Patients Of Reproductive Age Research Articles

Accelerated rehabilitation after hysterectomy in reproductive age patients

Background and aims. The principles of enhanced recovery in operative gynecology, comorbidity, and a multimodal approach in perioperative support require comprehensive study and optimization, and the ambiguity of literature reports determines the relevance of this study. The aim of this study was to evaluate the parameters of perioperative monitoring after hysterectomy for uterine leiomyoma in patients of reproductive age using enhanced recovery after surgery protocols and their impact on quality of life indicators. Materials and methods. To evaluate the effectiveness of the enhanced recovery protocol after hysterectomy, two groups were formed: the main prospective group, which included 46 patients, who underwent vaginal hysterectomy without appendages and 36 patients with abdominal hysterectomy, who used enhanced recovery after surgery (ERAS) protocols. The comparison group (group of standard management) included 44 patients who underwent vaginal hysterectomy without appendages and 34 patients with abdominal hysterectomy. The main parameters of monitoring were the postoperative pain level, intraoperative blood loss, diuresis rate, the timing of urinary catheter removal and recovery of peristalsis, as well as individual activation of motor activity. Results. When using the principles of ERAS, the quantitative assessment of pain level (“absence of pain”) was 1.6 times more severe compared to the data of the comparison group; the timing of urinary catheter removal was 2.0 times shorter, drain removal – 2.7 times shorter, recovery of peristalsis – 1.9 times shorter and individual activation of motor activity – 2.9 times earlier than in patients of the comparison group. Conclusions. Studies have demonstrated the feasibility of using laparoscopic technology in combination with the ERAS, which demonstrates a fall in the volume of intraoperative blood loss, a decrease in blood and fluid balance, a shortening of the time of invasive intravascular intervention, allows to improve the course of the early postoperative period, relieve postoperative pain syndrome, reduce the risk of intestinal paresis, shorten the rehabilitation period, and, as a result, improve quality of life indicators.

MP27-14 ELASTIN STAINING OF THE VESTIBULE

You have accessJournal of UrologyCME1 Apr 2023MP27-14 ELASTIN STAINING OF THE VESTIBULE Alyssa Yee, Alain Dury, Johanne Ouellet, Barry Komisaruk, Sue W Goldstein, and Irwin Goldstein Alyssa YeeAlyssa Yee More articles by this author , Alain DuryAlain Dury More articles by this author , Johanne OuelletJohanne Ouellet More articles by this author , Barry KomisarukBarry Komisaruk More articles by this author , Sue W GoldsteinSue W Goldstein More articles by this author , and Irwin GoldsteinIrwin Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003255.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The vestibule is an external genital structure lying 90° to the vaginal canal opening. The vestibule consists of non-keratinized squamous epithelium with numerous rete pegs, underlying lamina propria with nerves, blood vessels, glands, and extracellular matrix (ECM) proteins. During thrusting movements associated with penetrative sexual activity, the vestibule undergoes significant stretching during invagination/evagination. The vestibule also undergoes extreme stretching during childbirth. Elastin is an ECM protein in microfibrils that endows skin structures with ability to stretch, recoil, and have elasticity. Elastin has previously been shown to influence mechanical properties of tendons; degraded or abnormal elastin structures caused by aging or disease may contribute to pain and increased risk of injury. There are limited data on elastin in the vestibule in reproductive age patients and its role in vestibular elasticity/integrity. METHODS: 7 reproductive age patients with entrance dyspareunia from neuroproliferative vestibulodynia, with normal values of testosterone, estradiol, and progesterone, underwent complete vestibulectomy. Tissue blocks were created from the specimen, and 5 υm sections studied with IHC primary antibody. Finally, sections were counterstained with Gill-modified hematoxylin. RESULTS: In all vestibular specimen, there was very high density of elastin underneath the epithelium in rete pegs and throughout the entire lamina propria. There is a density gradient with the highest density immediately deep to the basement membrane of the epithelium. Elastin fibers were arranged in all orientations: coronal (frontal), sagittal (longitudinal), and transverse (axial) planes. CONCLUSIONS: The high density of elastin fibers in rete pegs and through the lamina propria in a multi-planar orientation is suggestive of extreme stretching capability in eugonadal vestibular tissues. The highest density of elastin staining was seen immediately below the basement membrane of the epithelium, which may provide tissue integrity and shear resilience to the epithelial layer. More research is needed on elastic fiber production, organization, and integration with other cutaneous extracellular matrix proteins, and how this may change during androgen insufficiency states such as menopause or with use of combined hormonal contraceptives. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e367 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alyssa Yee More articles by this author Alain Dury More articles by this author Johanne Ouellet More articles by this author Barry Komisaruk More articles by this author Sue W Goldstein More articles by this author Irwin Goldstein More articles by this author Expand All Advertisement PDF downloadLoading ...

Актуальные аспекты экстрагенитальной патологии: в фокусе – недостаточность секреторной функции щитовидной железы и дисфункциональные расстройства билиарного тракта

An important aspect of preconception preparation is the assessment of a woman's health and the identification of extragenital pathology. In the presented review, there are two urgent problems related to the health of women of reproductive age, insufficient attention to which by the first contact doctor (therapist, general practitioner) can further complicate the course of pregnancy – a decrease in hormonal function of the thyroid gland and dysfunctional disorders of the biliary tract. The main pathogenetic links between the insufficiency of the secretory function of the thyroid gland and the functional state of the biliary tract are considered. It is advisable for first contact physicians, including as part of preconception preparation, to examine patients of reproductive age with biliary disorders for the possible presence of thyroid insufficiency, which will contribute to the early detection of extragenital pathology.

Immunological and immunohistochemical features of endometrial implantation factor in healthy patients of late reproductive age

Аbstract. Relevance. The number of women of older reproductive age is steadily increasing, and repeated failures of Assisted Reproductive Technologies programs during the transfer of high-quality embryos indicate the possibility of disruption of embryo implantation processes associated with impaired receptivity and functionality of the endometrium. Morphological, immunological and immunohistochemical changes in the endometrium associated with age factor may be decisive for the formation of the «implantation window» and correction of these changes and may improve the outcomes of Assisted Reproductive Technologies for a cohort of patients of older reproductive age. The aim of the study - to expand the pathogenetic understanding of the violation of the implantation ability of the endometrium in healthy patients of older reproductive age. Materials and Methods. A prospective sample study of 46 patients (group 1), aged 38 to 45 years with an officially registered diagnosis of infertility lasting no more than 4 years, with a successful gynecological and obstetric history, who were about to have their first IVF attempt, was conducted. The patients were examined according to Order № 803n of the Ministry of Health of the Russian Federation. Additionally, the level of peripheral blood melatonin, the determination of progesterone, estrogen, HLA-DR (MHC II), CD56 (NK cells), CD138, leukemia inhibiting factor receptors in the endometrium were studied. Concentrations of IL-6, IL-10, TGFß, and VGEF were determined in the cervical secretion, with the calculation of the pro-inflammatory index, as the ratio of IL-6/IL-10 cu and the ratio of TGFß1/VEGF. Statistical data processing was performed using the Statistica 10.0 application software package (StatSoft, Inc., USA). Results and Discussion. In the group of healthy patients of older reproductive age, there is an imbalance of steroid receptors and secretory transformation of the endometrium against the background of relative hyperestrogenism, with a decrease in the reception of own hormones in the endometrium. A decrease in melatonin signals a disorder of pineal and pituitary control over ovarian cycling. There is a decrease in the expression of leukemia inhibiting factor. Signs of inactive chronic endometritis with an autoimmune component are monitored, confirmed by a pro-inflammatory cytokine balance. The predominance of fibrosis processes over angiogenesis processes is confirmed by an increase in the ratio of TGFß1/VEGF and highly resistant blood flow in the uterine arteries. Conclusion. Standard pre-gravidar preparation cannot compensate for all factors that violate the implantation potential of the endometrium in this cohort of patients and requires the development of new complex techniques that directly affect the diversity of all factors that ensure the natural extinction of reproductive potential in order to increase the effectiveness of Assisted Reproductive Technologies programs.

Uterine fibroids: modern methods of treatment, advantages and complications

The state of the reproductive system by women with uterine fibroids is considered as a part of this literature review. The main clinical manifestations of myomatous nodes were identified by writing the review: abnormal uterine and heavy menstrual bleeding, infertility, miscarriage, chronic pelvic pain, dysfunction of adjacent organs, which are indications for surgical treatment. It is noted that approximately 30 % of women with uterine fibroids suffer from abnormal uterine bleeding, leading to anemia and reduced quality of life. Chronic pelvic pain significantly reduces the quality of life of patients, worsening their functional and mental state and disrupting sexual function. This review focuses on reproductive problems in women with leiomyoma. Taking into consideration the high prevalence of this nosology and the need to preserve the fertility of patients, the review describes modern methods of treating patients with uterine myoma, including drug therapy surgical treatment and alternative methods. Currently, in order to stop the symptoms of uterine fibroids, as well as for preoperative preparation, conservative therapy is used, which allows to reduce pain, restore hemoglobin levels, reduce intraoperative blood loss and reduce surgery time. Reproductive disorders associated with uterine fibroids, such as infertility, recurrent miscarriage, and adverse obstetric outcomes, are a significant reason to improve organ-preserving therapies or develop new ones. Although hysterectomy is a radical treatment for uterine fibroids, it is unacceptable for patients who have not realized their reproductive function. Therefore, the most justified intervention is myomectomy with various surgical approaches, and as an alternative treatment, uterine artery embolization, radiofrequency ablation or high-intensity focused ultrasound treatment of uterine fibroids. These data allow us to conclude that the high prevalence and versatility of symptoms of uterine fibroids among patients of reproductive age determine the relevance of searching for optimal methods of treatment.

Results of surgical correction for cervical elongation with vaginal wall prolapse in patients of reproductive and premenopausal age

BACKGROUND: The problem of cervical elongation is becoming increasingly important due to the rising prevalence of pelvic organ prolapse. In Russia, descent and prolapse of pelvic organs account for 39% of all gynecological pathologies.
 AIM: This study aimed to compare the immediate and long-term results of surgical treatment for cervical elongation in combination with vaginal wall prolapse in patients of three clinical groups.
 MATERIALS AND METHODS: A total of 105 patients aged 30 to 55 years with a combination of cervical elongation and vaginal wall prolapse of degrees III were followed up. The patients were divided into three clinical groups based on the implemented surgical techniques, including group 1 (n=36) with Moscow surgery, group 2 (n=35) with modification of the Manchester surgery using synthetic implants, and group 3 (n=34) with Manchester surgery.
 The patients underwent a comprehensive clinical examination, surgical treatment, and follow-up in the early and long-term postoperative periods (1, 6, 12, 24, and 36 months). The efficacy of surgical treatment was assessed using a questionnaire. During dynamic monitoring, a gynecological examination with a Valsalva maneuver, and transperineal, and transvaginal echography were performed.
 RESULTS: During the first month after the surgery, patients noted irregular dragging pains in the perineum and/or inguinal region every second. A frequent urge to urinate was reported in 16.7%, 17.1%, and 17.6% of patients in groups 1, 2, and 3, respectively. A further survey revealed that the surgical treatment results were satisfactory, as it had a positive effect on the quality of life and mood and contributed to an increase in social and sexual activity. According to the physical examination, there were no signs of prolapse recurrence and mesh-associated complications. Erosion of the anterior vaginal wall over the polypropylene endoprosthesis was detected 6 months after the surgery in 3 (8.6%) patients of group 2.
 Genital prolapse recurrence was diagnosed after 1236 months in 7 (20.6%) patients of group 3. After 36 months, degree I prolapse of the posterior (n=1) and anterior (n=1) walls of the vagina was revealed in patients of groups 1 and 2, respectively.

Determination of the proliferative activity of the endometrium during the period of the implantation window in veteran women of reproductive age with a history of contusion

Today, more than 50.000 women serve in the Armed Forces of Ukraine. The number of people with post-traumatic stress disorder is 27.7 % among military personnel who took part in active combat operations. Post-traumatic syndrome is a frequent predictor of various states of proliferative activity of the endometrium in veteran women of reproductive age with changes in the hormonal background, morphofunctional changes of the endometrium, which in turn negatively affects the reproductive health of women. The purpose of the work: to determine the proliferative activity of the endometrium in patients of reproductive age who took part in hostilities and suffered a concussion. The selection criteria of the women included in the study were: the presence of contusion in the anamnesis, normospermia in the husband, the absence of pregnancy within a year after putting the main disease into remission, and unfulfilled reproductive plans. The age of the examined women ranged from 20 to 40 years. 457 women who took part in combat operations and suffered concussions were examined. The criterion for inclusion in the main group (O) was post-concussive syndrome as a consequence of a concussion sustained during hostilities. The number of examinees was 211 women. The criterion for inclusion in the comparison group (P) (n=246 women) was a concussion during combat operations, but the absence of post-concussion syndrome. The control group (K) included 30 civilian women without episodes of any trauma in the anamnesis. Clinical, instrumental and morphological research methods were used during the research. The most significant differences in the number of immunopositive endometrial cells in the state of proliferation and apoptosis were noted between groups P and O in chronic endometritis and simple atypical hyperplasia of the endometrium. Thus, in the structure of the endometrium of women with reproductive plans who participated in hostilities with episode of contusion in anamnesis, an increase in the proliferation processes in the glands and stroma of the endometrium against the background of intensification of the processes of apoptosis in the stroma and a decrease in the processes of apoptosis in the glands, which may interfere with the normal course of adhesion, was characteristic blastocysts and trophoblast invasions during implantation.

EFFECT OF SURGICAL TREATMENT ON SERUM AMH LEVELS IN OVARIAN DISEASES

Introduction The relationship between various ovarian diseases and its treatment on ovarian reserve is a subject of debate. It is difcult to determine the real impact of the ovarian surgery on future fertility of women. This study aimed to assess the effect of conservative ovarian surgeries on ovarian reserve in reproductive age women by correlation of preoperative and post operative S.AMH. Materials And Methods: This prospective study included 66 patients of reproductive age with various ovarian diseases. Ethical clearance was obtained from Institutional ethics committee and informed consent from all recruited patients. They were grouped into inammatory or benign disease, malignant disease and ovarian endometrioma by histology. S. AMH was compared in the three groups pre-operatively, after 4 weeks and after 3-6 months of surgery. The statistical analysis was done with SPSS version 15. Result: Mean decline in S> AMH at 4 weeks was 0.16, 0.40 and 0.33 respectively for inammatory/benign, malignant and endometrioma groups. Similarly, after 3-6months, it was 0.17, 0.75 and 0.37 respectively for the three groups. Statistically, both malignant and endometrioma groups showed signicantly higher decline as compared to inammatory/benign group (p<0.001). Conclusion: Baseline S.AMH levels are signicantly lower in endometrioma and malignant ovarian tumours as compared to benign ovarian tumours. They show a signicant decline following surgical treatment in all ovarian diseases but the decline is signicantly more endometrioma and malignancy.

HORMONAL CHANGES ASSOCIATED WITH PELVIC ORGAN PROLAPSE

Goal. To determine the characteristics of the level of sex hormones in the blood plasma in women with genital prolapse urinary incontinence. Material and methods. The study was conducted on the basis of the Surgical Training Building of the Azerbaijan Medical University from December 2017 to May 2021. Questionnaires for socio-demographic/clinical data PFDI-20 and PFIQ-7 to detect genital prolapse and urinary incontinence were applied to 144 patients of reproductive age. All patients were divided into three groups: I a - main group, prospective analysis of 50 women aged 25 to 50 years with prolapse of the anterior vaginal wall and urinary incontinence; I b is the main group, which will include women with relapses after surgical interventions for this pathology in the amount of 59 (retrospective material); II - comparative group: practically healthy women without genital prolapse and urinary incontinence, who had a history of 3 or more births (35 women). A hormonal background study was conducted in 50 women with signs of PG (the main group) aged 25 to 50 years (average age -39.7 ± 7.3 years). The levels of testosterone, estradiol, progesterone, Anti-Muller hormone and cortisol in the blood serum were determined. Determination of the level of hormones in blood plasma was carried out on the immunoanalyzer Miсroplate reader RD-2100C (PRC). Results. It was found that the level of estradiol in the examined women varied between 31.1 – 84.6 nmol/L. In 13 patients of the main Ia group, the level of estradiol varied from 31.3 to 44.8 nmol/L. In 14 patients, estradiol was in the range of 47.3 – 53.8 nmol/L, in 16 patients the estradiol level varied between 57.6 – 64.6 nmol/L, in 4 patients the estradiol index was in the range of 65.8 – 71.0 nmol/L and in 3 patients in the range of 76.3 – 84.6 nmol/L. Conclusions. The average levels of estradiol, progesterone and testosterone in patients of reproductive age with genital prolapse and urinary incontinence did not differ significantly. The Anti-Muller hormone index differs in patients with genital prolapse and urinary incontinence from compared with the control (U =613.0, p≤0.001). The quantitative value of Anti-Muller hormone is significantly reduced and is within the range that is typical for women during menopause. The cortisol index is statistically significantly different in patients with genital prolapse and urinary incontinence from healthy women.(U =690,0, p≤0,001)

Waterpipe Tobacco (Hookah) Use in Pregnancy: Associations with Nausea and Vomiting of Pregnancy.

Waterpipe tobacco (WPT) use is common among reproductive age patients and is often perceived as safer than cigarette use. Prior studies have shown a decrease in nausea and vomiting symptoms among pregnant women who use cigarettes, but no studies to date have examined these symptoms in pregnant women who use WPT. This study was aimed to investigate the extent of symptoms of nausea/vomiting of pregnancy among participants who self-reported WPT use during pregnancy. Secondary analysis of a prospective cohort study examining WPT use during pregnancy. Participants completed the Pregnancy-Unique Quantification of Emesis (PUQE) during first and third trimesters. Medical conditions were determined by medical record review. Participants were evaluated by sole WPT use versus dual/polysubstance WPT use and frequency of WPT use. Ninety-nine (100%) participants completed the PUQE questionnaire during first trimester and 82 (82.8%) completed the PUQE during third trimester. Almost all (91.9%) participants reported moderate nausea/vomiting symptoms at both assessments. There was no difference in frequency of WPT use in pregnancy or rates of dual/polysubstance WPT use in participants with all levels of the PUQE questionnaire. There was also no difference in rates of WPT use or PUQE scores between sole WPT users and dual/polysubstance users. When comparing low and high WPT use, those who were in the higher frequency use group had higher waterpipe dependence scale scores (7.2 vs. 5.3, p < 0.02). With regard to maternal medical comorbidities, the only difference between groups was that sole WPT users were more likely to have a diagnosis of asthma than dual/polysubstance users (36.8 vs. 14.9%, p < 0.02). There were no differences in symptoms of nausea and vomiting of pregnancy or medical conditions in pregnant women who use WPT with any frequency during pregnancy. However, sole WPT users had higher rates of asthma than dual/polysubstance WPT users. · Waterpipe tobacco use is one of the most common forms of tobacco use among reproductive age patients.. · Waterpipe tobacco use was not associated with any changes in nausea/vomiting of pregnancy symptoms.. · Future research on the use of waterpipe tobacco in pregnancy can aid in public health responses..

Quality of life as a criterion for assessing the effectiveness of rehabilitation programs in patients with painful external genital endometriosis

Introduction. Chronic pelvic pain negatively affects the quality of life (QoL) of patients with a painful form of external genital endometriosis (EGE) and adversely impacts on the physical, psychoemotional and sexual health of reproductive-age women resulting in distress, maladaptation, anxiety-depressive disorders, disrupted social functioning in family relationships. Aim: to assess the QoL of women with painful EGE after radical treatment in the rehabilitation period by using subjective research methods. Materials and Methods. We examined 104 female patients of reproductive age (42.4 ± 3.7 years) with painful EGE after radical treatment: group IA – 49 women underwent "active" rehabilitation, group IB – 55 patients underwent "passive" rehabilitation tactics in accordance with standards and National Clinical Guidelines. The assessment of QoL (subjective) was performed using specialized questionnaires: visual analog scale (VAS), PainDETECT questionnaire, Endometriosis Health Profile-30 (EHP-30) questionnaire, Hospital Anxiety and Depression Scale (HADS), Female Sexual Function Index (FSFI). Assessment of QoL parameters was carried out at 6 control time points: before, as well as 5–9 days, 1, 3, 6 and 12 months after surgical treatment. Results. Patients underwent "active" rehabilitation tactics (group IA) showed prominently reduced pain syndrome, neuropathic component of pain, anxiety-depressive disorders, normalized sexual function and improved all QoL parameters, unlike patients managed with "passive" tactics, who underwent a complex of rehabilitation measures within the framework of National Clinical Guidelines (group IB). More severe EGE course and significantly decreased QoL in patients with painful EGE at "passive" rehabilitation tactics were noted. Conclusion. Applying a complex personalized rehabilitation program along with multidisciplinary approach in patients with painful EGE after radical treatment can markedly improve overall well-being, timely correct psychoemotional and sexual dysfunction, and therefore prominently increase the patients' QoL.

Abstract P5-07-02: Embryo utilization in young breast cancer patients who have undergone egg harvesting for fertility preservation

Abstract INTRODUCTION: Much progress has been made related to fertility preservation in women diagnosed with breast cancer. This includes heightened awareness of impaired fertility due to breast cancer treatment, increased referrals to fertility specialists and development of safe and expeditious means of egg harvesting. Nevertheless, there has been limited investigation of the ultimate issue in fertility preservation, namely the frequency with which women who have undergone egg harvesting actually pursue childbearing. We have retrospectively reviewed a single institution’s experience with egg and embryo utilization among patients who expressly desired childbearing and underwent egg harvesting after a diagnosis of breast cancer. These issues have also been analyzed relative to race and insurance coverage. METHODS: In an IRB approved study, breast cancer patients treated in our institution between 2010 and 2020 were identified and their post-diagnosis fertility and childbearing history was reviewed. Inclusion criteria were age at presentation ≤ 45 years and diagnosis of either invasive breast cancer or ductal carcinoma in situ. Race (self-reported on clinic intake form) and insurance coverage data were analyzed. In cases of incomplete medical record data, we interviewed patients by telephone. RESULTS: 316 breast cancer patients of reproductive age were identified (average age at diagnosis = 39 years, range: 23 - 45). Of these, 168 patients (53%) were offered fertility referral and 118 (38%) saw a fertility specialist. 91 patients (29%) pursued egg harvesting followed by cryopreservation of eggs in 49 cases and embryos in 41 with 1 case unknown. Over an average of 5 years of follow-up (range: 2 - 12 years), 28 women (31% of those who pursued egg harvesting) utilized the egg or embryo to pursue childbearing. 17 underwent embryo transfer to themselves and 11 used surrogate carriers. To date, this has resulted in 20 childbirths from 24 pregnancies. Four pregnancies are currently ongoing and 1 woman is awaiting embryo transfer. Four patients who had undergone egg harvesting conceived without fertility intervention. Of the 55 Medicaid patients of reproductive age diagnosed with breast cancer, only 8 (15%) met with a fertility specialist, 4 harvested eggs, and none pursued childbearing. HMO/PPO insured patients were significantly more likely than Medicaid patients to pursue egg harvesting and embryo utilization (X2 = 7.320, df = 2, p = 0.026). Of 260 HMO/PPO insured patients, 110 (42%) met with a fertility expert, 87 harvested eggs and 28 pursued embryo transfer. Due to the small sample size of patients who utilized embryos in each racial subgroup, analysis did not yield statistically significant differences across groups (p=0.067). Nevertheless, apparent racial disparities exist. Our data reveal that 5 of 17 (29%) Asian patients and 22 of 62 (36%) White patients utilized embryos as opposed to Black patients (1/4 or 25%), Hispanic patients (0/4 or 0%) and those who identified their race as “other” (1/4 or 25%). CONCLUSIONS: These data demonstrate a low overall rate of cryopreserved egg and embryo utilization among women treated for breast cancer whose earlier pursuit of egg harvesting was evidence of a desire for childbearing. Furthermore, racial and insurance data demonstrate disparities in the pursuit of fertility treatment and utilization of preserved eggs and embryos. Further research will utilize interviews to analyze individual women’s decision-making process relevant to such issues as hormone therapy utilization, concerns about breast cancer recurrence, progression of disease and restraints imposed by relationship status and finances. Given the disparity findings reported here, finances will likely emerge as a significant barrier to childbearing in future qualitative research. Citation Format: Christina Weltz, Daniella Nevid, Alison Pruzan, Elisa Port, Ronald Couri. Embryo utilization in young breast cancer patients who have undergone egg harvesting for fertility preservation [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-02.

Mind the mechanical strength: tailoring a 3D matrix to encapsulate isolated human preantral follicles.

Would a hydrogel with similar mechanical properties to the human ovarian cortex support preantral follicle development? Yes, our tailored PEGylated fibrin hydrogel was shown to significantly improve follicle growth in vitro. One of the main challenges in developing an engineered ovary is to provide a 3D matrix that supports the follicle architecture and the interaction between granulosa cells and the oocyte as they are essential for folliculogenesis. Thanks to its biocompatibility and bioactivity, fibrin has been employed to fabricate a 3D matrix to encapsulate ovarian follicles. However, follicles lose their physical support within a few days owing to rapid fibrin degradation. Therefore, different strategies, including physical and chemical modifications, have been developed to enhance the stability of fibrin. By developing a matrix made of a synthetic (polyethylene glycol: PEG) and natural polymer (fibrin), we aimed to overcome fibrin degradation by the chemical reaction of PEGylation and tailor a PEGylated fibrin hydrogel formulation with mechanical strength similar to the ovarian cortex in women of reproductive age. To this end, response surface methodology was employed to obtain a tailored formulation of PEGylated fibrin. This hydrogel was then tested to encapsulate and support isolated human preantral follicles in vitro. A PEGylated fibrin formulation was tailored using mathematical modeling software to mimic the mechanical properties of human ovarian tissue at reproductive age. Human preantral follicles were isolated from 11 patients of reproductive age and encapsulated in the tailored hydrogels, which were cultured in vitro for 4 or 7 days. Follicle survival and diameter were assessed on Days 1 and 7. Furthermore, the follicles were subjected to confocal microscopy to evaluate their growth (Ki67 staining) on Day 7 and analyze cell-cell communication (connexin 43 and transzonal projection staining) on Day 4. In this study, mathematical modeling was applied to achieve the biomechanically tailored PEGylated fibrin formulation by targeting the specific goal of 3178 ± 245 Pascal, Young's modulus of ovarian cortical tissue in reproductive-age women. Our results demonstrated that the PEGylated fibrin hydrogel consisting of 39.06 mg/ml of PEGylated fibrinogen and 50.36 IU/ml of thrombin was the optimum condition with the desirability of 97.5%. This tailored hydrogel yielded a high follicle survival rate (83%) after 7 days of in vitro culture and supported its development up to the secondary stage. Follicle growth was confirmed by the presence of Ki67-positive granulosa cells on Day 7. Additionally, connexin 43 and Phalloidin staining indicated the retention of connections between granulosa cells and the oocyte. N/A. In this study, our tailored hydrogel was only tested in vitro, which is not the same as the physiological environment. It is crucial to conduct a study assessing the follicles following their encapsulation in the tailored hydrogel and transplantation, which will be the next step of our investigation. The findings from this study introduced a suitable biomaterial similar to the ovarian cortex in reproductive-age women in terms of biomechanical properties for encapsulating human preantral follicles. This biomaterial allowed the radial growth of follicles and preserved their viability. Furthermore, PEGylation improved the stability of fibrin and the physical support of follicles. This study was supported by grants from the Fondation Louvain (PhD scholarship awarded to S.M., as part of a legacy from Mr Frans Heyes, and PhD scholarship awarded to A.D. as part of a legacy from Mrs Ilse Schirmer). The authors declare no competing interests.

COVID-19 vaccination recommendations and practices for women of reproductive age, U.S. Physicians, Fall 2021

Pregnant people with COVID-19 are at increased risk for severe illness and adverse pregnancy outcomes. COVID-19 vaccinations are safe and effective, including for pregnant and recently pregnant people. The objective of this analysis was to describe the extent to which primary care physicians across the United States report confidence in talking with female patients of reproductive age about COVID-19 vaccination, recommending COVID-19 vaccinations to pregnant patients, and offering COVID-19 vaccinations at their practices in fall 2021.We analyzed cross-sectional data from the Fall 2021 DocStyles survey, a web-based panel survey of U.S. primary healthcare providers (64% response rate). Family practitioners/internists, obstetrician-gynecologists, and pediatricians were asked about confidence in talking with female patients of reproductive age about COVID-19 vaccination, vaccination practices regarding pregnant patients, and offering COVID-19 vaccinations. We describe results overall and by select physician characteristics. Among 1501 respondents, most were family practitioners/internists (67%), 17% were obstetrician-gynecologists, and 17% were pediatricians. Overall, 63% were very confident talking with female patients of reproductive age about COVID-19 vaccination, 80% recommended pregnant patients get vaccinated as soon as possible, and 50% offered COVID-19 vaccinations at their current practice. Obstetrician-gynecologists were most confident in talking with female patients, but only one-third offered the vaccine at their practices. This analysis found that most physicians felt confident talking about COVID-19 vaccinations and recommended pregnant patients get vaccinated as soon as possible. Provider recommendation for vaccination remains a key strategy for achieving high vaccination coverage, and consistent recommendations may improve vaccine acceptance among pregnant and postpartum people.

RISK FACTORS OF UMBILICAL CORD PATHOLOGY AND FACTORS OF NEGATIVE PERINATAL CONSEQUENCES AND NEWBORN INCIDENCE

According to literature sources, the real frequency of many umbilical cord pathologies differs significantly from the statistical data indicated by researchers in their works (from 15% to 38%). The implementation of a system of diagnostic and treatment and preventive measures, based on mandatory antenatal and postnatal assessment of the features and characteristics of the umbilical cord, allows to improve perinatal outcomes and reduce perinatal morbidity. The aim of the work was to identify the main risk factors of umbilical cord pathology and negative perinatal consequences; to develop elements of standardization of antenatal and postnatal diagnosis of umbilical cord pathology. Research materials and methods. A retrospective assessment of medical documentation data (3,280 individual medical records of pregnant women) made it possible to establish the frequency of umbilical cord pathology in the population. In the future, a more detailed extended antenatal and postnatal examination of the umbilical cord and placenta after delivery was carried out in 637 patients of reproductive age with pregnancy complicated by pathology of the umbilical cord (main group). The control group was formed by 40 patients with an uncomplicated course of pregnancy and live birth of full-term healthy children. The study was conducted taking into account the main principles of the Helsinki Declaration on Biometric Research and the powers of the GCH ICH, in accordance with biometric norms with compliance with the principles of confidentiality and ethics (excerpt from protocol No. 128/22 of the meeting of the Bioethics Commission dated September 29, 2022, Ivano-Frankivsk National Medical University, Ministry of Health of Ukraine).Data analysis was performed using the Statistica 7.0 package of statistical programs (StatSoftInc., USA). The association of independent variables with the condition being studied is presented as odds ratio (OR) and 95% confidence interval (CI).The materials of the article are the result of the research of the complex research work fragment of the Department of Obstetrics and Gynecology named after I.D. Lanovyi of the Ivano-Frankivsk National Medical University: “Development of diagnostic tactics and pathogenetic substantiation of effective methods of preserving and restoring reproductive potential and improving parameters of a woman’s quality of life in obstetric and gynecological pathology” (state registration number 0121U109269, implementation dates 2021-2026 ), the author is a co-executor of the topic.Research results and their discussion. The following data were noted: an excess of the population norm of the length of the umbilical cord, a high proportion of eccentric and marginal insertion of the umbilical cord (22.14%) and umbilical cord coiling (33.28%), a decrease in the proportion of the reference limits of the umbilical cord tortuosity index (15.86%), in 56.7% of observations, the specific gravity of the umbilical cord was lower. Probable risk factors for umbilical cord pathology with a predominance of age over 35 years, nicotine addiction in pregnant women, multiple fertility, use of IVF programs, change in the amniotic fluid index, overweight and obesity, other clinical conditions associated with metabolic disorders (gestational diabetes, insulin resistance) were identified. Conclusion. The share of the umbilical cord pathology both in the isolated type and in the combination of characteristic features of the umbilical cord is 40.98%. The increase in the risk of negative perinatal consequences has a close relationship with the umbilical cord pathology and the combination of different types of pathology, as well as the addition of gestational complications, which allows for the formation of screening programs and optimization of the diagnostic algorithm.

Family planning and multiple sclerosis: A qualitative study of patient experiences to understand information needs and promote informed decision-making

ObjectivesAmbiguity exists about the impact of multiple sclerosis (MS) on fertility and pregnancy. We explored female and male patients’ experiences with MS regarding family planning to understand information needs and opportunities to improve informed decision-making. MethodsSemi-structured interviews were conducted with Australian female (n = 19) and male (n = 3) patients of reproductive age diagnosed with MS. Transcripts were analysed thematically, adopting a phenomenological approach. ResultsFour main themes emerged: ‘reproductive planning’, revealing inconsistent experiences about pregnancy intention discussions with health care professionals (HCPs), and involvement in decisions about MS management and pregnancy; ‘reproductive concerns’, about the impact of the disease and its management; ‘information awareness and accessibility’, with participants generally reporting they had limited access to desired information and received conflicting information about family planning; and ‘trust and emotional support’, with continuity of care and engagement with peer-support groups about family planning needs valued. ConclusionPatients with MS want consistent engagement with HCPs regarding discussion of pregnancy intent and desire improvements in quality and accessibility of available resources and support services to address reproductive concerns. Practice implicationsFamily planning conversations should be a part of routine care planning for MS patients and contemporary resources are required to support these discussions.

Bilateral Tubal Pregnancies Presenting 11 Days Apart: A Case Report.

Ectopic pregnancy is the most common cause of maternal mortality in the first trimester. Bilateral tubal pregnancy is the rarest subset with an estimated incidence of one in 725 to 1,580 ectopic pregnancies. Of the cases of bilateral tubal pregnancy reported in the literature, most were associated with the use of assisted reproductive techniques. Here we present the case of a patient, without a prior history of reproductive technology use, who underwent treatment for a tubal pregnancy and was subsequently found to have a second, contralateral tubal pregnancy 11 days later. A 35-year-old female gravida eight para two with a history of left tubal pregnancy and salpingectomy 11 days prior, presented to the emergency department (ED) with two days of left lower and upper quadrant abdominal pain. The patient's last menstrual period had been several months prior. A physical examination revealed left lower quadrant abdominal tenderness, rebound, guarding, and left adnexal tenderness. Her vital signs were unremarkable, and her laboratory studies revealed normal white blood cell and hemoglobin values. Her human chorionic gonadotropin had tripled from her last presentation 11 days prior. Transvaginal ultrasound showed a possible ectopic pregnancy adjacent to the right ovary. She promptly underwent a right salpingectomy. Pathology findings confirmed a tubal pregnancy, and the patient's postoperative course was uneventful. This case highlights the importance of maintaining a high index of suspicion for ectopic pregnancy in all biologically female patients of reproductive age who present to the ED with abdominal pain.

Iron deficiency anemia in reproductive-aged women: options for treatment and prevention

Objective. To assess the frequency of iron deficiency states among reproductive-aged women and to consider the features of their prevention. Subjects and methods. The investigation enrolled 2401 reproductive-aged patients who came first to the Clinic of the Kuban State Medical University in 2019. The patients’ mean age was 36.71±6.32 years; the follow-up period was 36 months. Results. Iron deficiency and iron deficiency anemia (IDA) were detected in 518 (21.6%) and 591 (15.9%) patients, respectively. At the same time, IDA was mild, moderate, and severe in 383 (15.9%); 202 (8.2%), and 6 (0.5%) patients, respectively. New-onset anemia was recorded in 70.3% of patients. A re-examination was carried out after 36 months, which involved 1917 patients (79.8% of the baseline patients). A total of 156 (8.1%) patients were diagnosed with mild and moderate (in 149 (7.7%) and 7 (0.3%) patients, respectively; latent iron deficiency was identified in 518 (21.6%) patients. At the same time, IDA was undetected in the patients who had followed the recommendations for prophylactic iron supplementation after reaching the target levels of serum hemoglobin and ferritin. Conclusion. An integrated approach that includes the informing of a patient about iron deficiency consequences, etiotropic and pathogenetic treatment, preventive drug use recommendations, and dynamic monitoring, assist in overcoming iron deficiency in reproductive-aged women.

Prognosis of abnormal uterine bleeding in women of reproductive age with extragenital disorders

The purpose of the study was to elaborate on a prognostic model for predicting the development of abnormal uterine bleeding in women of reproductive age with accompanying extragenital disorders based on mathematical methods.&#x0D; Materials and methods. The study, which was in 2019-2022, involved 100 women of reproductive age with AUB and accompanying extragenital disorders under observation, who made up the main group. The control group comprised 50 women of reproductive age undergoing medical checkups. On the basis of 23 diagnostic indicators, the most informative ones were mathematically selected for the prognosis of AUB in women with extragenital abnormalities.&#x0D; Results and their discussion. The prognosis of the risk of developing AUB in women of reproductive age with extragenital disorders was carried out on a double scale (0 – low probability, 1 – high probability). The search for diagnostically informative factors involved a set of 23 working indicators that were investigated in the examined patients using four levels of the risk scale. In order to solve this issue, the factors that have the greatest importance in the formation of the prognosis were selected using discriminant analysis methods, and a corresponding mathematical model was created. The classification functions made it possible to enter the practical plane and form rules for assessing the presence/absence of the risk of developing AUB in patients of reproductive age with extragenital disorders. The corresponding expressions are the following equations:&#x0D; NP = BAS ART*75.57+FSH*2.96+prolac*0.02+estrad*0.02-40.78&#x0D; PP = BAS ART*105.35+FSH*0.79+prolac*0.1+estrad*0.08-114.49,&#x0D; where NP is a negative prognosis, PP is a positive prognosis.&#x0D; If NP &gt; PP, then the most likely prognosis is the absence of AUB in the patient; otherwise, if PP &gt; NP – there is an increased risk of AUB.&#x0D; Conclusion. Pulsation index in the basal arteries of the uterus, FSH, prolactin and estrogens are prognostically significant indicators for predicting the risk of abnormal uterine bleeding in patients of reproductive age with extragenital disorders. The above formula, obtained from the conducted discriminant analysis, makes it possible to predict bleeding in a specific patient

Sex difference in neurological outcome and post-cardiac arrest care in out-of-hospital cardiac arrest patients treated with targeted temperature management

Abstract Funding Acknowledgements Type of funding sources: None. Objectives Conflicting results regarding sex-based differences in the outcomes of out-of-hospital cardiac arrest (OHCA) patients have been reported. Furthermore, no study has examined whether differences in in-hospital interventions and courses are driven by sex differences. This study evaluated the effect of sex on the in-hospital course of these patients as well as the survival rates and long-term neurological outcomes of comatose OHCA patients treated with targeted temperature management (TTM). Methods We retrospectively analyzed the Korean Hypothermia Network prospective registry composed of data collected from 22 hospitals in Korea between October 2015 and December 2018. To evaluate the effect of sex on patient outcomes, we created various multivariate logistic regression models including baseline characteristics, resuscitation, and in-hospital care variables with an interaction term (age × sex). We also performed a stratified analysis of different age groups (less than 50 years of age and older). Regarding the difference in in-hospital courses, we compared daily total and SOFA sub-scores between the sexes and analyzed whether the decision regarding early cardiac interventions and limitations in in-hospital care were associated with sex. Results Among 1339 patients included in the study, 952 were men and 387 were women. There were no differences in age or modified comorbidity index values between the gender groups. Women were more likely to experience cardiac arrest at home and unwitnessed arrests, whereas men were more likely to have shockable initial rhythm, cardiac cause arrest, and ST-segment elevation myocardial infarction (STEMI) on initial electrocardiography and undergo early coronary interventions. The rate of survival to discharge was similar, but men showed better 6-month neurological outcomes. After adjusting for confounders, the male sex was not associated with survival to discharge or good 6-month neurological outcomes. There was no association between sex and outcome in patients of reproductive age and no interaction between age and sex. Regarding the in-hospital course, the daily total and SOFA sub-scores were similar in both sexes. The adjusted effect of sex was not associated with the clinician’s decision to perform early cardiac interventions. The decision to discontinue life-sustaining treatment was determined by poor prognostic factors, not by sex. Conclusions The findings suggested that men had more favorable 6-month survivals and good neurological outcomes compared to women since they had more favorable resuscitation variables. However, after adjusting for confounders, there was no difference between the sexes. This result was consistent with the data in patients of reproductive age. The results regarding in-hospital course showed that daily patient severity scores, early cardiac interventions, resource consumption, and the rates of withdrawal/withholding of in-hospital care were similar in men and women.