Pub Date : 2021-01-13DOI: 10.23736/S0026-4784.20.04765-6
L. Muzii, Chiara Di Tucci, G. Galati, Giulia Mattei, A. Chiné, G. Cascialli, I. Palaia, P. Benedetti Panici
Endometriosis is a chronic disease frequently associated with female infertility. The choice of treatment in case of endometriosis is one of the most discussed topics in Reproductive Medicine. The approach to the patient with endometriosis and infertility should be tailored based on different parameters. The localization of the disease, the severity of symptoms and the age of the patient are just some of them. Management options include surgery, in-vitro fertilization (IVF), or a combination of both. Data, mostly uncontrolled, would favour surgery at any stage of endometriosis, increasing the chances of natural conception compared to expectant management. Laparoscopic excision of the ovarian endometrioma should be the treatment of choice when there is associated pain. Surgery should be performed following appropriate techniques to reduce the possible damage to the ovarian reserve. Pregnancy rates around 50% have been consistently reported after surgery, which compare favorably with those obtained with IVF. IVF, on the other hand, may be preferred in case of associated male or tubal factor, in case of a reduced ovarian reserve, or if previous surgery has failed, particularly if there is no associated pain, and when the ultrasonographic features of the ovarian cyst are reassuring. Sometimes IVF may be preceded by surgery, when a difficult access to follicles at pick-up, due to the size and location of the ovarian cyst, or to severe adhesions, is anticipated. Due to the lack of solid evidence in the scenario of endometriosis-associated infertility, robust data from randomized clinical trials (RCTs) are strongly needed.
{"title":"Endometriosis-associated infertility: surgery or IVF?","authors":"L. Muzii, Chiara Di Tucci, G. Galati, Giulia Mattei, A. Chiné, G. Cascialli, I. Palaia, P. Benedetti Panici","doi":"10.23736/S0026-4784.20.04765-6","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04765-6","url":null,"abstract":"Endometriosis is a chronic disease frequently associated with female infertility. The choice of treatment in case of endometriosis is one of the most discussed topics in Reproductive Medicine. The approach to the patient with endometriosis and infertility should be tailored based on different parameters. The localization of the disease, the severity of symptoms and the age of the patient are just some of them. Management options include surgery, in-vitro fertilization (IVF), or a combination of both. Data, mostly uncontrolled, would favour surgery at any stage of endometriosis, increasing the chances of natural conception compared to expectant management. Laparoscopic excision of the ovarian endometrioma should be the treatment of choice when there is associated pain. Surgery should be performed following appropriate techniques to reduce the possible damage to the ovarian reserve. Pregnancy rates around 50% have been consistently reported after surgery, which compare favorably with those obtained with IVF. IVF, on the other hand, may be preferred in case of associated male or tubal factor, in case of a reduced ovarian reserve, or if previous surgery has failed, particularly if there is no associated pain, and when the ultrasonographic features of the ovarian cyst are reassuring. Sometimes IVF may be preceded by surgery, when a difficult access to follicles at pick-up, due to the size and location of the ovarian cyst, or to severe adhesions, is anticipated. Due to the lack of solid evidence in the scenario of endometriosis-associated infertility, robust data from randomized clinical trials (RCTs) are strongly needed.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2021-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47240930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-13DOI: 10.23736/S0026-4784.20.04701-2
Carlo Dorizzi, Francesca Scotton, F. Merlin, G. Guidetti, E. Marcon, D. Montemurro, Alberto Rigo, P. Benini
BACKGROUND Since COVID-19 was declared a pandemic governments have taken actions to limit the transmission of the virus such as lockdown measures and reorganization of the local Health System. Quarantine measures have influenced pregnant women's daily lives. The aim of this study is to understand the impact of the changes imposed by COVID-19 emergency on the wellbeing of pregnant women and how the transformation of Schiavonia Hospital into a dedicated Covid Hospital affected their pregnancy experience. METHODS A cross-sectional survey was conducted. Pregnant women who gave birth in Schiavonia Hospital during the period May-September 2020 have been included. The assessment examined clinical characteristics, attitudes in relation to the pandemic and how it affected birth plans, perception of information received and attitudes regards giving birth in a Covid Hospital. RESULTS 104 women responded to the survey, with an enrolment rate of 58%. About the influence of COVID-19 pandemic, 51% of respondents reported changing some aspect of their lifestyle. The identification of Schiavonia hospital as Covid Hospital did not modify the trust in the facility and in the Obstetrics Ward for the 90% of women, in fact for the 85,6% it was the planned Birth Centre since the beginning of pregnancy. The communication was complete and exhaustive for 82,7% of the respondents. CONCLUSIONS Despite the Covid Hospital transformation, the women who came to give birth at Schiavonia Birth Centre rated the healthcare assistance received at high level, evidencing high affection for the structure and the healthcare workers.
{"title":"Re-birth in a Covid hospital: a point of view.","authors":"Carlo Dorizzi, Francesca Scotton, F. Merlin, G. Guidetti, E. Marcon, D. Montemurro, Alberto Rigo, P. Benini","doi":"10.23736/S0026-4784.20.04701-2","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04701-2","url":null,"abstract":"BACKGROUND\u0000Since COVID-19 was declared a pandemic governments have taken actions to limit the transmission of the virus such as lockdown measures and reorganization of the local Health System. Quarantine measures have influenced pregnant women's daily lives. The aim of this study is to understand the impact of the changes imposed by COVID-19 emergency on the wellbeing of pregnant women and how the transformation of Schiavonia Hospital into a dedicated Covid Hospital affected their pregnancy experience.\u0000\u0000\u0000METHODS\u0000A cross-sectional survey was conducted. Pregnant women who gave birth in Schiavonia Hospital during the period May-September 2020 have been included. The assessment examined clinical characteristics, attitudes in relation to the pandemic and how it affected birth plans, perception of information received and attitudes regards giving birth in a Covid Hospital.\u0000\u0000\u0000RESULTS\u0000104 women responded to the survey, with an enrolment rate of 58%. About the influence of COVID-19 pandemic, 51% of respondents reported changing some aspect of their lifestyle. The identification of Schiavonia hospital as Covid Hospital did not modify the trust in the facility and in the Obstetrics Ward for the 90% of women, in fact for the 85,6% it was the planned Birth Centre since the beginning of pregnancy. The communication was complete and exhaustive for 82,7% of the respondents.\u0000\u0000\u0000CONCLUSIONS\u0000Despite the Covid Hospital transformation, the women who came to give birth at Schiavonia Birth Centre rated the healthcare assistance received at high level, evidencing high affection for the structure and the healthcare workers.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2021-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45483764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-13DOI: 10.23736/S0026-4784.20.04753-X
J. Casarin, C. Cimmino, V. Artuso, A. Cromi, F. Ghezzi
INTRODUCTION The word "minilaparoscopy" refers to laparoscopic surgical procedures performed using < 5-mm trocars, with the exception of the umbilical access. The aim of this review is to explore the feasibility of minilaparoscopy in gynecologic surgery, focusing on instruments, surgical techniques, application and limits of this approach. EVIDENCE ACQUISITION In this review the Authors discuss positive features and limitation of 3-mm laparoscopy for gynecologic surgery. EVIDENCE SYNTHESIS Using smaller trocars decreases incisional and postoperative pain, and shortens hospitalization, and provides a better cosmetic outcome. Transvaginal specimen extraction can be used to maximize the aesthetic outcomes. A minilaparoscopic surgical procedure is accomplished with lower carbon dioxide pressures, reducing pneumoperitoneum related complications. Accurate patient selection is critical in order to offer the best laparoscopic approach, considering that obesity and endometriosis may represent a challenge for 3-mm surgical tools, which are more flexible and have lower grasping ability. Minilaparoscopy has been shown as a valid alternative to conventional laparoscopy both for diagnostic purpose, major surgical procedures and oncological surgery. CONCLUSIONS Minilaparoscopy in gynecologic surgery represents an option for selected patients, for both benign and malignant indications. The aesthetic outcome represents the main benefit of this approach. Surgeons have to be aware of few limitations of this technique such as severe obesity and endometriosis.
{"title":"Minilaparoscopy in gynecology: applications, benefits and limitations.","authors":"J. Casarin, C. Cimmino, V. Artuso, A. Cromi, F. Ghezzi","doi":"10.23736/S0026-4784.20.04753-X","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04753-X","url":null,"abstract":"INTRODUCTION\u0000The word \"minilaparoscopy\" refers to laparoscopic surgical procedures performed using < 5-mm trocars, with the exception of the umbilical access. The aim of this review is to explore the feasibility of minilaparoscopy in gynecologic surgery, focusing on instruments, surgical techniques, application and limits of this approach.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000In this review the Authors discuss positive features and limitation of 3-mm laparoscopy for gynecologic surgery.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000Using smaller trocars decreases incisional and postoperative pain, and shortens hospitalization, and provides a better cosmetic outcome. Transvaginal specimen extraction can be used to maximize the aesthetic outcomes. A minilaparoscopic surgical procedure is accomplished with lower carbon dioxide pressures, reducing pneumoperitoneum related complications. Accurate patient selection is critical in order to offer the best laparoscopic approach, considering that obesity and endometriosis may represent a challenge for 3-mm surgical tools, which are more flexible and have lower grasping ability. Minilaparoscopy has been shown as a valid alternative to conventional laparoscopy both for diagnostic purpose, major surgical procedures and oncological surgery.\u0000\u0000\u0000CONCLUSIONS\u0000Minilaparoscopy in gynecologic surgery represents an option for selected patients, for both benign and malignant indications. The aesthetic outcome represents the main benefit of this approach. Surgeons have to be aware of few limitations of this technique such as severe obesity and endometriosis.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2021-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43991726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-14DOI: 10.23736/S0026-4784.20.04681-X
L. Carbone, G. Saccone, A. Conforti, G. Maruotti, V. Berghella
The cesarean section is utilized to deliver babies since the late 19th century. Nowadays, the frequency of cesarean section is enormously increased, mainly because of the low rate of complications and for the increasing demand from future mothers, scared by the idea of painful labor. Although the technique to perform cesarean section has been refined over time, infections, hemorrhage, pain and other consequences still represent matter of debate. To try to reduce the incidence of these complications many trials, randomized or not, have been performed, with the aim to analyse different technical aspects of this surgery. The aim of our review is to resume all the evidence-based instructions on how to best approach to cesarean section practice, in a step-to-step fashion, considering pre-operative actions, opening and closing steps, and post-operative prophylaxis.
{"title":"Cesarean delivery: an evidence-based review on of the technique.","authors":"L. Carbone, G. Saccone, A. Conforti, G. Maruotti, V. Berghella","doi":"10.23736/S0026-4784.20.04681-X","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04681-X","url":null,"abstract":"The cesarean section is utilized to deliver babies since the late 19th century. Nowadays, the frequency of cesarean section is enormously increased, mainly because of the low rate of complications and for the increasing demand from future mothers, scared by the idea of painful labor. Although the technique to perform cesarean section has been refined over time, infections, hemorrhage, pain and other consequences still represent matter of debate. To try to reduce the incidence of these complications many trials, randomized or not, have been performed, with the aim to analyse different technical aspects of this surgery. The aim of our review is to resume all the evidence-based instructions on how to best approach to cesarean section practice, in a step-to-step fashion, considering pre-operative actions, opening and closing steps, and post-operative prophylaxis.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42831455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-14DOI: 10.23736/S0026-4784.20.04751-6
M. Vignali, E. Solima, V. Barbera, C. Becherini, G. Belloni
Endometriosis is a chronic inflammatory gynecological disorder associated with pelvic pain symptoms and infertility. Ovarian cysts (endometriomas) are the most common localization of endometriosis in the pelvis. Considering non-invasive methods, transvaginal ultrasound has high sensitivity and specificity for endometrioma diagnosis. Laparoscopic removal of endometrioma is related to a damage to the ovarian reserve and should be limited to patients with suspicious cysts or unresponsive to medical treatment. The main goal of medical therapy of symptomatic endometrioma is the control of pain symptoms, while no benefits have been demonstrated in terms of improving fertility rates of women seeking pregnancy. The aim of medical treatment is the inhibition of ovulation, stop of menstruation and achievement of a stable hypo-hormonal milieu. Estroprogestins and progestins are indicated by guidelines as first line medications for symptomatic patients. Several hormonal treatments have been proposed for the treatment of symptomatic endometriomas. In particular, Dienogest, a relatively new progestin, has shown promising results. Medical treatment should be conceived as a long-term treatment. Safety, tolerability, a low percentage of side effects and an easy route of administration are essential for patient acceptance and adherence to therapy.
{"title":"Approaching ovarian endometrioma with medical therapy.","authors":"M. Vignali, E. Solima, V. Barbera, C. Becherini, G. Belloni","doi":"10.23736/S0026-4784.20.04751-6","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04751-6","url":null,"abstract":"Endometriosis is a chronic inflammatory gynecological disorder associated with pelvic pain symptoms and infertility. Ovarian cysts (endometriomas) are the most common localization of endometriosis in the pelvis. Considering non-invasive methods, transvaginal ultrasound has high sensitivity and specificity for endometrioma diagnosis. Laparoscopic removal of endometrioma is related to a damage to the ovarian reserve and should be limited to patients with suspicious cysts or unresponsive to medical treatment. The main goal of medical therapy of symptomatic endometrioma is the control of pain symptoms, while no benefits have been demonstrated in terms of improving fertility rates of women seeking pregnancy. The aim of medical treatment is the inhibition of ovulation, stop of menstruation and achievement of a stable hypo-hormonal milieu. Estroprogestins and progestins are indicated by guidelines as first line medications for symptomatic patients. Several hormonal treatments have been proposed for the treatment of symptomatic endometriomas. In particular, Dienogest, a relatively new progestin, has shown promising results. Medical treatment should be conceived as a long-term treatment. Safety, tolerability, a low percentage of side effects and an easy route of administration are essential for patient acceptance and adherence to therapy.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47401439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-11DOI: 10.23736/S0026-4784.20.04743-7
Sarah Milliken, J. May, Pete Sanderson, M. Congiu, O. D’Oria, T. Golia D’Augè, G. Caruso, V. Di Donato, P. Benedetti Panici, A. Giannini
INTRODUCTION Vulvar cancer accounts for ~4% of all gynaecological malignancies and the majority of tumours (>90%) are squamous cell (keratanising, ~60% and warty/basaloid, ~30%). Surgical excision forms the foundation of treatment, with resection margin status being the single most influential factor when predicting clinical outcome. There has been a paradigm shift concerning surgical approaches and radicality when manging vulvar cancer within recent times, largely owing to a desire to preserve vulvar structure and function without compromising oncological outcome. As such the safety of the size of resection margin has been called into question. In this narrative review we consider the current literature on the safety of resection margins for vulvar cancer. METHODS PubMed, Medline and the Cochrane Database were searched for original peer-reviewed primary and review articles, from January 2005 to January 2020. The following search terms were used vulvar cancer surgery, vulvar squamous cell carcinoma, excision margins, adjuvant radiation. CONCLUSIONS A surgical resection margin of 2-3mm does not appear to be associated with a higher rate of local recurrence than the widely used limit of 8mm. As such the traditional practice of reexcision or adjuvant radiotherapy on the basis of 'close' surgical margins alone needs to be closely evaluated, since the attendant morbidity associated with these procedures may not be outweighed by oncological benefit.
{"title":"Reducing the radicality of surgery for vulvar cancer: are smaller margins safe?","authors":"Sarah Milliken, J. May, Pete Sanderson, M. Congiu, O. D’Oria, T. Golia D’Augè, G. Caruso, V. Di Donato, P. Benedetti Panici, A. Giannini","doi":"10.23736/S0026-4784.20.04743-7","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04743-7","url":null,"abstract":"INTRODUCTION\u0000Vulvar cancer accounts for ~4% of all gynaecological malignancies and the majority of tumours (>90%) are squamous cell (keratanising, ~60% and warty/basaloid, ~30%). Surgical excision forms the foundation of treatment, with resection margin status being the single most influential factor when predicting clinical outcome. There has been a paradigm shift concerning surgical approaches and radicality when manging vulvar cancer within recent times, largely owing to a desire to preserve vulvar structure and function without compromising oncological outcome. As such the safety of the size of resection margin has been called into question. In this narrative review we consider the current literature on the safety of resection margins for vulvar cancer.\u0000\u0000\u0000METHODS\u0000PubMed, Medline and the Cochrane Database were searched for original peer-reviewed primary and review articles, from January 2005 to January 2020. The following search terms were used vulvar cancer surgery, vulvar squamous cell carcinoma, excision margins, adjuvant radiation.\u0000\u0000\u0000CONCLUSIONS\u0000A surgical resection margin of 2-3mm does not appear to be associated with a higher rate of local recurrence than the widely used limit of 8mm. As such the traditional practice of reexcision or adjuvant radiotherapy on the basis of 'close' surgical margins alone needs to be closely evaluated, since the attendant morbidity associated with these procedures may not be outweighed by oncological benefit.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44678507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-11DOI: 10.23736/S0026-4784.20.04726-7
G. Bogani, V. Di Donato, V. Chiappa, Salvatore Lopez, M. Monti, L. Muzii, P. Benedetti Panici, A. Ditto, F. Raspagliesi
In recent years, minimally invasive surgery has replaced open surgery for almost all surgical indications in gynecological practice. Recently, the results of the Laparoscopic Approach to Cervical Cancer (LACC) trial questioned the role of minimally invasive surgery for patients affected by earlystage cervical cancer. In the present paper, we discussed the current evidence regarding the adoption of minimally invasive surgery for patients with cervical cancer. We evaluated the current evidence focusing on four interesting features: (i) the impact of tumor volume; (ii) reasons explaining worse outcomes of patients undergoing minimally invasive surgery; (iii) methods to reduce the risk of recurrence during minimally invasive surgery; and (iv) the effect of minimally invasive surgery in patients with locally advanced cervical cancer. At the moment, in the light of current evidence, minimally invasive radical hysterectomy should be offered only in the context of clinical trials. Extensive counseling and appropriate patients' selection are needed. Further prospective evidence is warranted to identify the better approach for cervical cancer patients.
{"title":"Minimally invasive surgery in cervical cancer.","authors":"G. Bogani, V. Di Donato, V. Chiappa, Salvatore Lopez, M. Monti, L. Muzii, P. Benedetti Panici, A. Ditto, F. Raspagliesi","doi":"10.23736/S0026-4784.20.04726-7","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04726-7","url":null,"abstract":"In recent years, minimally invasive surgery has replaced open surgery for almost all surgical indications in gynecological practice. Recently, the results of the Laparoscopic Approach to Cervical Cancer (LACC) trial questioned the role of minimally invasive surgery for patients affected by earlystage cervical cancer. In the present paper, we discussed the current evidence regarding the adoption of minimally invasive surgery for patients with cervical cancer. We evaluated the current evidence focusing on four interesting features: (i) the impact of tumor volume; (ii) reasons explaining worse outcomes of patients undergoing minimally invasive surgery; (iii) methods to reduce the risk of recurrence during minimally invasive surgery; and (iv) the effect of minimally invasive surgery in patients with locally advanced cervical cancer. At the moment, in the light of current evidence, minimally invasive radical hysterectomy should be offered only in the context of clinical trials. Extensive counseling and appropriate patients' selection are needed. Further prospective evidence is warranted to identify the better approach for cervical cancer patients.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44053005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-11DOI: 10.23736/S0026-4784.20.04740-1
A. La Marca, M. Capuzzo, M. G. Imbrogno, V. Donno, G. Spedicato, S. Sacchi, M. Minasi, F. Spinella, P. Greco, F. Fiorentino, E. Greco
BACKGROUND Female age is the strongest predictor of embryo chromosomal abnormalities and has a non linear relationship with the blastocyst euploidy rate: with advancing age there is an acceleration in the reduction of blastocyst euploidy. Aneuploidy was found to significantly increase with maternal age from 30% in embryos from young women to 70% in women older than 40 years old. The association seems mainly due to chromosomal abnormalities occurring in the oocyte.We aimed to elaborate a model for the blastocyst euploid rate for patients undergoing IVF/ICSI cycles using advanced machine learning techniques. METHODS This was a retrospective analysis of IVF/ICSI cycles performed from 2014 to 2016. In total, data of 3879 blastocysts were collected for the analysis. Patients underwent PGT-Aneuploidy analysis (PGT-A) at the Center for Reproductive Medicine of European Hospital, Rome, Italy have been included in the analysis. The method involved whole-genome amplification followed by array comparative genome hybridization. To model the rate of euploid blastocysts, the data were split into a train set (used to fit and calibrate the models) and a test set (used to assess models' predictive performance). Three different models were calibrated: a classical linear regression; a Gradient Boosted Tree (GBT) machine learning model; a model belonging to the Generalized Additive Models (GAM). RESULTS The present study confirms that female age, which is the strongest predictor of embryo chromosomal abnormalities, and blastocyst euploidy rate have a non-linear relationship, well depicted by the GBT and the GAM models. According to this model, the rate of reduction in the percentage of euploid blastocysts increases with age: the yearly relative variation is -10% at the age of 37 and -30% at the age of 45. Other factors including male age, female and male body mass index, fertilization rate and ovarian reserve may only marginally impact on embryo euploidy rate. CONCLUSIONS Female age is the strongest predictor of embryo chromosomal abnormalities and has a non-linear relationship with the blastocyst euploidy rate. Other factors related to both the male and female subjects may only minimally affect this outcome.
{"title":"The complex relationship between female age and embryo euploidy.","authors":"A. La Marca, M. Capuzzo, M. G. Imbrogno, V. Donno, G. Spedicato, S. Sacchi, M. Minasi, F. Spinella, P. Greco, F. Fiorentino, E. Greco","doi":"10.23736/S0026-4784.20.04740-1","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04740-1","url":null,"abstract":"BACKGROUND\u0000Female age is the strongest predictor of embryo chromosomal abnormalities and has a non linear relationship with the blastocyst euploidy rate: with advancing age there is an acceleration in the reduction of blastocyst euploidy. Aneuploidy was found to significantly increase with maternal age from 30% in embryos from young women to 70% in women older than 40 years old. The association seems mainly due to chromosomal abnormalities occurring in the oocyte.We aimed to elaborate a model for the blastocyst euploid rate for patients undergoing IVF/ICSI cycles using advanced machine learning techniques.\u0000\u0000\u0000METHODS\u0000This was a retrospective analysis of IVF/ICSI cycles performed from 2014 to 2016. In total, data of 3879 blastocysts were collected for the analysis. Patients underwent PGT-Aneuploidy analysis (PGT-A) at the Center for Reproductive Medicine of European Hospital, Rome, Italy have been included in the analysis. The method involved whole-genome amplification followed by array comparative genome hybridization. To model the rate of euploid blastocysts, the data were split into a train set (used to fit and calibrate the models) and a test set (used to assess models' predictive performance). Three different models were calibrated: a classical linear regression; a Gradient Boosted Tree (GBT) machine learning model; a model belonging to the Generalized Additive Models (GAM).\u0000\u0000\u0000RESULTS\u0000The present study confirms that female age, which is the strongest predictor of embryo chromosomal abnormalities, and blastocyst euploidy rate have a non-linear relationship, well depicted by the GBT and the GAM models. According to this model, the rate of reduction in the percentage of euploid blastocysts increases with age: the yearly relative variation is -10% at the age of 37 and -30% at the age of 45. Other factors including male age, female and male body mass index, fertilization rate and ovarian reserve may only marginally impact on embryo euploidy rate.\u0000\u0000\u0000CONCLUSIONS\u0000Female age is the strongest predictor of embryo chromosomal abnormalities and has a non-linear relationship with the blastocyst euploidy rate. Other factors related to both the male and female subjects may only minimally affect this outcome.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43919935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-04DOI: 10.23736/S0026-4784.20.04742-5
T. Ghi
{"title":"Up to date management of labor.","authors":"T. Ghi","doi":"10.23736/S0026-4784.20.04742-5","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04742-5","url":null,"abstract":"","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46511002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01Epub Date: 2020-10-26DOI: 10.23736/S0026-4784.20.04640-7
Irene Peregrin-Alvarez, Robert Roman, Mary E Christiansen, Ginika Ikwuezunma, Laura Detti
Background: The current literature and guidelines are largely silent regarding the contribution of the fallopian tubes to the fluid deficit (FD) during hysteroscopy. We explored whether the FD could be in part due to transtubal passage.
Methods: This was a prospective cohort study. Patients who underwent hysteroscopy because of benign gynecologic pathology with, or without, laparoscopy were enrolled. The fluid deficit and, in laparoscopic cases, the amount of fluid found in the pelvis were prospectively reported.
Results: Comparisons between FD and intraperitoneal fluid were performed. Sixty-five patients were included in the study. Forty-five underwent hysteroscopy prior to laparoscopy and 20 patients underwent hysteroscopy-only. These were further divided into operative hysteroscopy and diagnostic hysteroscopy subgroups. In the laparoscopy group, the average FD was 525.9 mL (95% CI: 482.1-569.7) and the calculated FD due to intravasation was 286.6 mL (95%CI: 253.0-320.3). In the hysteroscopy without laparoscopy group, the average FD was 303.0 mL (95% CI: 85.2-520.8). There was no correlation between the intrauterine fluid pressure and the amount of FD, or the presence of intraperitoneal fluid.
Conclusions: Most women with patent tubes undergoing hysteroscopy have accumulation of distention fluid in the pelvis and that the passage was not correlated with the intrauterine fluid pressure. These findings add new insight to the current guidelines, suggesting more accurate and patient-centered safety protocols.
背景:目前的文献和指南在很大程度上对宫腔镜下输卵管对液体不足(FD)的贡献保持沉默。我们探讨了FD是否部分是由经舌根通道引起的。方法:这是一项前瞻性队列研究。患者接受子宫镜检查，因为良性妇科病理，或不，腹腔镜检查。液体不足，在腹腔镜下的情况下，在骨盆中发现的液体量被前瞻性地报道。结果:FD与腹腔内液比较。65名患者参与了这项研究。45例患者在腹腔镜前行宫腔镜检查，20例仅行宫腔镜检查。进一步分为手术宫腔镜亚组和诊断宫腔镜亚组。腹腔镜组平均FD为525.9 mL (95%CI: 482.1 ~ 569.7)，计算的内腔FD为286.6 mL (95%CI: 253.0 ~ 320.3)。无腹腔镜宫腔镜组平均FD为303.0 mL (95% CI: 85.2-520.8)。宫内液压与FD量或腹腔内液存在无相关性。结论:大多数宫腔镜下输卵管未闭的女性盆腔内存在积存的膨胀液，其通过与宫内液压无关。这些发现为当前的指导方针提供了新的见解，提出了更准确和以患者为中心的安全方案。
{"title":"Fluid deficit calculation at hysteroscopy: could consideration of intraperitoneal fluid accumulation add insight to safety limits?","authors":"Irene Peregrin-Alvarez, Robert Roman, Mary E Christiansen, Ginika Ikwuezunma, Laura Detti","doi":"10.23736/S0026-4784.20.04640-7","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04640-7","url":null,"abstract":"<p><strong>Background: </strong>The current literature and guidelines are largely silent regarding the contribution of the fallopian tubes to the fluid deficit (FD) during hysteroscopy. We explored whether the FD could be in part due to transtubal passage.</p><p><strong>Methods: </strong>This was a prospective cohort study. Patients who underwent hysteroscopy because of benign gynecologic pathology with, or without, laparoscopy were enrolled. The fluid deficit and, in laparoscopic cases, the amount of fluid found in the pelvis were prospectively reported.</p><p><strong>Results: </strong>Comparisons between FD and intraperitoneal fluid were performed. Sixty-five patients were included in the study. Forty-five underwent hysteroscopy prior to laparoscopy and 20 patients underwent hysteroscopy-only. These were further divided into operative hysteroscopy and diagnostic hysteroscopy subgroups. In the laparoscopy group, the average FD was 525.9 mL (95% CI: 482.1-569.7) and the calculated FD due to intravasation was 286.6 mL (95%CI: 253.0-320.3). In the hysteroscopy without laparoscopy group, the average FD was 303.0 mL (95% CI: 85.2-520.8). There was no correlation between the intrauterine fluid pressure and the amount of FD, or the presence of intraperitoneal fluid.</p><p><strong>Conclusions: </strong>Most women with patent tubes undergoing hysteroscopy have accumulation of distention fluid in the pelvis and that the passage was not correlated with the intrauterine fluid pressure. These findings add new insight to the current guidelines, suggesting more accurate and patient-centered safety protocols.</p>","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":"72 6","pages":"420-424"},"PeriodicalIF":1.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38528364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：