Clinica e Investigacion en Ginecologia y Obstetricia最新文献

Introduction

Disseminated peritoneal leiomyomatosis (DPL) is a benign pathology, defined by the presence of multiple disseminated nodules in the peritoneum of different sizes composed of bundles of smooth muscle cells. Several theories are postulated about its origin related to hormonal stimulus, genetic susceptibility and iatrogenesis after surgeries such as laparocopic myomectomies.

Clinical findings

Patients usually present with abdominal discomfort of various kinds, and it may even be asymptomatic, being an incidental finding on imaging tests.

Main diagnoses

The differential diagnosis usually includes carcinomatosis, endometriosis, endosalpingiosis, tumours of the gastrointestinal tract or leiomyosarcoma.

Therapeutic interventions

There is insufficient evidence about the best approach, with some advocating expectant management or medical treatment and others advocating more radical surgical management. Among medical treatments, one of the most widely used are GnRH agonists, aromatase inhibitors and selective progesterone receptor modulators such as ulipristal acetate have also been used with good results.

Results

In this case we present a patient with LPD with 15 years of follow-up in our hospital, with no evidence of malignancy.

Conclusion

Knowing the generally benign nature of this disease, it is necessary to opt for the least invasive approach possible. The long-term evolution of this disease is unknown, as most published cases do not have sufficient follow-up time.

Introduction

Metastasis of breast cancer to the uterus is an exceptionally rare occurrence, typically presenting with vaginal bleeding as the predominant symptom. Here, we present a case of synchronous lobular breast cancer metastasis to a uterine myoma.

Main symptoms and/or clinical findings

A 42-year-old infertile patient was admitted to the gynecology clinic with the complaints of meno/metrorrhagia. Ultrasound revealed a 5 cm intramural myoma on the anterior wall of the uterus, leading to a myomectomy. The patient exhibited no symptoms related to breast cancer.

Main diagnosis

Histomorphological and immunohistochemical findings were indicative of breast-derived lobular carcinoma metastasis into leiomyoma.

Therapeutic interventions and outcomes

Positron emission tomography/computed tomography (PET/CT) scan revealed no pathological involvement beyond the breast and both axillary lymph nodes. The patient was diagnosed with stage IV breast lobular cancer and initiated chemotherapy treatment. Presently, the patient is undergoing regular monitoring at six-month intervals.

Conclusion

Uterine metastasis from extragenital organ cancers is exceedingly rare. In this instance, lobular breast cancer metastasis was confined to the uterine myoma. Clinicians and pathologists should exercise caution regarding gynecological metastases in breast cancer cases.

Cryobiology focuses on understanding how biological materials react to very low temperatures. This field has experienced significant advances, particularly in the field of assisted reproduction, where programs have been developed to preserve fertility. These developments are of critical importance for those exploring alternatives in fertility and gamete preservation. Fertility preservation aims to protect a person's reproductive capacity under various health conditions, medical treatments, and social reasons that may compromise it. Accepted techniques for human fertility preservation include the cryopreservation of gametes and embryos. There is growing promising evidence on different experimental techniques within this field, such as cryopreservation of gonadal tissue or in vitro maturation strategies, as well as new methodologies in cryogenic protocols that will optimize results and mark a turning point in the field of assisted reproduction. This work aims to explore the current state-of-the-art strategies offered to women in the context of fertility preservation, review advances in cryobiology, and its role in the evolution of this area.

Background

The sustained increase and the disparities in the rate of caesarean deliveries (CS) pose a public health challenge. Optimising the use of CS is of global concern and a challenge for public health. Machine Learning (ML) techniques can assist clinicians in decision-making, improving treatment modalities and patient outcomes.

Methods

Original data correspond to the 41,037 deliveries that took place at La Paz University Maternity Hospital (Madrid, Spain) between 2010 and 2018. Machine Learning (ML) model algorithm Random Forest (RF) was performed to determine the risk of CS. The first analysis was Mean Decrease Accuracy carried out on 50 permutations. The second analysis was ceteris-paribus and partial-dependence profiles.

Results

The RF models obtained identify a higher risk of CS delivery in multiple gestations, macrosomic foetuses and in those with prolonged gestation associated with other maternal–foetal characteristics. Results deny the consideration that older nulliparous mothers represent a specific obstetrtic risk goup.

Conclusions

ML techniques can be very useful in identifying risk factors to be addressed to optimise the number of CS. Macrosomia prevention programmes, reduction in the rate of multiple pregnancies or finishing pregnancy before the onset of risks associated with prolonged pregnancy may be ways to optimise the number of CS.

In recent decades, the field of female fertility preservation has experienced substantial growth. Reliable techniques such as cryopreservation of oocytes and ovarian tissue have emerged, along with more established methods such as embryo freezing. Among the group of patients who can benefit from these new techniques are patients with endometriosis, a common disease capable of compromising ovarian reserve and fertility prospects. Unfortunately, comprehensive recommendations for fertility preservation in patients with endometriosis are still lacking.

This narrative review comprehensively explores fertility preservation in patients with endometriosis, using a range of relevant literature, including available national and international guidelines. Additionally, it explains the weight of several factors that contribute to the decision-making process for fertility preservation, including age, severity of endometriosis, ovarian reserve, and previous or future surgery.

This manuscript summarizes available recommendations that provide guidance for this vital but challenging aspect of reproductive medicine. Underlines the need for personalized care for patients with an early diagnosis of endometriosis and initial medical treatment to try to reduce the deterioration of ovarian reserve and emphasizes the importance of research to refine fertility preservation strategies in people with endometriosis.

Gender affirming hormone therapy (GAHT) in transmasculine people (individuals who identify as men or on the masculine spectrum and were assigned female sex at birth) makes it possible to modify the secondary sexual characteristics of the sex assigned at birth, thus alleviating the symptoms of gender dysphoria, during the process called transition. However, it is necessary to highlight that the effect of GAHT on long-term fertility and its potential gonadotoxic effects are currently unknown. Knowledge of the effects of testosterone on fertility and reproduction has increased recently, whilst the request for comprehensive reproductive counselling and the option of performing fertility preservation (FP) techniques have increased exponentially in recent years, leading to profound changes in the clinical management of this population.

In this review, we analyzed all the information published regarding the effect of GAHT on reproduction and the FP techniques available in this group, mainly oocyte vitrification. In addition, we carry out an exhaustive analysis of the reproductive results published to date after the use of preservation techniques and present the latest laboratory advances concerning ovarian tissue cryopreservation and in vitro oocyte maturation, together with future options in the transmasculine people.

Purpose

To explore the prevalence of hopelessness in patients diagnosed with endometriosis and how it may influence their relationships.

Material and methods

Prospective–descriptive study among patients with a clinical and/or anatomopathological diagnosis of endometriosis. Demographic data (age, religion, educational level, marital status, occupation, etc.) and pain data have been processed. Pain associated with endometriosis has been evaluated with an analogue scale of pain. The Beck Hopelessness Scale (BHS) was used to determine the level of hopelessness. The results have been classified into 0–3 normal; 4–8 mild; 9–14 moderate and 15–20 severe. SPSS Statistics 26 has been used and the statistical significance has been stipulated at p < 0.05.

Results

One hundred and ten patients have been recruited with an average age of 39.8 ± 7.09 years. The average on the Beck Hopelessness Scale is 5.08 with a SD 3.14. In our sample, we obtained that 38.2% of women experienced some level of hopelessness at the time the questionnaire was completed (mild = 28.2%, moderate = 9.1%, severe = 0.9%). We found a significant relation between hopelessness and low income but not with regard to education, employment status or marital status.

Regarding the pain experienced and its relation with hopelessness, we found that it was significantly connected to pain during urination and dyspareunia and not to chronic pelvic pain dysmenorrhea and dyschezia.

Conclusion

Four out of ten patients with endometriosis experience hopelessness, mostly mildly. This hopelessness is influenced by demographic factors such as income level and also pain, specifically pain during intercourse and during urination.

An accurate diagnosis in infertile patients is key to determine the treatment of choice in an assisted reproduction program. In the case of the male, the initial diagnosis is based on the result of the semen analysis. The semen analysis can detect problems related to the couple's infertility, but it is insufficient for the correct diagnosis of male infertility, since it does not predict the functional capacity of the spermatozoa. In recent years, multiple studies have appeared that relate sperm ADN integrity to fertility. At the same time, IVF laboratories have within their reach new methods of sperm selection, such as microfluidics, which would make it possible to reduce the degree of ADN fragmentation in the sample. In this paper we review the impact of sperm ADN fragmentation and the use of microfluidic devices on IVF outcomes based on a selection of relevant studies published up to February 2023.

Background

Cesarean section rate is controversial and the Robson classification is a method for standardizing the evaluation of the causes of cesarean section. The aim of this study was to evaluate whether the measures to improve prenatal and intrapartum management implemented after the Robson classification evaluation lead to a decrease in the rate of cesarean sections without increasing the rates of neonatal and maternal morbidity and mortality.

Material and method

Quasi-experimental study before-after,between-2019 and 2020, including a total of 2181 patients with delivery at Hospital-Universitario-Valme(1027 patients in Group-2019, and 1154 patients in group-2020)..

Results

We observed that there was a statistically significant decrease in the cesarean section rate between 2019 and 2020 (21.0% vs 15.8%; p = 0.001) without the decrease being significant in any study subgroup. There was a lower rate of induced labor(29.3% vs 24.6%; p = 0.01), an increased rate of vaginal delivery (79.0% vs 84.2%; p = 0.001), both eutocic and instrumental deliveries (57.9% vs 60.3%; 21% vs 23.9%; p = 0.005) and a statistically significant decrease in the rate of cesarean sections due to failure of induction or non-progression of labor(34.7% vs 20.9%;p = 0.008). In inductions using the balloon-Cook we observed a decrease in the rate of cesarean section (45.3% versus 22.2% p = 0.001). We found a decrease in the percentage of admission to the Neonatal ICU (10.5% vs 7.6%; p = 0.016) and global neonatal morbidity(11.4% vs 8.2%; p = 0.013) without observing a difference in maternal outcomes.

Conclusions

The application of the Robson classification can be a useful method to identify groups that require the application of specific measures aimed at standardizing the management of these patients, thus allowing to reduce the rate of cesarean sections.

Borderline ovarian tumors (BOTs) are defined as “tumors of low malignant potential”. These are epithelial neoplasms that debut mainly in young women, and are usually diagnosed in the initial stages of the disease.

The main key to its treatment is surgery, thus compromising the fertility of the patient who has not fulfilled her reproductive desire. In general, the choice of surgery for BOTs should consider the characteristics of the tumor, the patient's fertility desires, and the extent of the disease. The decisions made in this regard must be individualized and advised by a multidisciplinary team.

Fertility preservation (FP) plays an important role in the management of these patients, and there are different strategies to improve and maintain their quality of life.

Reproductive counseling should be an integral part of clinical management, with risks and benefits carefully considered.

Given its low incidence, there is little literature on the matter, requiring well-designed prospective studies to address specific fertility problems both in the initial diagnosis and in recurrences of patients with BOTs.