,"abstract":"Background: The incidence of postoperative nausea and vomiting (PONV) when intrathecal morphine (ITM) is used for caesarean delivery (CD) is up to 80% without antiemetic prophylaxis. Prophylactic antiemetics can reduce this rate by 50%, except for dexamethasone that did not show to be effective in this context. Combinations showed divergent results. We investigated the incidence of PONV when different combinations of antiemetics were used for CD in parturients receiving ITM.Methods: Retrospective, single centre cohort study of patients undergoing elective CD with ITM between January 2016 and October 2017. The primary outcome was the incidence of PONV requiring treatment in the first 24 hours following CD. Interactions were sought using multivariate modelling for predictors of PONV following surgery. Results: Overall, 598 women were included in the study. The rate of PONV requiring treatment was 29.1%. The rate of PONV decreased with increasing numbers of prophylactic medications (p < 0.001). Women who did not experience PONV received a greater number of antiemetics in the operating room (p < 0.001). There was a dose response relationship between ITM dose and PONV rate (p < 0.001). Dexamethasone, either alone or in combination with other agents was not protective against PONV when compared with other drug combinations (p = 0.08). Conclusions: We have demonstrated an inverse relationship between the number of prophylactic antiemetics given and the rates of PONV after caesarean delivery in the context of intrathecal morphine use. Dexamethasone use, either alone or in conjunction with other drugs did not offer advantages over other combinations where dexamethasone was avoided.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44141206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: The purpose of this review is to provide an overview of existing studies on the specificities of gene expression in the endometrium in PCOS and possible molecular mechanisms linking those specificities with reproductive and obstetric consequences of PCOS. Mechanism: Polycystic ovary syndrome (PCOS) is a complex disorder combining features of reproductive, metabolic, and psychological disturbances. The effect of metabolic, inflammatory, and endocrine abnormalities on ovulatory function and oocyte quality has been seen as the main reproductive issue in PCOS women. However, even after the restoration of ovulation, this group exhibits lower than expected reproductive outcomes. Functionally relevant sequence alterations in genes involved in regulating endometrial receptivity could also be relevant in PCOS as a property independent of extra-endometrial influences. Findings: Hyperandrogenism, ovulatory dysfunction, and insulin resistance are associated with the alterations in endometrial gene expressions leading to suboptimal endometrial receptivity in PCOS. Endometrial steroid receptor malfunction seems to be a contibuting factor to the intrinsic suboptimal endometrial receptivity in PCOS. Conclusion: epigenetic or epigenomics mechanisms altering gene expressions on the endometrial level in PCOS should not be ruled out. Future studies should focus on investigating specificities of each PCOS phenotype and developing individual treatment strategies to meet the specific needs of every PCOS patient.
{"title":"Endometrial receptivity and PCOS; endometrial gene expression specificities — literature review","authors":"M. Alebić","doi":"10.31083/j.ceog4902048","DOIUrl":"https://doi.org/10.31083/j.ceog4902048","url":null,"abstract":"Objectives: The purpose of this review is to provide an overview of existing studies on the specificities of gene expression in the endometrium in PCOS and possible molecular mechanisms linking those specificities with reproductive and obstetric consequences of PCOS. Mechanism: Polycystic ovary syndrome (PCOS) is a complex disorder combining features of reproductive, metabolic, and psychological disturbances. The effect of metabolic, inflammatory, and endocrine abnormalities on ovulatory function and oocyte quality has been seen as the main reproductive issue in PCOS women. However, even after the restoration of ovulation, this group exhibits lower than expected reproductive outcomes. Functionally relevant sequence alterations in genes involved in regulating endometrial receptivity could also be relevant in PCOS as a property independent of extra-endometrial influences. Findings: Hyperandrogenism, ovulatory dysfunction, and insulin resistance are associated with the alterations in endometrial gene expressions leading to suboptimal endometrial receptivity in PCOS. Endometrial steroid receptor malfunction seems to be a contibuting factor to the intrinsic suboptimal endometrial receptivity in PCOS. Conclusion: epigenetic or epigenomics mechanisms altering gene expressions on the endometrial level in PCOS should not be ruled out. Future studies should focus on investigating specificities of each PCOS phenotype and developing individual treatment strategies to meet the specific needs of every PCOS patient.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2022-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49537933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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