Emergency Contraception. Literature Review. Experience in a Greek Center. Greece Used Methods

The sexual liberation of women can now be taken for granted, and access to information is particularly easy, but even today there is still many lack of information about contraceptive methods. No method of contraception has a 100% guaranteed result as success depends on many factors such as faithful adherence to the instructions of family planning centers, age of the woman, the frequency of the sexual act, and of course the type of contraception. Emergency contraception refers to any method of contraception used after intercourse and before implantation. It differs from the medical termination of pregnancy, which has 75–89% effectiveness and copper IUDs. Contraception is used to stop the sperm from fertilizing the egg or to stop the fertilized egg from implantation in the uterus. All contraceptive methods require educational awareness and emergency contraception should not be used as normal contraceptive treatment. It does not fall into the sphere of moral dilemmas if it is taught correctly at the levels of primary and secondary education and in the family sphere. Undoubtedly, the organization of family planning centers for women of reproductive age as well as for teenagers is deemed necessary and should become a priority of every government

Cervical Length and Perinatal Outcome

Prematurity nowadays has taken on significant dimensions. It is a complex medical issue with socio-economic consequences. The estimation of cervical length, assessed during the second trimester of pregnancy, using transvaginal ultrasound, may help to reduce rates of prematurity. By predicting the risk of preterm birth and identifying women who are at high risk of preterm birth, certain practices could be implemented, such as the use of progesterone or cerclage placement. Nonetheless, it remains unsolved the question of certain strategies, such as the use of progesterone in pregnant women with shortened cervical lengths. This work examines the relationship of cervical length during pregnancy to the perinatal outcome

Vaginal Seeding in Term Cesarean Section Is a Mandatory Condition for Improvement of Neonatal Health

The human vaginal microbiota is an important component of the defense system to fight microbial and viral infections. During pregnancy, a significant decrease in overall diversity is observed in the vaginal flora, and there is an increase in stability as the composition of the vaginal flora changes gradually. These alterations are linked to a decrease in vaginal pH and an augmentation in vaginal secretions. The composition of the vaginal microbiome changes according to gestational age, with its composition in advanced weeks of pregnancy resembling that of nonpregnant women. There is supporting evidence for the existence of differences in the neonate’s microbiome between those born via C-section and those delivered vaginally. The evidence suggests that this difference is a result of the changes that occur in the mother’s microbiome, particularly in the vagina. The vaginal microbiome serves as a crucial barrier between the external environment and the intra-amniotic cavity. The vaginal microbiome appears to play a significant role as an additional defense mechanism of the mother and, consequently, the fetus. Any abnormalities in this microbiome can potentially impact the pregnancy and perinatal outcome

Antiphospholipid Syndrome and Pregnancy-Diagnosis, Complications and Management: An Overview

Antiphospholipid syndrome which is also known as APS is an autoimmune disease which represents an acquired form of thrombophilia. The etiology of APS remains unknown. This disorder occurs when the immune system mistakenly attacks some of the normal human proteins and manifests itself as recurrent arterial or venous thrombosis and it could emerge after abortions or in recurrent pregnancy loss. In APS, the body produces the wrong antibodies against phospholipid-binding proteins, that is present in the blood and plays an important role in coagulation. Antibodies are specific proteins that usually target and neutralize the body’s invaders, such as viruses and bacteria. When antibodies attack phospholipid-binding proteins, blood clots abnormally. Specifically, it could cause blood clots in veins or arteries leading to stroke and various pregnancy complications such as: endometrial death, miscarriage, preeclampsia, intrauterine growth restriction and prematurity. APS is divided into primary and secondary, which is associated with autoimmune diseases and more often with systemic lupus erythematosus (SLE), while antibodies against cardiolipin are detected in many other conditions (infections, malignancies, drugs, etc.). The symptoms of APS, in addition to arterial and/or venous thrombosis and pregnancy complications, are multisystemic and the differential diagnosis of the primary APS from the secondary, in the context of SLE, is of particular clinical interest and is subject of this literature review

The Contribution of Uterine Artery Embolization as a Safe Treatment Option for Uterine Fibroids

Uterine fibroids have remarkably heterogeneous clinical characteristics with unknown exact etiology. The treatment of fibroids should be individualized based on their size, location, growth rate, the symptoms that they cause, the desire to have children and the age of the woman. Embolization is currently the most advanced non-surgical technique. The majority of women report satisfactory post-treatment results like shorter hospitalization period and recovery time in comparison to hysterectomy and improvement or complete remission of clinical symptoms. Complications include amenorrhea (in the majority of cases: recurrence after three months) and infections that are generally treated with antibiotics. The results from most clinical studies and our published experience indicate that embolization improves pelvic symptoms related to uterine fibroids. Collaborative efforts between gynecologists and interventional radiologists are necessary in order to optimize the safety and efficacy of this procedure. In the future, embolization could be generally recommended as treatment option for women who desire future fertility/pregnancy

Twin Pregnancies Labour Modus and Timing

Twin pregnancies are categorized according to three factors, zygosity, chorionicity and amnionicity. Dizygotic twins are always dichorionic and diamniotic, where each twin has its own chorionic and amniotic sac. Monozygotic twins account for 1/3 of twin pregnancies and show higher morbidity and mortality. In monozygotic twins, chorionicity and amnionicity are determined by the time of zygote division. Chorionicity and amnionicity determine the risks of twin pregnancy. Morbitidies are shown notable decreasing tendency depending on improving of high risk obstetric and neonatal care, however is still discussed the optimum labour management in twin pregnancies Vaginal delivery in twin pregnancies is possible when both have cephalic presentation and in the late weeks of pregnancy during which the risks of prematurity are minimized. The aim of this review was the assessment and evaluation the impact of the labour modus and timing of termination of twin pregnancies due to rise of their occurrence based on scientific aspects of the new published literature on perinatal outcome

Uterine Embolization as a New Treatment Option in Adenomyosis Uteri

Adenomyosis is characterized by the development of endometrial ectopic glands and tissue in the myometrium layer in depth greater than 2.5 mm from the endometrial surface of the separative area by -myomas well as by hypertrophy and hyperplasia of the smooth muscles of the myometrium. This is filtration, not mere displacement, of the myometrium, from the endometrium. Clinical symptoms include dysmenorrhea and menorrhagia. It is diffuse (adenomyosis) or focal (adenomyoma), asymmetrically affects the uterine wall of premenopausal women (usually the posterior) and often coexists with myomas. The pathogenesis of adenomyosis remains unknown. The treatment options are: drug therapy, invasive treatment of fibroids: myomectomy (open—intra-abdominal, laparoscopic, hysteroscopic), hysterectomy, myolysis—cryocatalysis, microwave or radiofrequency thermal catalysis (RF-ablation), ultrasound focus catalysis (FUS), laser photocatalysis and percutaneous selective uterine artery embolization (UAE). Embolization remains an alternative and not a substitute of hysterectomy. The medical indication is made on a case-by-case basis, depending on age, desire for pregnancy and the clinical symptoms of adenomyosis

BRCA 1, 2 mutation and earlier menopause. Could BRCA 1, 2 be used as predictor of menopause?

Many studies have shown that BRCA mutation is not only related to cancer but also to ovarian aging. Studies in both human and mice oocytes have shown that Double-strand breaks (DSBs) accumulate with age. Genome-wide association studies (GWAS) have found 44 genetic loci that are related to variations when a female is about to have menopause. BRCA1 is involved in these 44 loci that are associated with the age of menopause. This review has gathered all results of literature search about the association between BRCA genes and early menopause. The majority of the articles found that women with BRCA mutation have earlier menopause compared to non-carriers. In conclusion, in the near future BRCA1,2 genes could be used as predictive biomarkers of menopause

Investigation of correlation between leptin, adiponectin and kisspeptin levels with the ovarian reserves of women of reproductive age

Aim: To investigate the possible correlation of leptin, adiponectin and kisspeptin levels with the ovarian reserves of women of reproductive age.Patients and Methods: 80 women aged 19-40 agreed to participate. Of these, 74 were finally included as in 6 women the blood sample was considered inappropriate due to hemolysis. Women were categorized into three main groups according to their ovarian reserve patterns: women with adequate ovarian reserves (Group A - AOR) (n=30), women with increased ovarian reserves (Group B - PCOS) (n=31) and women with diminished ovarian reserves (Group C - DOR) (n=13).Results: Women with diminished ovarian reserves had statistically significantly increased age and FSH compared to the other two groups. No statistically significant difference was found between the groups for E2, TSH. Moreover, BMI, LH, TT, 17-OHP, DHEA, AMH and AFC were increased in women with PCOS compared to the other two groups. Also, AMH and AFC were decreased in women with diminished ovarian reserves compared to the other two groups as expected. Leptin levels were elevated in women with PCOS but there was no statistically significant difference compared to the other two groups. Regarding adiponectin, women with PCOS had decrease levels compared to the other groups, but the difference was not statistically significant. Finally, the comparison of kisspeptin levels between the three groups showed that kisspeptin levels were increased in women with diminished ovarian reserves, compared to the other two groups, but without a statistically significant difference.As no statistically significant difference was found between the groups for leptin, adiponectin and kisspeptin, these three parameters were further compared per two groups. When these three parameters were compared between group A (AOR) and group C (DOR), a statistically significant difference was found for kisspeptin. Conclusion: In our study the categorization of women based on ovarian reserves is in full agreement with the international literature. Leptin, adiponectin and kisspeptin have a certain effect on reproduction. However, all three peptides are affected by many different factors and at the same time in our study the number of samples was limited. This specific area needs further investigation with a larger number of samples in order to reach safe conclusions.Σκοπός: Σκοπός της παρούσας διδακτορικής διατριβής είναι η διερεύνηση της πιθανής συσχέτισης των επιπέδων της λεπτίνης, της αδιπονεκτίνης και της kisspeptin με τα ωοθηκικά αποθέματα γυναικών αναπαραγωγικής ηλικίας.Υλικό και μέθοδος: Για τη μελέτη συμφώνησαν να συμμετάσχουν 80 γυναίκες ηλικίας 19-40 ετών. Από αυτές τελικά συμπεριλήφθηκαν οι 74 καθώς στις 6 κρίθηκε ακατάλληλο το δείγμα του αίματος λόγω αιμόλυσης. Οι γυναίκες κατηγοριοποιήθηκαν σε τρεις κύριες ομάδες σε σχέση με τα πρότυπα των ωοθηκικών τους αποθεματικών: γυναίκες με επαρκείς ωοθηκικές εφεδρείες (Ομάδα A - AOR) (n=30), γυναίκες με αυξημένες ωοθηκικές εφεδρείες (Ομάδα B - PCOS) (n=31) και γυναίκες με μειωμένες ωοθηκικές εφεδρείες (Ομάδα Γ - DOR) (n=13).Αποτελέσματα: Η ομάδα με μειωμένες ωοθηκικές εφεδρείες είχε στατιστικά σημαντικά υψηλότερη ηλικία και τιμές FSH σε σχέση με τις δύο άλλες ομάδες. Δεν βρέθηκε στατιστικά σημαντική διαφορά μεταξύ των ομάδων για τις τιμές της Ε2, TSH. Η τιμή του ΔΜΣ, της LH, της TT, της 17-OHP, της DHEA, της AMH και του AFC ήταν υψηλότερη στις γυναίκες με υψηλές ωοθηκικές εφεδρείες συγκριτικά με τις άλλες δύο ομάδες. Η AMH και το AFC ήταν χαμηλότερο στις γυναίκες με χαμηλές ωοθηκικές εφεδρείες σε σύγκριση με τις άλλες ομάδες όπως αναμενόταν. Τα επίπεδα της λεπτίνης ήταν αυξημένα στις γυναίκες με PCOS όμως δεν υπήρχε στατιστικά σημαντική διαφορά σε σχέση με τις δύο άλλες ομάδες. Όσον αφορά στην αδιπονεκτίνη, η σύγκριση των τιμών της μεταξύ των τριών ομάδων έδειξε ότι οι γυναίκες με PCOS είχαν χαμηλότερες τιμές σε σύγκριση με τις άλλες ομάδες χωρίς όμως να είναι στατιστικά σημαντική η διαφορά. Τέλος η σύγκριση των επιπέδων της kisspeptin μεταξύ των τριών ομάδων έδειξε ότι τα επίπεδα της kisspeptin ήταν αυξημένα στις γυναίκες με χαμηλές ωοθηκικές εφεδρείες, συγκριτικά με τις άλλες δύο ομάδες, χωρίς όμως να υπάρχει στατιστικά σημαντική διαφορά. Καθώς δεν βρέθηκε σημαντικά στατιστική διαφορά μεταξύ των ομάδων για τις τιμές της λεπτίνης, της αδιπονεκτίνης και της kisspeptin έγινε στη συνέχεια περαιτέρω σύγκριση αυτών των τριών παραμέτρων ανά δύο ομάδες μεταξύ τους. Όταν πραγματοποιήθηκε σύγκριση των τριών αυτών παραμέτρων μεταξύ ομάδας Α (AOR) και ομάδας Γ (DOR) τότε βρέθηκε στατιστικά σημαντική διαφορά για την kisspeptin. Συμπεράσματα: Η κατηγοριοποίηση των γυναικών που πραγματοποιήσαμε με βάση τις ωοθηκικές εφεδρείες συμφωνεί απόλυτα με τη διεθνή βιβλιογραφία. Όσον αφορά τη λεπτίνη, την αδιπονεκτίνη και την kisspeptin, η σύνδεσή τους με την αναπαραγωγή είναι αδιαμφισβήτητη. Παρόλα αυτά και τα τρία πεπτίδια επηρεάζονται από πολλούς παράγοντες ταυτόχρονα και στη δική μας μελέτη, ο αριθμός των δειγμάτων ήταν περιορισμένος. Ο συγκεκριμένος τομέας χρήζει περαιτέρω διερεύνησης με μεγαλύτερο αριθμό δειγμάτων για να οδηγηθούμε σε ασφαλέστερα συμπεράσματα

Our Experience with Hydrogel-Coated Trisacryl Microspheres in Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids and Adenomyosis: A Follow-Up of 11 Years

Uterine artery embolization (UAE) for the treatment of symptomatic uterine fibroids and non-controllable adenomyosis symptoms is a relatively new procedure for organ-preserving therapy. These benign conditions can become symptomatic in about 30% of women between the ages of 35 and 50. The purpose of the UAE either for fibroids or adenomyosis is the elimination of blood loss, the reduction in pain, and bulky or rectal pressure symptoms. The purpose of this study is to present our experience in UAE with the use of hydrogel-coated tris acryl microspheres for the treatment of symptomatic uterine fibroids and adenomyosis