Clinica e Investigacion en Ginecologia y Obstetricia最新文献

Introduction

Meigs syndrome is an underdiagnosed pathology and should be suspected in the presence of an ovarian tumor associated with pleural and peritoneal effusion. In addition, it usually presents elevation of the tumor marker CA-125. All these clinical and analytical parameters improve after surgical removal of the tumor. Most cases are associated with benign ovarian tumors (fibroids). When it is associated with another type of ovarian/uterine tumor, whether benign or malignant, it is called «Pseudo Meigs Syndrome.» The diagnostic confirmation of the tumor will be histological.

Main symptoms and/or clinical findings

The clinical case of a patient is presented, in which a uterine tumor is observed that produces repetitive vasovagal syncope due to compression of pelvic organs, associated with right pleural effusion and ascites with mild-moderate elevation of CA-125.

Main diagnoses

The main suspected diagnosis is Pseudo-Meigs syndrome, due to the association of a uterine tumor with pleural effusion and ascites.

Therapeutic interventions and results

After resection of the tumor, which turned out to be a uterine leiomyoma, both effusions resolved and the tumor marker CA-125 normalized, corresponding to Pseudo Meigs Syndrome.

Conclusion

In the differential diagnosis of a pleural effusion associated with ascites, the presence of an ovarian/uterine tumor must be ruled out, since, if observed, we could be dealing with Meigs/Pseudo Meigs Syndrome; which will be confirmed by the disappearance of the pleural effusion, ascites and normalization of the CA-125 marker after surgical resection of the tumor and which represents its resolution.

Background

The non-invasive prenatal test (NIPT) is a screening test that allows for conducting a screening of major chromosomal abnormalities in the fetus during pregnancy using maternal blood. In February 2019, NIPT was included as part of the prenatal diagnosis for genetic anomalies during the first trimester of pregnancy by the Public Health System of the Valencian Community.

The objective is to assess the diagnostic and economic performance of NIPT in pregnant women within our Department since its implementation.

Methods

A retrospective observational study was conducted, analyzing NIPT performed since its integration into the screening for chromosomal abnormalities in pregnant women within our department. The analysis includes the number of invasive tests conducted, improvements in the detection of studied chromosomal abnormalities, and the economic feasibility in comparison to invasive testing.

Results

A total of 4719 combined first and second-trimester screenings were conducted with a population coverage of 98%, of which TPNI was indicated in 337 patients. Aneuploidies were detected in 4 patients: two cases of Down syndrome, one case of Patau syndrome, and one case of Turner syndrome, with the first three confirmed and the latter resulting in a false positive. The sensitivity obtained was 100%, and the specificity was 99% (95% CI). The economic savings amounted to €52,035.90.

Conclusions

TPNI is a highly sensitive test with high specificity. Since its incorporation into the screening for aneuploidies in pregnant women, the performance of invasive tests has been reduced, resulting in a corresponding decrease in the risk of fetal loss and significant economic savings.

Background

The mean age for women giving birth to their first child is increasing globally, with few therapeutic options to counteract an age-related decline in female fertility. This study aimed to investigate the effect of dietary micronutrient supplements on spontaneous pregnancy rates in women of advanced reproductive age with infertility of unknown etiology.

Materials & methods

This was a retrospective, comparative study of 270 infertile women aged 35–40 years with non-pathological fertility work-up and normal male partner semen analysis attending a fertility clinic in Vienna, Austria. 146 women received an oral micronutrient preparation (omega-3 fatty acids, coenzyme Q10, vitamin E, folic acid, selenium, catechins and glycyrrhizin) daily for 6 months and subsequent monthly rates of spontaneous clinical pregnancy were compared to a control group of 124 women receiving only daily folic acid supplements. No other fertility-related interventions took place during the observation period.

Results

The total spontaneous pregnancy rate after 6 months was significantly higher in the study group, reaching 43.8%, compared to 29.8% in the control group (p = 0.018). Moreover, the cumulative pregnancy rate in the study group taking micronutrient supplementation was 54.5%, and 34.1% in the control group.

Conclusions

The findings of this study suggest that the intake of specific micronutrients might be associated with a higher occurrence of spontaneous pregnancies and thus improvement in female fertility among women of advanced reproductive age who experience unexplained infertility.

Introduction

Fibroids are common benign gynecological tumors but a rare finding in adolescents. Although infrequent, some symptomatic cases have been described in literature.

Main symptoms and/or clinical findings

A 16-year-old Caucasian patient came to our attention for abdominal pain and dysmenorrhea appeared two months before. Her gynecological history was characterized by regular menstrual cycles, normal in quantity, with dysmenorrhea. Bimanual pelvic examination revealed an anteverted mobile uterus, no adnexal tenderness or masses. Speculum examination showed a normal cervix. No vaginal bleeding or discharge was observed during the visit.

Main diagnoses

Transabdominal/transvaginal ultrasound demonstrated an anteverted uterus of 71 mm × 44 × 48 mm, with a heterogeneous myometrial structure and a hypoechoic subserosal-intramural mass (FIGO leiomyoma subclassification system: O-4) localized in the posterior uterine wall, measuring 26 mm × 19 mm × 16 mm, slightly vascularized at the Color-Doppler (Color Score 2). Magnetic resonance imaging confirmed the ultrasound diagnosis.

Therapeutic interventions and outcomes

Considering pelvic mass dimension and the patient age, a “wait and see” approach was chosen and the patient was re-evaluated a month and three months after the first ultrasound. The second and the third transvaginal ultrasound exam showed an unchanged picture.

Conclusion

The management of leiomyoma in young patients should be targeted to dimension and symptoms of the mass. When facing myomas of small dimension, paucisymptomatic or asymptomatic, with no signs of malignity, we suggest an expectant management.

Idiopathic granulomatous mastitis (IGM) is a benign chronic inflammatory disease affecting the breast stroma. Diagnosis is by exclusion and requires histopathological confirmation, as its clinical and radiological presentation may be similar to breast carcinoma. Treatment is mainly medical, complemented by percutaneous drainage and ultimately surgical.

Although it is a benign pathology, it can cause significant impairment of quality of life. Due to its nature, it requires a multidisciplinary approach. It is necessary to protocolise the management of this entity both to establish the diagnosis and to initiate appropriate treatment early and prevent progression to advanced stages.

The aim of this work is to standardise the diagnosis and treatment of IGM from a multidisciplinary approach following medical consensus. The diagnostic algorithm is described, considering risk factors for IGM, typical radiological signs in order to be able to detect suspected cases early and subsequently ensure early treatment, which is described in the following algorithm for treatment. We also describe a specific follow-up circuit.

These multidisciplinary diagnostic-therapeutic algorithms are proposed to raise awareness and standardise the approach to this rare disease, accelerating its diagnosis and optimising its treatment.

ertility preservation is indicated in most cases of oncologic diseases and when gonadotoxic treatments are prescribed. However, in recent years, there has been an increase in preservation cycles carried out for benign diseases and conditions with a risk of developing premature ovarian failure. Premature ovarian insufficiency is related to a genetic disorder in 10% of cases. The most common known conditions are FMR1 premutation and Turner syndrome, and recently, other diseases such as mutations in the BRCA 1/2 genes have been implicated in this pathology.

We conducted a bibliographic review on premature ovarian insufficiency associated with the premutation of the FMR1 gene or Fragile X Messenger Ribonucleoprotein 1, the various pathophysiological theories described, and the difficulty in predicting which women will develop ovarian failure due to the lack of a useful predictive marker. Additionally, we evaluated different recommendations for managing these women and when to indicate the implementation of fertility preservation techniques. This option could prevent the psychological impact women of these women's reproductive health impairment.

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.

The significant increase in pediatric and adolescent cancer survivors in the last few decades, has highlighted on options to minimize long-term side effects related to treatment. Fertility preservation alternatives in girls after a cancer diagnosis are moving from being considered experimental to becoming an increasingly widespread healthcare practice. On the other hand, the real possibilities in prepubertal boys still have a longer way to improve. Since these are minor and especially vulnerable patients, multidisciplinary work is essential, with homogeneous criteria in patient selection and application of techniques. The following publication summarizes the state of the art on this subject, emphasizing the differentiating features in relation to the adult population.

Background

As sexuality and its related issues are significantly associated with sociocultural settings, addressing the sexual health status of individuals in different societies is of the utmost importance. Women with vaginismus have more stress, anxiety, depression, and they also feel hopeless and have low self-esteem. And this problem can disturb intimacy between couples and women's sexual self-concept. Therefore, the present study was to determine and compare sexual self-concept and intimacy in women presenting with and without vaginismus.

Methods

This case–control study was conducted in 2021–2022 on 240 women with and without vaginismus, referring to selected sexual health clinics based in Iran. The data collection tools recruited were the demographic characteristics’ information, the Multidimensional Sexual Self-Concept Questionnaire, and the Sexual Intimacy Scale. To calculate the odds ratio of the studied variables, the logistic regression analysis using the SPSS Statistics software (ver. 25) was also employed.

Results

The mean age of women with and without vaginismus was 27.85 ± 4.62 and 28.51 ± 4.34, respectively. According to the regression results, the variables of sexual intimacy (odds ratio (OR) = 0.864, P < 0.001), sexual awareness (OR = 6.090, P = 0.003), sexual-anxiety (OR = 1.613, P < 0.001), fear of sex (OR = 1.338, P = 0.021) and sexual problem prevention (OR = 0.765, P = 0.016) were significantly associated with vaginismus.

Conclusions

According to these results, sexual intimacy, sexual awareness, sexual-anxiety, fear of sex and sexual problem prevention were significantly associated with vaginismus. Therefore, it is suggested that for the treatment of women with vaginismus, interventions can be designed to improve sexual intimacy, sexual knowledge and positive sexual self-concept and reduce sexual anxiety.

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.