An Observational Study of Mask Guideline Compliance In An Outpatient OB/GYN Clinic Population The preponderance of recent evidence indicates mask usage decreases the risk of SARS CoV-2 transmission . Wake Forest Baptist Health (WFBH), mandated masking by all patients and visitors to our outpatient clinics on June 1, 2020. This was communicated via campaign of digital contact through our healthcare portal, signage outside and inside clinics, billboard and transport advertisements, and telephone communication during appointment reminder calls. Masking/social distancing messaging currently accounts for 70-80% of the WFBH advertising expenditures (WFBH Communications, Marketing & Media, personal communication, September 29, 2020).
Implications of non-invasive prenatal testing for identifying and managing high-risk pregnancies Non-invasive prenatal testing is regularly used to screen for aneuploidies and Rhesus status of a fetus. Since 1997 when free fetal DNA (ffDNA) in the maternal circulation was first identified, it has been hypothesized that it may be possible to use non-invasive prenatal testing (NIPT) to identify high-risk pregnancies including pre-eclampsia, growth restriction and preterm birth. Since then there has been much interest in this area as a way to identify and understand disease processes. This review presents the current evidence for this approach.
Informational Needs of Couples undergoing Intracytoplasmic Sperm Injection with Surgical Sperm Retrieval: a qualitative study Infertile couples consider patient information a very important dimension of patient-centred care. Although testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) has long been offered to infertile couples, little is known about couples’ informational needs. The aim of this study was to identify the informational needs of couples undergoing TESE and ICSI, including information content and the channels providing the information as a first step to improve patient-centred care.
Sexual assault as a risk factor for gynaecological morbidity: An exploratory systematic review and meta-analysis Among Australian females, sexual assault affects 1 in 5 Australian women , and 1 in 10 girls . While it is well known that females who experience sexual assault have an increased risk of future pelvic pain, there is limited knowledge regarding the occurrence of other gynaecological morbidity.We performed systematic review and meta-analysis for the relationship between sexual assault and gynaecological morbidity. We searched online electronic databases for observational studies on the subject published between 1993 and 2018.
200 years of diagnosis and treatment of cervical precancer The history of the diagnosis and treatment of cervical precancer is fragmentary. Findings in the English-speaking and German-speaking areas vary considerably. We aim to describe the history of clinical advances in diagnosis and treatment of cervical precancer and identify areas where further work is required.
Obstetric anal sphincter injury associated with preterm delivery The rate of pre-term delivery has increased in high-income countries over the last decade, with rates of 8.7 % in Europe . Despite this rising incidence, research into the complications arising from preterm birth have mostly focused on neonatal outcomes, with maternal outcomes being much less commonly reported. Obstetric anal sphincter injury (OASI) remains the leading cause of anal incontinence in women , though the majority of research into OASI has excluded pre-term births. Some work in vaginal twin deliveries—often occurring at preterm gestations—has demonstrated a reduced rate of sphincter injury when compared to singletons .
Changes in physiology and immune system during pregnancy and coronavirus infection: a review Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the 3rd epidemic coronavirus after severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Since December 2019, the outbreak of the Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 has aroused great attention around the world. Pregnant women and their fetuses have been concerned as a high-risk population. We explained why pregnant women are susceptible to coronavirus in terms of their adaptive changes in physiology and immune system during pregnancy, and described the associations between maternal clinical symptoms, perinatal outcomes and coronavirus infections.
Molecular characterization in the prediction of disease extent in endometrial carcinoma Tumour stage plays an important role in determining the prognosis of patients with endometrial cancer. Compared with the 5-year survival rate of 78–90% for stage I disease, the survival rate is 74% for stage II disease and only 21–57% for advanced stages (III–IV) . Due to the favourable outcome, patients with stage I endometrial cancer can generally forgo adjuvant therapies, especially if hysterectomy and bilateral salpingo-oophorectomy have been complemented with regional lymphadenectomy to confirm disease stage.
A novel surgical approach with cervical preservation for pelvic organ prolapse with uterine descent: The TAP-GAN technique The lifetime risk for prolapse surgery is nearly 20 % , and worldwide vaginal hysterectomy is the most commonly performed surgical procedure for uterine prolapse. On the other hand, some authors have recently supported the view that uterine-sparing procedures are attractive options in women without contraindications for these surgeries . The majority of these procedures involve mesh-based approaches; however, patients and surgeons are increasingly worried about the use of meshes due to recent warnings by the UK and the Food and Drug Administration [3–5].
Incidentally diagnosed hydatid cyst of uterus A 62-year-old postmenopausal woman, resident of Tunisia was admitted to the department of Gynecology and Obstetrics for low abdominal pain lasting for six months. She had no history of disease. Ultrasonography of the abdomen and pelvis was performed and revealed a large pelvic and cystic mass measuring 8 × 7 cm that was thought to be most likely from the left ovary. No other lesion was found. In order to better assess the mass, a magnetic resonance imaging (MRI) of pelvis was carried out and suggested the diagnosis of serous cystadenoma of the left ovary.
Delivery in breech presentation: perinatal outcome and neurodevelopmental evaluation at 18 months of life Obstetric management of breech presentation at term is heterogeneous, and whether to recommend caesarean section or vaginal delivery is still a subject of debate. Moreover, studies on the neonatal mortality and morbidity of infants with breech presentation depending on the method of delivery have yielded inconsistent results. A major change in the clinical practice of breech presentation occurred after the publication of the Term Breech Trial study, which suggested that perinatal and neonatal mortality and serious neonatal morbidity were increased in breech pregnancies delivered vaginally, despite similar maternal outcomes [1–3].
External cephalic version for breech presentation: the guideline landscape and a quest for an optimal approach Breech birth is associated with a higher rate of short-term perinatal complications compared to cephalic birth (1,2). For breech presentation at or near term, there are three options: external cephalic version (ECV), elective cesarean section, or trial of labor in breech (breech TOL). The evidence for the effectiveness of ECV to reduce breech vaginal and cesarean deliveries is strong (3–5). ECV is considered the first line option in most western countries (6–10). Although ECV is a safe procedure with few complications it should be performed in a setting where fetal monitoring and surgical delivery is available (6,11,12).
The impact of the Covid-19 pandemic on maternity services: a review of maternal and neonatal outcomes before, during and after the pandemic Covid-19 has been described as the pandemic of the century1. The Republic of Ireland (ROI) has been successful in its endeavour to ‘flatten the curve’ and reduce transmission of the virus through strict public health measures overseen by the National Public Health Emergency Team (NPHET). The first detected case of SARS CoV2 in the Republic of Ireland was reported on 29th February 2020. Schools, colleges and childcare facilities were closed on 12th March followed by a nationally enforced ‘lockdown’ on 27th March which saw government-mandated closure of all non-essential businesses, restricted non-essential journeys and advised isolation of vulnerable individuals.
Extra-abdominal ovarian cancer presenting with breast metastases at diagnosis: case report and literature review Malignant ovarian tumours are diagnosed at an advanced stage in the majority of cases. However, only a small percentage present as extra-abdominal, non-lymph-node solid metastases, as in the breast, and they are usually cases of relapse. The discovery of mono- or bilateral breast lesions with peritoneal carcinosis and/or abdomino-pelvic lesions can be cumbersome in the differential diagnosis of primary tumours. This article aims to summarize current evidence on the detection of breast metastases at diagnosis of ovarian cancer.
Development of placenta over entire uterine cavity following laparoscopic uterine-sparing adenomyomectomy Laparoscopic uterine-sparing surgery is being performed increasingly in women with severe symptoms or subfertility secondary to adenomyosis. Although the purpose of this surgery is to increase fertility and improve quality of life, this surgery has not become the standard treatment for adenomyosis as it is difficult to excise the affected adenomyotic tissue completely, and critical complications (e.g. placenta increta and uterine rupture) may develop [1,2]. The exact mechanism resulting in the effectiveness of this surgery remains unclear, and some of the advantages of removing an affected area are theoretical.
Perinatal mortality and morbidity of SARS-COV-2 infection during pregnancy in European countries: Findings from an international study After being epidemic in China, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) infection has rapidly spread in many countries as a global pandemic, with the number of affected cases dramatically increasing worldwide on a daily basis. Although the median age of hospitalized patients with confirmed infection is usually more advanced , with older age reported to be associated to higher mortality rate , physiological adaptations occurring during pregnancy have been claimed to be potentially responsible for a more severe respiratory disease, thus leading to higher rates of maternal and fetal complications [3,4].
We thank professor Maged for his interest in our study. We have already replied to similar concerns raised by Dr Badawy and Dr Abu Hashim themselves (1,2). Our concern about their trials is not limited to the failure of some of their data to follow Benford’s law. We also showed that (1) their trials’ baseline data are highly unlikely to have been the result of a properly conducted randomized treatment allocation; and (2) there are multiple similarities in the baseline or outcome tables of several studies, which strongly suggests that data were copied from one study to another.
High prevalence of thalassemia with a novel α-thalassemia mutationin in Baoan populations in Guangdong province, China Thalassemia is a highly prevalent monogenic inherited disease characterized by abnormal hemoglobin production . Approximately 5 % of the population are thalassemia carriers in the world . It is highly prevalent in southern China which imposes significant challenges for the public health services . Herein, we conducted a baseline survey on the epidemiological status of thalassemia in Baoan Region in southern China. Moreover, we identified a novel mutation at HBA2:c.217_218insC heterozygosity for the first time, which further fill the blank of the HbVar database.
Perinatal and maternal outcomes after frozen versus fresh embryo transfer cycles in women of advanced maternal age The delay of childbearing in women has become a worldwide issue in recent decades. The application of assisted reproductive technology in women of advanced maternal age (AMA) is increasing. Evidence on the safety and outcomes of frozen embryo transfer (FET) compared with fresh embryo transfer (ET) in AMA women is still lacking. Therefore, the objective of the present study was to compare perinatal and maternal outcomes after autologous FET and fresh ET cycles in women of AMA.
Letter to the editor We have read the article entitled “Data integrity of 35 randomised controlled trials in women’ health” with great interest. Even so, I find it difficult to reach any solid conclusions based on the author’s own frequent use of adjectives and adverbs (e.g. suggestive, may be, may reflect, etc.) to describe any possible associations they have identified. This makes it unclear what level of confidence the authors have in the validity of the findings based on the methods they used.
British gynaecological cancer society (BGCS) cervical cancer guidelines: Recommendations for practice Cervix cancer in many countries is declining and screening programmes and immunisation will reduce the incidence in the next few decades. This guideline attempts to cover management of invasive disease reflecting diagnosis and imaging including new imaging and sentinel lymph node biopsies. Smaller volume disease is usually managed surgically whereas advanced disease is treated with (chemo)- radiation. It also includes discussion of fertility sparing procedures. Practices are changing frequently for all aspects of care usually in attempts to reduce complications and improve quality of life.
Frictional keratosis of the vulva: A new entity We present the clinical and histological features seen in six females who all undertook regular and repetitive exercise who presented with thickened plaques on the vulva and propose the term frictional keratosis of the vulva to describe this benign entity.
Endometriosis and strategies of fertility preservation: a systematic review of the literature Endometriosis is a common chronic inflammatory disorder, often causing both pain and infertility. It is estimated that 25–50 % of patients undergoing fertility treatments have had endometriosis as it involves an impairment of the ovarian reserve. For these reasons, endometriosis has been highlighted as a condition that may require a fertility preservation procedure, while being benign in nature. The aim of this review is to summarize the current evidence on fertility preservation techniques for patients affected by endometriosis, focusing on the main characteristics of the different approaches.
Changes in fetoplacental Doppler indices following intrapartum maternal sildenafil citrate treatment Uterine contractions during labour can result in a 60 % decline in fetoplacental perfusion, predisposing the fetus to hypoxic brain injury. Sildenafil citrate (SC) has shown promise in increasing uteroplacental perfusion as well as reducing the risk of operative birth for intrapartum fetal compromise (IFC). The aim of this study was to investigate the effect of intrapartum SC administration on fetoplacental blood flow indices.
Association of female genital mutilation and female sexual dysfunction: A systematic review and meta-analysis Female genital mutilation (FGM), also referred to as female genital cutting, circumcision or excision, is a cruel action against girls and women that is widespread in the Middle East and in several Africans regions and South Asian countries [1–3]. It represents an aggression to girls and women carried out by the removal and damaging of healthy and normal female genital tissue, thus interfering with their natural corporal functions. FGM may range from the excision of minor skin parts around the clitoris to almost the removal/destruction of the entire vulva .
Preference for mode of delivery in a low-risk population in Cape Town, South Africa There has been an increase in Caesarean section rates in many developed countries with maternal request frequently being cited as a reason. There are few studies examining African women’s preference for mode of delivery. The objectives this study were to determine women’s preference for mode of delivery in a low risk population to describe the major reasons for their preferences.
Magnetic resonance imaging evaluation of cervical length by the women’s age: a retrospective cohort study The anthropometric characteristics of the uterus evolve with pubertal development in girls. It is therefore permissible to ask until these anthropometric characteristics change, in order to know if the cervical length criterion defined for preterm delivery threats is applicable to all ages. The main objective of our study was to analyze the evolution of cervical length with the women’s age outside pregnancy to overcome factors related to pregnancy that can affect cervical length.
Why are first time expectant fathers afraid of birth? : A qualitative study Fear of childbirth in women, perceiving childbirth negatively, childbirth continuing for a longer time, childbirth with interventions or emergency cesarean section childbirth are the cause of an increase in the ratios of elective cesarean sections . Men, just like women, also experience fear of childbirth [2–4].
Universal screening identifies asymptomatic carriers of SARS-CoV-2 among pregnant women in India Asymptomatic women with coronavirus disease 2019 (COVID-19) are at risk of infecting their newborns and also pose a risk to healthcare providers and other patients [1,2,3]. Considering this, Indian Council of Medical Research (ICMR) recommended universal testing for SARS-CoV-2 in pregnant women . Maharashtra is the worst-hit state in India and universal screening strategy for pregnant women was implemented in several public hospitals during this time. Herein, we report the outcome of implementation of this strategy.
Factors associated with maternal readmission to hospital, attendance at emergency rooms or visits to general practitioners within three months postpartum While most women remain healthy after giving birth to their baby, others experience complications that require medical attention or readmission to hospital. However, data on maternal attendance for medical care postpartum or readmission to hospital are not collected or reported routinely in many countries so the extent of health problems experienced remain unknown. Collecting data on the proportion of women who seek medical care in the early postpartum period may deepen understanding of risk factors, the consequences for women, their families and the maternity care system and, ultimately, help identify preventative strategies and processes.
Recurrent Wilms tumor in a Chinese family caused by a novel WT1 variant inherited from a mosaic parent Wilms tumor (WT) is an embryonal malignant neoplasm of the kidney in young children . The usual clinical presentation of WT is that of an abdominal mass in a child who appears to be otherwise healthy. WT has the potential for both local spread and distant metastasis. Although WT is sporadic, about 2% of these patients present a family history. We here describe a family with two siblings affected with WT, which led us to detect a WT1 variant in the affected cases inherited from a mosaic parent.
The reproducibility of trophectoderm biopsies – The chaos behind preimplantation genetic testing for aneuploidy Chromosomal mosaicism is a common feature of early human embryos development. “Mosaic” embryos display very low rates of concordance between multiple trophectoderm biopsies and between multiple trophectoderm and inner cell mass biopsies using next-generation sequencing. The here presented data clearly demonstrate the limitations and shortages of the preimplantation genetic testing for aneuploidy screening test, which are not in alignment with WHO basic requirements.
Is COVID-19 a risk factor for severe preeclampsia? Hospital experience in a developing country We have read with great interest the article published by Todros ; it states that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and preeclampsia have common pathophysiological characteristics, as shown by inflammatory changes. In the present work, we want to report our experience in a reference hospital of Peru regarding the clinical course of hypertensive disorders of pregnancy in pregnant women with SARS-CoV-2 infection.
Daily life attitudes of women with moderate or severe chronic pelvic pain. A qualitative study Pain is an experience that reflects a person's apprehension of a threat to their physical or existential integrity . Chronic pelvic pain (CPP) is defined as nonmenstrual pelvic pain of six or more months duration that is severe enough to cause functional disability or require medical or surgical treatment . CPP affects 3.8%–24% of women worldwide . Most affected women are in reproductive age. In the Brazilian public health system, the prevalence of CPP is about 15 % for women in the reproductive age .
The general populations’ understanding of first trimester miscarriage: a cross sectional survey First trimester miscarriage is a common adverse pregnancy outcome,1 yet can be a devastating and distressing event in the reproductive lives of women and their families.2 Retrospective studies indicate one in five pregnancies will end in first trimester miscarriage, while prospective studies have reported miscarriage to occur as frequently as one in two pregnancies in women of advanced maternal age and with other risk factors.4 The variation in miscarriage rates could potentially be attributed to the manner in which they are calculated as many studies record the outcome from clinically recognised pregnancies within the first trimester.
Racial-ethnic disparities and pregnancy outcomes in SARS-CoV-2 infection in a universally-tested cohort in Houston, Texas Hispanic and Black communities are disproportionately affected by coronavirus disease 2019 (COVID-19) . Emerging U.S. data suggest that in pregnancy, Hispanic people are diagnosed with SARS-CoV-2 infection at higher rates than other racial-ethnic groups . Existing reports are primarily limited to case series of symptomatic individuals, which are prone to selection bias, while the few cohort studies reporting on pregnancy outcomes include relatively small numbers of Hispanic people . Contemporary data from representative populations in high-incidence areas are urgently needed.
Seroepidemiology of TORCH antibodies in the reproductive-aged women in China TORCH, the acronym of Toxoplasma gondii (TOX), others, rubella virus (RUV), cytomegalovirus (CMV) and herpes simplex virus (HSV), is a major contributor to congenital infection. National population-based study on the seroepidemiology of TORCH in women is yet lacking, and it is still obscure whether TORCH infection in the women was associated with adverse pregnancy outcomes. A total of 48,406 asymptomatic women from eight hospitals in China which covered the most areas of mainland China were enrolled in this study, and 26,400 were simultaneously subjected to 7 detection tests for TORCH specific antibodies.
Intestinal parasitic infections in pregnancy – A review Intestinal parasitic infections are widespread worldwide and with increased global travel and transport of food, these are not entirely limited to traditionally endemic areas. The prevalence of parasitic infections in endemic areas among pregnant women ranges from 24 to 70 % with approximately 10 % of women having multiple parasites. Pregnancy with its increased nutritional demands and altered immunological defenses is an especially vulnerable time for acquiring parasitic infections, which may be associated with adverse outcomes such as anaemia, which in some cases may even contribute to mortality.
Two-dimensional Speckle tracking echocardiography in Fetal Growth Restriction: a systematic review Ten percent of pregnancies are affected by fetal growth restriction (FGR), defined as an estimated fetal weight (EFW) below the 10th percentile . The main cause of FGR is thought to be impaired placental function resulting in an insufficient transplacental transport of nutrients and oxygen [2,3]. Growth-restricted fetuses have an increased risk of stillbirth, adverse perinatal outcome, and long-term cardiovascular and metabolic diseases [4,5].
Irisin level and neonatal birthweight: A systematic review and meta-analysis Irisin is an important crosstalk myokine between adipose and muscle tissue. Disorders in irisin secretion can lead to fetal growth abnormalities and even lead to metabolic syndromes in adult life. This study aimed to evaluate the association between irisin level in umbilical cord blood and maternal serum with neonatal birthweight. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline were followed.
Letter of response (2) — Data integrity of 35 randomised controlled trials in women' health Thank you for the opportunity to respond on the concerns of Dr Abu Hashim. As we described in our letter of response to the letter from Dr Badawy , we studied all trials in which Dr Badawy or Dr Abu Hashim had been involved. We did this as several people had noted overlapping results in the work of both authors. Our results suggest that the research processes and hence the resulting data of many of these trials have been compromised. Consequently, we advised that all studies of Dr Badawy and Dr Abu Hashim should be the subject of further investigation.
A Systematic Review of Intracranial Aneurysms in the Pregnant Patient ― A Clinical Conundrum The unique physiological changes of pregnancy may contribute to vascular stress increasing the risks of aneurysm formation, growth, and rupture [1–3]. The incidence of subarachnoid hemorrhage ranges from 3 to 11 per 100,000 pregnancies [4–7], with fetal and maternal mortality rates estimated to be 17% and 35%, respectively [3,8–10]. In comparison, subarachnoid hemorrhage incidence in the general population is 7.9 (95% CI, 6.9-9.0) per 100,000 person-years . The relative rarity of subarachnoid hemorrhage in the pregnant patient has likely resulted in a lack of clear treatment guidelines, although proper guidelines for the management of pregnant patients with intracranial aneurysm would provide clarity and facilitate care management.
Ectopic pregnancy following in vitro fertilization after bilateral salpingectomy: A review of the literature Ectopic pregnancy after bilateral salpingectomy is rare and is therefore easily misdiagnosed. To provide information regarding the clinical manifestations, diagnosis, management, mechanism and prognosis of this condition, we reviewed all cases reported in the English literature. All English language reports on ectopic pregnancy after bilateral salpingectomy were retrieved from the PubMed database. A total of 19 English language articles were collected and 20 cases of ectopic pregnancy were reported.
Antenatal management of multiple pregnancies within the UK: A survey of practice To identify variation in the antenatal management of multiple pregnancy. The UK has 10,000 twin pregnancies per year. There is established guidance on the management of dichorionic (DC) and monochorionic (MC) twin pregnancy from both the RCOG and NICE, however it is likely that the provision and practice of multiple pregnancy management varies amongst units.
Unexplained repeated pregnancy loss and T helper cells Miscarriage is one of the most important issues in human reproduction. Spontaneous pregnancy loss occurs in 15 % of pregnancies. It is defined as a fetal loss prior to 20 weeks of gestation or fetal weight of less than 500 g. Around 12–15 % of women suffer at least one miscarriage in their lifetime . Nearly 5% women experience two consecutive pregnancy losses, whereas 1% experience three or more losses [1,2].
A rare case of streptococcus B meningitis in post-partum We describes a case of a 39-year-old Portuguese woman was seen for her second pregnancy. She had a previous normal delivery and her antenatal course was uncomplicated. She underwent a collection of vaginal and rectal exudates at 34 + 5weeks of gestation, to search for group B Streptococcus (GBS), without isolation.
Which second trimester placenta previa remains a placenta previa in the third trimester: A prospective cohort study A placenta previa, a placenta overlying the internal os of the cervix, is a major risk factor for maternal complications, in particular massive haemorrhage in the third trimester . Placenta previa has an increased risk of fetal complications as well, as women with a placenta previa have a risk of 43 % on preterm delivery and 20 % of women with placenta previa will deliver prematurely in an emergency setting [2,3]. In case of a placenta previa during delivery a cesarean delivery is always indicated .
Myomectomy during pregnancy: A systematic review Uterine fibroids affect 2–10 % of pregnant women. Although usually asymptomatic, they may be associated with pregnancy complications. Myomectomy is preferably avoided antenatally, however, it has been reported in symptomatic cases that did not respond to conservative management. The aim of this study was to summarize the published literature and present the reported outcomes and associated risks of this procedure.
Letter of response - Data integrity of 35 randomised controlled trials in women' health Thank you for the opportunity to respond on the concerns of Dr Badawy. While we understand that Dr Badawy disagrees with us on many issues, let us first look at issues on which we likely agree. First, we all consider evidence from randomised controlled trials should be at the core of how we make decisions to treat our patients. Second, we all acknowledge that this evidence is used by policy makers to determine whether the cost of treatments should be reimbursed or not, and by clinicians to determine the best estimate of the effect of a treatment, often with the help of meta-analysis.
WITHDRAWN: Diagnostic evaluation of uterine myomas This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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