General Gynecology Research Articles

Statewide assessment of telehealth use for obstetrical care during the COVID-19 pandemic

The COVID-19 pandemic started a period of rapid transition to telehealth in obstetrical care delivery to maintain social distancing and curb the spread of the virus. The use of telehealth, such as telephone and video visits, remote imaging interpretation, and provider-to-provider consultations, increased in the early months of the pandemic to maintain access to prenatal and postpartum care. Although there is considerable literature on the use of telehealth in obstetrical care, there are limited data on widespread telehealth use among different practice types and patient populations during the pandemic and whether these are preferred technologies. This study aimed to describe variations in telehealth use for obstetrical care among practices in North Carolina during the COVID-19 pandemic and to outline future preferences and needs for continued telehealth use. This study also aimed to delineate telehealth use among rural and micropolitan and metropolitan practices to better understand if telehealth use varied by practice location. A web-based survey was distributed to practice managers of obstetrical practices in North Carolina from June 14, 2020 to September 14, 2020. Practice managers were contacted through assistance of the Community Care of North Carolina Pregnancy Medical Home program. Practice location was defined as rural, micropolitan, or metropolitan based on the county population. The survey assessed telehealth use before and during the COVID-19 pandemic, types of modalities used, and preferences for future use. Descriptive statistics were performed to describe survey responses and compare them by practice location. A total of 295 practice managers were sent a web-based survey and 98 practice managers responded. Responding practices represented 66 of 100 counties in North Carolina with 50 practices from rural and micropolitan counties and 48 practices from metropolitan counties. The most common type of provider reported by practice managers were general obstetrician and gynecologists (85%), and the most common practice type was county health departments (38%). Overall, 9% of practices reported telehealth use before the pandemic and 60% reported telehealth use during the pandemic. The most common type of telehealth modality was telephone visits. There were no significant differences in the uptake of telehealth or in the modalities used by practice location. A total of 40% of practices endorsed a preference for continued telehealth use beyond the COVID-19 pandemic. The most commonly reported need for continuation of telehealth use was assistance with patient access to telehealth technologies (54%). There were no significant differences in the preferences for telehealth continuation or future needs by practice location. Telehealth use increased among a variety of practice types during the pandemic with no variation observed by practice location in terms of modalities used, future preferences, or needs. This study assessed statewide uptake of and differences in obstetrical telehealth use during the early COVID-19 pandemic. With telehealth becoming an integral part of obstetrical care delivery, this survey has implications for anticipating the needs of practices and designing innovative solutions for providers and pregnant people beyond the COVID-19 pandemic.

Urinary tract injury during hysterectomy: Does surgeon specialty and surgical volume matter?

Ureteral injury is a known complication of hysterectomies. Recent studies have attempted to correlate surgeon volume and experience with incidence of urinary tract injuries during hysterectomies. Some studies have reported that as surgeon volume increases, urinary tract injury rates decrease. To our knowledge, no studies have assessed the relationship between surgeon subspecialty and the rate of urinary tract injury rates during minimally invasive hysterectomy. To determine the incidence of urinary tract injury between urogynecologists, gynecologic oncologists, and general gynecologists. The study took place from January 1, 2016 to December 1, 2021 at a large community hospital in Detroit, Michigan. We conducted a retrospective chart review of adult patients who underwent minimally invasive hysterectomy. After we identified eligible patients, the surgeon subspecialty was identified and the surgeon's volume per year was calculated. Patient demographics, medical history, physician-dictated operative reports, and all hospital visits postoperatively were reviewed. Urologic injury occurred in four patients (2%) in the general gynecologist group, in one patient (1%) in the gynecologic oncologist group, and in one patient (1%) in the urogynecologist group. When comparing high and low-volume surgeons, there was no statistically significant difference in urinary tract injury (1% vs 2%) or bowel injury (1% vs 0%). There were more complications in the low-volume group vs the high-volume group excluding urinary tract, bowel, or major vessel injury. High-volume surgeons had four (1%) patients with a complication and low-volume surgeons had 12 (4%) patients with a complication (P = 0.04). Our study demonstrated that there was no difference in the urinary tract injury rate in general gynecologists vs subspecialists, however our study was underpowered.

Measuring the Awareness of Polycystic Ovarian Syndrome (PCOS) among Women in Punjab, Pakistan

Polycystic ovarian syndrome (PCOS) is the most prevailing endocrine disorder among women of reproductive age, worldwide. Its prevalence is 52% in Pakistani women and the rate of infertility is gradually increasing. It can be treated through early diagnosis, management of symptoms, and a healthy lifestyle. This cross-sectional study aimed to determine the level of awareness and knowledge regarding PCOS in the women of Punjab, Pakistan. For this purpose, a total of 350 women between the ages of 16 and 50 years were included in the current study. data was obtained through a questionnaire and analyzed through SPSS (version 25). The results determined that 56% of women were found to have the knowledge of PCOS, while 44% had never heard about it. Furthermore, about 67% of 196 PCOS-aware women were unaware of its signs and symptoms. Moreover, in 14% of the cases, a friend was the source of knowledge regarding PCOS. Whereas, approximately 10% of these women had heard about the syndrome through education, 9% through their family, 7% through various media such as newspapers, television, and social media, and 17% through other sources including general physicians and gynecologists. It was concluded that only 33% of the participants who claimed to have heard of PCOS were aware of its symptoms, whereas 67% were unaware of them. A total of 152 women, out of 350, had never heard about PCOS.

Perspective of Dutch healthcare professionals on care for female urinary incontinence: A mixed-methods study

Introduction and hypothesis: Health care professionals (HCP) can reveal practical recommendations to improve processes and address challenges in the care of women with urinary incontinence (UI) in the Netherlands. Methods: We conducted an exploratory, sequential, mixed-methods study among HCPs, using the outcomes of six focus group sessions (30 HCPs) to inform a subsequent survey. HCPs included general practitioners (GPs), practice assistants (PAs), pelvic physiotherapists (PPTs), and urologists and gynecologists (UGs). Results: The main themes arising from the six focus group sessions (with 6 GPs, 7 PAs, 6 (resident) UGs, 8 PPTs, and 7 PPTs) were “identification of UI,” “current state of care,” and “guiding patients through the healthcare system.” The survey respondents included 351 PAs, 124 GPs, 75 PPTs, and 183 UGs. Of these 741 respondents, 72.8% (strongly) agreed that the identification of UI in general practice required improvement and 60% confirmed the need for further education on this topic. Most HCPs (83.1%) found it useful to offer women a patient information leaflet when buying incontinence products, but less useful to ask about UI routinely in specific scenarios, and most (75%) agreed that a multidisciplinary guideline could improve healthcare. Interestingly, 86% of PPTs and 21% of UGs advocated referral to a PPT before referral to a specialist, while 87% of PPTs wanted primary care services to offer a UI consultation hour and 36% of the GPs (strongly) disagreed. Conclusion: Poor UI identification in primary care and a lack of patient guidance through the health care system hamper continence care provision.

Kelly K. Ward, MD

Clinical Associate Professor of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology. Medical Director, Labor and Delivery Unit and Mother-Baby Care, Department of Obstetrics and Gynecology. Associate Residency Director, Department of Obstetrics and Gynecology

Perioperative Techniques for the Use of Botulinum Toxin in Overactive Bladder: Results of a Multinational Online Survey of Urogynecologists in Germany, Austria, and Switzerland

Botulinum toxin (BoNT) is a widely used treatment for overactive bladder (OAB). Despite its common use, no standardized treatment regimen exists so far. The aim of this survey was to evaluate the variation in perioperative treatment strategies among members of the German-speaking urogynecologic societies. A clinical practice online survey was carried out between May 2021 and May 2022, and all members of the German, Swiss, and Austrian urogynecologic societies were invited to participate. Participants were grouped in two ways. First, they were grouped into (1) urogynecologists with board certification and (2) non-board-certified general obstetricians and gynecologists (OBGYNs). Second, we set a cut-off at 20 transurethral BoNT procedures per year to differentiate between (1) high- and (2) low-volume surgeons. One hundred and six completed questionnaires were received. Our results demonstrated that BoNT is mostly used as a third-line treatment (93%, n = 98/106), while high-volume surgeons used it significantly more often as a first/second-line treatment (21% vs. 6%, p = 0.029). Large variations existed in the use of perioperative antibiotics, preferred sites of injection, the number of injections, and the timing of the measurement of the postvoid residual volume (PVRV). Forty percent of participants did not offer outpatient treatment to patients. Local anesthesia (LA) was mostly used by board-certified urogynecologists (49% vs. 10%, p < 0.001) and high-volume surgeons (58% vs. 27%, p = 0.002). Injections into the trigone were also more often performed by board-certified urogynecologists and high-volume surgeons (22% vs. 3% (p = 0.023) and 35% vs. 6% (p < 0.001), respectively). PVRV was controlled between weeks 1 and 4 by only 54% of participants (n = 57/106). Clean intermittent self-catheterization (CISC) was infrequently taught (26%). Our survey confirmed that BoNT is widely used by urogynecologists in the three German-speaking countries, but practice patterns vary widely, and no standardized method could be detected, despite interviewing urogynecologic experts. These results clearly demonstrate that there is a need for studies to define standardized treatment strategies for the best perioperative and surgical approach regarding the use of BoNT in patients with OAB.

In Reply.

Division of General Obstetrics and Gynecology Specialists and Division of Family Planning, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts Financial Disclosure The author did not report any potential conflicts of interest.

Ticket to perform: an explorative study of trainees’ engagement in and transfer of surgical training

BackgroundResearch suggests that simulation-based surgical skills training translates into improved operating room performance. Previous studies have predominantly focused on training methods and design and subsequent assessable performances and outcomes in the operating room, which only covers some aspects of training engagement and transfer of training. The purpose of this qualitative study was to contribute to the existing body of literature by exploring characteristics of first-year trainees’ engagement in and perceptions of transfer of surgical skills training.MethodsWe conducted an explorative study based on individual interviews with first-year trainees in General Surgery, Urology, and Gynaecology and Obstetrics who participated in a laparoscopic skills training program. Informants were interviewed during and two months after the training program. A thematic cross-case analysis was conducted using systematic text condensation.ResultsWe interviewed 12 informants, which produced 24 transcripts for analysis. We identified four main themes: (1) sportification of training, (2) modes of orientation, (3) transferrable skills, and (4) transfer opportunities. Informants described their surgical training using sports analogies of competition, timing, and step-by-step approaches. Visual orientations, kinaesthetic experiences, and elicited dialogues characterised training processes and engagement. These characteristics were identified in both the simulated and the clinical environment. Experiences of specific skills transfer included ambidexterity, coordination, instrument handling, and visuospatial ability. General transfer experiences were salient in informants’ altered training approaches. Informants considered the simulation-based training an entry ticket to perform in the operating room and mentioned supervisor-trainee relationships and opportunities in the workplace as critical conditions of transfer.ConclusionsOur findings elucidate characteristics of surgical training engagement that can be interpreted as self-regulated learning processes that transcend surgical training environments. Despite appreciating the immediate skills improvements resulting from training, trainees’ narratives reflected a struggle to transfer their training to the clinical setting. Tensions existed between perceptions of transferable skills and experiences of transfer within the clinical work environments. These results resonate with research emphasising the importance of the work environment in the transfer process. Our findings provide insights that may inform the development of training programs that support self-regulated learning and transfer of training from the simulated to the clinical environment.

Migraine treatment in pregnancy: A survey of comfort and treatment practices of women's healthcare providers.

The objective of this study was to assess women's healthcare providers' treatment practices for pregnant women with migraine. Migraine is associated with several maternal and fetal complications during pregnancy, including preeclampsia and preterm birth. Migraine treatment during pregnancy can present significant challenges due to lack of controlled clinical trials and risks associated with specific medications. Women's healthcare providers were queried regarding practice patterns and comfort with use of acute and preventive migraine treatments during pregnancy. The survey was distributed online. The survey was completed by 92 women's healthcare providers (response rate 22.9% [92/402]), with most specializing in general obstetrics and gynecology (91% [83/92]). Approximately one-fourth (26% [24/92]) of respondents indicated they counseled women on migraine treatment in pregnancy as early as before pregnancy contemplation, while over one-third (35% [32/92]) counseled on migraine treatment once the patient became pregnant. The majority of respondents reported feeling somewhat or very comfortable with recommending (63% [58/92]) or continuing (64% [59/92]) acute treatments for pregnant patients with migraine, with highest comfort levels for acetaminophen (100% [92/92] for prescribing or continuing) and caffeine (94% [85/90] prescribing, 91% [82/90] continuing). Higher levels of discomfort were reported with triptans (88% [80/91] rarely or never prescribe during pregnancy). Survey respondents felt less comfortable with recommending preventive migraine treatments to pregnant patients (40% [37/92] somewhat or very comfortable), compared with a higher comfort level with continuing preventive medications (63% [58/92] somewhat or very comfortable). Highest comfort levels were reported with use of magnesium (69% [63/91] comfortable prescribing, 82% [75/92] comfortable continuing) and non-pharmacologic approaches (70% [62/89] comfortable prescribing, 84% [75/89] comfortable continuing). Nearly 40% (35/92) of respondents reported that they typically refer to neurologists or headache specialists for migraine treatment during pregnancy. This survey of women's healthcare providers revealed varying levels of comfort regarding migraine management during pregnancy, and highlights the need for additional education regarding migraine treatment safety data during pregnancy.

Initial results of use and prospects of hospital-substituting technologies in gynecology

Background. The first day-care hospital (DCH) in the Russian Federation with 30 beds was established in the departments of general surgery, urology, and gynecology of the Botkin Hospital in 2016 in Moscow.&#x0D; Aim. To analyze the six-year experience of the gynecological DCH based on the Botkin Hospital.&#x0D; Materials and methods. The six-year experience (20162021) of the gynecological DCH based on the Botkin Hospital was analyzed.&#x0D; Results. The number of patients treated in the DCH increased progressively from 2016 to 2019. Due to the gain in the experience of DCH, patients with a broader spectrum of diseases can receive care in DCH settings, the number of hospitalized patients with a higher anesthetic risk has increased, and the proportion of patients over 65 years of age has also increased.&#x0D; Conclusion. Analysis of the activities of the DCH based on the Botkin Hospital showed that the pilot project can be considered successful due to good clinical and economic indicators. This activity format can be widely implemented, and it is optimal to establish such hospitals in multidisciplinary clinics.

Comparisons of Effectiveness in Differentiating Benign from Malignant Ovarian Masses between Conventional and Modified Risk of Malignancy Index (RMI).

To compare the predictive performance in differentiating benign from malignant ovarian masses between the modified risk malignancy index (RMI) and the conventional RMI (RMI-1 and RMI-2). Women scheduled for elective surgery because of adnexal masses were recruited to undergo pelvic sonography within 24 h before surgery to assess the sonographic characteristics of the masses, focusing on loculi, solid part, ascites, bilateralness, papillary projection, and color flow mapping (CFM). Preoperative CA-125 levels were also measured. Modified RMI, RMI-1, and RMI-2 systems were used to predict malignant masses. The gold standard was pathological or intraoperative diagnosis. A total of 342 ovarian masses, benign: 243 (71.1%); malignant: 99 (28.9%), meeting the inclusion criteria were analyzed. The sensitivity and the specificity of the modified RMI (87.9% and 81.9%) were significantly higher than those of RMI-1 (74.7% and 84.4%), and RMI-2 (79.8% and 81.1%, respectively). Based on ROC curves, the area under the curves were 0.930, 0.881 and 0.882 for modified RMI, RMI-1 and RMI-2, respectively. Modified RMI had better predictive performance than the conventional RMI in differentiating between benign and malignant ovarian masses. Modified RMI may be useful to help general gynecologists or practitioners to triage patients with an adnexal mass, especially in settings of low resources.

Antibiotic prophylaxis compliance differences in surgery and gynecology/obstetrics services in Huánuco, Peru.

Surgical site infections (SSIs) can increase mortality and morbidity in patients after surgery. Antibiotic prophylaxis is an effective measure to prevent SSIs, but inappropriate prescription is frequent. The objective of the study was to determine compliance with the clinical practice guideline for antibiotic prophylaxis in the general surgery and gynecology and obstetrics wards in the city of Huánuco, Peru. An analytical cross-sectional study was carried out on all surgical interventions in the general surgery and gynecology and obstetrics services during the year 2019. Compliance was determined based on the chosen antibiotic, dose, time of administration, and duration of prophylaxis. Related factors considered were age, presence of co-morbidities, surgery performed, duration of surgery, types of procedure, anesthesia, as well as years as a surgeon and anesthesiologist. A total of 557 medical records of patients with a median age of 33 years undergoing surgery were collected,. Antibiotic prophylaxis was correctly followed in all aspects in 14.6% of cases in the general surgery service and only in 5.6% of cases in the gynecology and obstetrics service. The correct duration of prophylaxis was 11.6% and 19.7% in general surgery and gynecology and obstetrics, respectively. Low compliance with institutional clinical practice guidelines for antibiotic prophylaxis was identified in both services. However, surgical interventions in the general surgery service presented better compliance with antibiotic prophylaxis compared to gynecology and obstetrics procedures.

What impact does the attitude toward COVID-19 vaccination have on physicians as vaccine providers? A cross sectional study from the German outpatient sector.

COVID-19 vaccination is recognized as a key component in addressing the COVID-19 pandemic. Physicians' attitudes toward vaccination are known to play a defining role in the management and dissemination of medical advice to patients. In Germany, outpatient practitioners are predominantly responsible for the dissemination of vaccines. Using a cross-sectional online survey, 932 outpatient general practitioners, gynecologists, and pediatricians in Germany were asked in fall, 2021, about their attitude toward COVID-19 vaccination and - among others - their communication in vaccine discussions, their assessment of vaccine safety, and reporting of suspected adverse events. Physicians were divided into two groups along their attitudes toward COVID-19 vaccination. In addition, multivariate linear regression models were constructed to assess differences in communication strategies. 92% of physicians had a positive or very positive attitude toward COVID-19 vaccination. Own vaccination status, practice-based vaccination delivery, and estimated vaccination coverage among patients were significantly associated with the attitude toward vaccination. Confidence in vaccine safety was significantly lower among physicians with negative attitudes. There were no differences between the two groups in self-assessment of the ability to detect suspected adverse events, but there were differences in the observing and reporting of adverse events. For the linear regression models, we found that a more negative attitude toward COVID-19 vaccination was significantly associated with increased acceptance of patient refusal of COVID-19 vaccination and empathic behavior for patient concerns. In contrast, willingness to engage in a detailed persuasion consultation was significantly lower. Pediatricians showed significantly higher empathy for patient-side concerns compared to general practitioners, whereas gynecologists showed less empathy than general practitioners. The physician's attitude toward COVID-19 vaccination influences the physician's practices as a vaccine provider. However, when providing medical advice and healthcare, the physician should focus on the actual needs of the patient.

Influence of comorbid diseases in the elderly on the efficiency complex conservative of pain in efficacy of treatment of back pain in the elderly with comorbidities

The aim of the study: to determine the structure of dorsalgia and comorbid diseases and the possibilities of rehabilitation in elderly patients with degenerative-dystrophic diseases of the spine (DDSD). The results of observation of 120 elderly patients who received sanatorium treatment in the Urgench sanatorium during 2020-21, aged 60-74 years, were analyzed, including 71 women, 49 men. All patients underwent a neurological examination, X-ray, CT or MRI of the spine, to identify comorbid diseases - ECG, ultrasound of internal organs, consultations with a general practitioner, urologist or gynecologist. According to the literature data and the results obtained, when selecting elderly patients with dorsalgia for treatment, it is necessary to take into account the “red flags” and refer such patients to specialized specialists. In addition, other comorbid diseases are identified in the elderly, which may limit the treatment of drug and physiotherapy (rehabilitation) therapy, which must be considered. Finally, in the elderly, it is necessary to take into account the so-called “yellow flags” - cognitive and depressive manifestations that affect the subjective sensation of pain.

Standardization of laparoscopic trays using an inventory optimization model to produce immediate cost savings and efficiency gains.

Perioperative services comprise a large portion of hospital budgets; the procurement and processing of surgical inventories can be an area for optimization in operational inefficiency. Surgical instrument trays can be customized as procedure-specific or standardized as trays that can be used in numerous procedure types. We conducted an interventional study to determine the cost savings from standardizing laparoscopic surgery instrument trays. A single-period inventory optimization model was used to determine the configuration of a standardized laparoscopic (SL) tray and its minimal stock quantity (MSQ). Utilization of instruments on the general surgery, gynecology, and gynecological oncology trays was recorded, and daily demand for trays (mean, SD) was assessed using daily operating room (OR) case lists. Pre- and post-intervention costs were evaluated by reviewing procurement data and quantifying medical device reprocessing (MDR) and OR processes. The SL tray was trialled in the OR to test clinical safety and user satisfaction. Prior to standardization, the customized trays had a total inventory size of 391 instruments (mean instruments per tray: 17, range: 12-22). Daily demand was an MSQ of 23 trays. This corresponded to a procurement cost of $322,160 and reprocessing cost of $41,725. The SL tray (mean instruments per tray: 15, mean trays/day: 9.2 ± 3.2) had an MSQ of 17 trays/day. The total inventory decreased to 255 instruments, corresponding to a procurement cost of $266,900 with savings of $55,260 and reprocessing cost of $41,562 with savings of $163/year. After 33 trial surgeries, user satisfaction improved from 50% to 97% (p < .05). Standardization to a single SL tray using the inventory optimization model led to increased efficiency, satisfaction, and significant savings through aggregating specific service demands. The inventory optimization model could provide custom solutions for various institutions with the potential for large-scale financial savings. Thus, future work using this model at different centres will be necessary to validate these results.

Maternal Characteristics, Intention, Self-Efficacy, Perceived Social Support, and Exclusive Breastfeeding Practice: Structural Equation Modeling Approaches

Breast milk is a perfect food for infants; however, the rate of exclusive breastfeeding is low. The relationship between exclusive breastfeeding practices and influencing factors is complex and remains unclear. This cross-sectional study was conducted in Changsha County, China, and 414 mothers were enrolled. An online questionnaire was used to collect data on general information, obstetrics and gynecology characteristics, the initial breastfeeding intention, breastfeeding practice, frequency of attending conventional breastfeeding programs before delivery, the status of breastfeeding self-efficacy, and the status of perceived social support. Structural equation modeling (SEM) was used to estimate the association between exclusive breastfeeding and potential risk factors of failing to practice exclusive breastfeeding for 6 months. The rate of exclusive breastfeeding for 6 months was 46.1%. The median and interquartile range of the scores for breastfeeding self-efficacy and perceived social support were 51.0 (18.0) and 68.0 (20.0), respectively. Factors that were statistically significant in the univariate analysis were included in the SEM and model fitness was acceptable based on the results. Exclusive breastfeeding for 6 months was directly associated with intention and self-efficacy, while it was indirectly associated with perceived social support and frequency of attending a breastfeeding program. The findings support the recommendation that comprehensive breastfeeding promotion strategies should be implemented to call on the intention and self-efficacy of breastfeeding mothers through various measures, such as education or providing medical and health services.

Fertility preservation in patients with gynecological cancer - is it possible?

The aim of this review article is to present current options for fertility preservation in young women with gynecological tumors (ovarian, endometrial or cervical cancer). An early pretreatment referral to multidisciplinary team which consists of general gynecologists, gynecologic oncologists, embryologists, radiologists, pathologists, and reproductive endocrinologists should be suggested to young women with gynecologic cancer, concerning the risks and benefits of fertility preservation options. Only a small percentage of patients with ovarian cancer and borderline ovarian tumors, are appropriate candidates for fertility preservation (FIGO stage IA and IC epithelial ovarian cancer). Following oophorectomy, ovarian tissue or oocytes are removed from the ovary for the use of cryopreservation; after completion of oncological treatment patient undergoes orthotopic retransplantation of ovarian tissue whereas oocytes may be used for in vitro fertilization. Live birth rates up to 53.8% have been reported after fertility preservation treatment in selected patients. In patients with endometrial cancer fertility preservation treatment means conserving of the uterus. Appropriate candidates for fertility preservation are younger women with well differentiated endometrial cancer, which does not invade the myometrium. Fertility preservation treatment in endometrial cancer is hormonal, based on progestins. After completion of fertility preservation treatment, frequent follow-ups are necessary, with tissue sampling (via curettage or endometrial biopsy) remaining standard approach in follow- up. Live birth rates after progestin therapy are around 60%, or even higher with the help of assisted reproductive procedures. In cervical cancer, fertility preservation treatment can be considered in women with early-stage disease (FIGO IA1, IA2, or IB1). Cone biopsy or conization followed by laparoscopic lymphadenectomy has been described as an appropriate procedure, with conception rates up to 47%.

Evaluation of Insulin-Like Growth Factor-I (IGF-I) as a Predictor of Preeclampsia

Introduction: Preeclampsia (PE) is a serious pregnancy-induced disease characterized by hypertension, proteinuria and other systemic disorders after 20 weeks of gestation and is a leading cause of maternal and fetal morbidity and mortality. The main pathological characteristics of preeclampsia are poor trophoblast cell invasion and uterine spiral artery remodeling dysfunction caused by placenta ischemia and oxidative stress. Nowadays, preeclampsia is considered to be the results of the interactions of genetic and environmental factors. However, its accurate pathogenesis remains unknown. It was considered IGF-1 might be involved in the pathogenesis of preeclampsia. As is known, the behaviors of cells, the formation of placenta and the growth of fetus are widely regulated by insulin-like growth factor 1 (IGF-1). Several studies have shown that IGF-1 was significantly reduced in preeclampsia. Objectives: To assess the role of Insulin like Growth Factor-I (IGF-I) as a Predictor of Preeclampsia. Materials and Methods: It was a prospective cohort study conducted in General Obstetrics and Gynaecology Unit OPD, Dhaka Medical College Hospital from January, 2020 to December, 2020. Pregnant women between 8 weeks to 15 weeks were enrolled for study after fulfilling selection criteria. Serum concentration of Insulin like growth factor-I (IGF-I) was assessed with cut off value of IGF-I 175.9 ng/ml. The value above 175.9 ng/ml was categorized as normal IGF-I and value below 175.9 ng/ml was categorized as low IGF-I. The patients who had value above 175.9 ng/ml were grouped as A. The value below 175.9 ng/ml was grouped as B. Then they were followed up monthly upto 28 weeks, two weekly upto 36 weeks, weekly upto delivery and puerperium for development of preeclampsia or not. All information was recorded in data collection sheet. Data were analyzed by SPSS-23. Data were compared and correlated among groups and presented by tables and figures. Result: Maternal serum concentration .....

Problematyka ginekologii wieku rozwojowego – ze szczególnym uwzględnieniem stanów zapalnych w kontekście także opieki dietetycznej, pielęgniarskiej, psychologicznej

Developmental age gynecology, also known as pediatric and adolescent gynecology, has emerged in general gynecology due to differences in the physiology and pathology of the genital organs patients in developmental age. Pediatric gynecology deals with patients from the neonatal period until adulthood. Also in terms of gynecology developmental age, it is important that the doctor fulfills his tasks in the whole team other doctors (e.g. pediatricians, dermatologists, endocrinologists, urologists, dentists) and medical service, and staff is of particular importance in this team and in this field nurses, a team of psychologists, and nutritionists. Among the gynecological problems in girls, inflammation constitutes a significant group genitals. All their problems from an early age girls should be able to entrust their parents, guardians. Unfortunately, not always so is and often need appropriate interdisciplinary help with inclusion psychologists.

Pattern of Candida Species Isolated from Patient with Vulvovaginal Candidiasis in Pregnancy

Background: Vulvovaginal candidiasis (VVC) is one of the most prevalent genital tract diseases in women. The identification of the isolated Candida species is critical for guiding empirical antifungal therapy. Purpose: To determine the Candida species that cause vulvovaginal candidiasis in pregnancy at the Obstetrics and Gynecology Outpatient Clinic, Dr. Soetomo General Academic Hospital, thus providing scientific and therapeutic benefits. Methods: Pregnant woman receiving antenatal care (ANC) at Dr. Soetomo General Academic Hospital Obstetric and Gynecology Outpatient Clinic. Subjects were enrolled in a cross-sectional study during 3 months between March and May 2021. Vaginal swab samples were taken from subjects after informed consent. A specific color change in CHROMagar cultures and VITEK 2 compact were used to identify Candida species. Result: During the study period, 15 pregnant patients were diagnosed with VVC. The majority of the women in the study were pregnant women of sexually active age who complained of a whitish body and genital irritation. There were 18 candida isolates from CHROMagar cultures, with C. non albicans (61.1%) predominating over C. albicans (38.3%). With details, non albicans were C. glabrata (54.4%), C. dubliniensis (36.3%), and C. parapsilosis (18.1%). Conclusion: This study revealed a high prevalence of Candida non-albicans species causing VVC. Culture investigation and identification of Candida are critical to avoid diminished susceptibility to antifungal treatments and recurrence.