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Diagnostics
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Diagnosis and Management for Obstetric and Gynecologic Diseases 2.0
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Diagnosis and Management for Obstetric and Gynecologic Diseases 2.0

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (2 December 2022) | Viewed by 20938

Special Issue Editor

Prof. Dr. Fujiwara Hiroshi

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
Interests: embryo implantation; placental formation; reproductive immunology; reproductive endocrinology; gynecologic oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

When a novel diagnostic system is proposed, a new strategy of clinical management for corresponding diseases must be developed. Currently, more effective diagnostic tools for infertility, perinatal disorders, and gynecologic cancers are required in OB and GYN. Based on this background, this Special Issue focuses on new waves of approaches to diagnosis and management in the fields of reproductive medicine, perinatology, and gynecologic oncology. Proposals of new diagnostic markers, methods, and techniques or new strategies of clinical management are welcome. Animal experiments that can lead to development of clinical diagnosis and management are also acceptable. We warmly invite experts who contribute original research articles or reviews.

Prof. Dr. Fujiwara Hiroshi
Guest Editor

Manuscript Submission Information

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Keywords

  • clinical diagnosis
  • clinical management
  • reproductive medicine
  • perinatology
  • gynecologic oncology

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Related Special Issue

Published Papers (7 papers)

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Research

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10 pages, 2323 KiB  
Article
Does a Caesarean Section Scar Affect Placental Volume, Vascularity and Localization?
by Diana Bokučava, Anda Ķīvīte-Urtāne, Pavels Domaševs, Laura Lūse, Natālija Vedmedovska and Gilbert G. G. Donders
Diagnostics 2022, 12(11), 2674; https://doi.org/10.3390/diagnostics12112674 - 3 Nov 2022
Viewed by 1329
Abstract
Caesarean section is associated with an increased risk of abnormal placental implantation and adverse pregnancy outcomes in subsequent pregnancies. Besides the placenta accrete spectrum, only a few of the previous studies focused on other placental development alterations in the scarred uterus. We assessed [...] Read more.
Caesarean section is associated with an increased risk of abnormal placental implantation and adverse pregnancy outcomes in subsequent pregnancies. Besides the placenta accrete spectrum, only a few of the previous studies focused on other placental development alterations in the scarred uterus. We assessed placental development deviations in the uterus with a Caesarean section scar by evaluating placental volume (PV) and vascular flow indexes. From 1 January 2021 until 31 March 2022, placental volumes and vascularization indexes (VI, FI, VFI) were prospectively measured by 3D power Doppler and VOCAL techniques in 221 patients attending the first trimester screening program. We also calculated the placental quotient to standardize PV to the gestational age. No statistically significant differences in the values of placental volume, placental quotient and placental vascularization indexes were detected between women with previous Caesarean section delivery or women with vaginal delivery. FI was significantly lower in nulliparous in the first trimester. The results of our study suggest that 3D placental evaluation was not able to detect placental development alteration in the uterus with a Caesarean section scar. Future research needs to verify whether 3D power Doppler and Vocal techniques can provide more information if used in an earlier gestational age. Full article
(This article belongs to the Special Issue Diagnosis and Management for Obstetric and Gynecologic Diseases 2.0)
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16 pages, 622 KiB  
Article
Impact of Follicle Stimulating Hormone Receptor (FSHR) Polymorphism on the Efficiency of Co-Treatment with Growth Hormone in a Group of Infertile Women from Romania
by Mihai Surcel, Bogdan Doroftei, Iulia Adina Neamtiu, Daniel Muresan, Gabriela Caracostea, Iulian Goidescu, Adelina Staicu, Georgiana Nemeti, Michael S. Bloom and Cristina Zlatescu-Marton
Diagnostics 2022, 12(10), 2371; https://doi.org/10.3390/diagnostics12102371 - 29 Sep 2022
Cited by 2 | Viewed by 1982
Abstract
“Poor responders” (PR) are an important category of infertile women who experience a modest response to controlled ovarian stimulation. In this study, we evaluated response to growth hormone (GH) administration among PR patient subtypes stratified by follicle stimulation hormone receptor (FSHR) polymorphism (c.2039A [...] Read more.
“Poor responders” (PR) are an important category of infertile women who experience a modest response to controlled ovarian stimulation. In this study, we evaluated response to growth hormone (GH) administration among PR patient subtypes stratified by follicle stimulation hormone receptor (FSHR) polymorphism (c.2039A > G p.Asn680Ser). We conducted a cohort study of 125 women with poor ovarian response, 58 of whom received GH in addition to the standard treatment, and 67 of whom received the standard treatment only. The Ala307Thr polymorphism genotypes were analyzed using a polymerase chain reaction-restriction fragment length polymorphism method, and the FSHR gene polymorphism was analyzed using a predesigned TaqMan SNP Genotyping Assay (rs6166). A comparative analysis detected statistically significant differences in mean mature follicles (p = 0.0002), metaphase-II oocytes (p = 0.0005), progesterone levels (p = 0.0036), and IGF levels (follicle IGF1, p = 0.0004) between GH-treated and non-GH-treated participants with the FSHR (Ser/Ser) polymorphism. However, the differences were modest among participants with the other two FSHR polymorphisms (Ser/Asn and Asn/Asn). The subcategory of patients with the FSHR Asn680Ser (Ser/Ser) polymorphism showed a stronger response when GH was added to the IVF protocol. Full article
(This article belongs to the Special Issue Diagnosis and Management for Obstetric and Gynecologic Diseases 2.0)
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11 pages, 9648 KiB  
Article
Our Experience in Using the Endovascular Therapy in the Management of Hemorrhages in Obstetrics and Gynecology
by Octavian Munteanu, Diana Secara, Maria Narcisa Neamtu, Alexandru Baros, Adela Dimitriade, Bogdan Dorobat, Alexandra Carp, Daniela Elena Gheoca Mutu and Monica Mihaela Cirstoiu
Diagnostics 2022, 12(6), 1436; https://doi.org/10.3390/diagnostics12061436 - 10 Jun 2022
Cited by 4 | Viewed by 2137
Abstract
(1) Background: A quarter of maternal deaths are caused by post-partum hemorrhage; hence obstetric bleeding is a significant cause of morbidity and mortality among women. Pelvic artery embolization (PAE) represents a minimally invasive interventional procedure which plays an important role in conservative management [...] Read more.
(1) Background: A quarter of maternal deaths are caused by post-partum hemorrhage; hence obstetric bleeding is a significant cause of morbidity and mortality among women. Pelvic artery embolization (PAE) represents a minimally invasive interventional procedure which plays an important role in conservative management of significant bleeding in Obstetrics and Gynecology. The aim of this study was to evaluate the effect and the complications of PAE in patients with significant vaginal bleeding with different obstetrical and gynecological pathologies. (2) Methods: We conducted an observational, retrospective study on 1135 patients who presented to the University Emergency Hospital of Bucharest with vaginal bleeding of various etiology treated with endovascular therapy. All the patients included in the study presented vaginal hemorrhage that was caused by: uterine leiomyomas, genital tract malignancies, ectopic pregnancy, arterio-venous mal-formations and other obstetrical causes. We excluded patients with uncontrolled high blood pressure, severe hepatic impairment, congestive heart failure, renal failure or ventricular arrhythmias. (3) Results: Bleeding was caused in 88.19% of cases by uterine leiomyomas (n = 1001), 7.84% (n = 89) by cervical cancer, 2.29% by ectopic pregnancy (n = 26), 1.23% by arteriovenous malformation (n = 14) and 0.52% by major hemorrhage of obstetrical causes. Endovascular procedures were used in all the cases. In patients with uterine leiomyomas, supra-selective uterine arteries embolization was used. In 97% (n = 1101) of patients, bleeding was stopped after the first attempt of PAE. 3% (n = 34) needed a second embolization. In 12 of 14 cases of AVM, PAE was successful, two other cases needed reintervention; (4) Conclusions: Endovascular procedures represent a major therapy method for both acute and chronic hemorrhage in Obstetrics and Gynecology. It can be used in post-partum or post-traumatic causes of vaginal bleeding, but also in patients with chronic hemorrhage from uterine leiomyomas or inoperable genital malignancies or even as a preoperative adjuvant in cases of voluminous uterine fibroids or invasive malignant tumors, aiming to reduce intraoperative hemorrhage. Full article
(This article belongs to the Special Issue Diagnosis and Management for Obstetric and Gynecologic Diseases 2.0)
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10 pages, 246 KiB  
Article
The Application of Artificial Intelligence-Assisted Colposcopy in a Tertiary Care Hospital within a Cervical Pathology Diagnostic Unit
by Aleksandra Zimmer-Stelmach, Jan Zak, Agata Pawlosek, Anna Rosner-Tenerowicz, Joanna Budny-Winska, Michal Pomorski, Tomasz Fuchs and Mariusz Zimmer
Diagnostics 2022, 12(1), 106; https://doi.org/10.3390/diagnostics12010106 - 4 Jan 2022
Cited by 10 | Viewed by 2703
Abstract
The rising global incidence of cervical cancer is estimated to have affected more than 600,000 women, and nearly 350,000 women are predicted to have died from the disease in 2020 alone. Novel advances in cancer prevention, screening, diagnosis and treatment have all but [...] Read more.
The rising global incidence of cervical cancer is estimated to have affected more than 600,000 women, and nearly 350,000 women are predicted to have died from the disease in 2020 alone. Novel advances in cancer prevention, screening, diagnosis and treatment have all but reduced the burden of cervical cancer in developed nations. Unfortunately, cervical cancer is still the number one gynecological cancer globally. A limiting factor in managing cervical cancer globally is access to healthcare systems and trained medical personnel. Any methodology or procedure that may simplify or assist cervical cancer screening is desirable. Herein, we assess the use of artificial intelligence (AI)-assisted colposcopy in a tertiary hospital cervical diagnostic pathology unit. The study group consisted of 48 women (mean age 34) who were referred to the clinic for a routine colposcopy by their gynecologist. Cervical images were taken by an EVA-Visualcheck TM colposcope and run through an AI algorithm that gave real-time binary results of the cervical images as being either normal or abnormal. The primary endpoint of the study assessed the AI algorithm’s ability to correctly identify histopathology results of CIN2+ as being abnormal. A secondary endpoint was a comparison between the AI algorithm and the clinical assessment results. Overall, we saw lower sensitivity of AI (66.7%; 12/18) compared with the clinical assessment (100%; 18/18), and histopathology results as the gold standard. The positive predictive value (PPV) was comparable between AI (42.9%; 12/28) and the clinical assessment (41.8%; 18/43). The specificity, however, was higher in the AI algorithm (46.7%; 14/30) compared to the clinical assessment (16.7%; 5/30). Comparing the congruence between the AI algorithm and histopathology results showed agreement 54.2% of the time and disagreement 45.8% of the time. A trained colposcopist was in agreement 47.9% and disagreement 52.1% of the time. Assessing these results, there is currently no added benefit of using the AI algorithm as a tool of speeding up diagnosis. However, given the steady improvements in the AI field, we believe that AI-assisted colposcopy may be of use in the future. Full article
(This article belongs to the Special Issue Diagnosis and Management for Obstetric and Gynecologic Diseases 2.0)

Review

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11 pages, 10051 KiB  
Review
Prenatal Diagnosis of Neu–Laxova Syndrome
by Adriana Serrano Olave, Alba Padín López, María Martín Cruz, Susana Monís Rodríguez, Isidoro Narbona Arias and Jesús S. Jiménez López
Diagnostics 2022, 12(7), 1535; https://doi.org/10.3390/diagnostics12071535 - 23 Jun 2022
Cited by 4 | Viewed by 2200
Abstract
Neu–Laxova syndrome is a rare and lethal genetic disease with autosomal recessive inheritance involving abnormalities of multiple systems. It was first reported in 1971. Since then, just eighty-eight cases have been reported. The syndrome is characterized by early and severe growth restriction, and [...] Read more.
Neu–Laxova syndrome is a rare and lethal genetic disease with autosomal recessive inheritance involving abnormalities of multiple systems. It was first reported in 1971. Since then, just eighty-eight cases have been reported. The syndrome is characterized by early and severe growth restriction, and craniofacial anomalies, such as microcephaly, hypertelorism and other malformations, resulting in quite characteristic features. Additionally, it might appear as generalized edema, flexion contractures and other malformations of the extremities, abnormalities in the CNS (central nervous system), skin (severe ichthyosis), and genitourinary and cardiac abnormalities. We present the case of a patient who had her first pregnancy with a fetus with Neu–Laxova syndrome diagnosed in our center during the second-trimester ultrasound. The ultrasound findings suggested the diagnosis, which was confirmed with a genetic study of the amniotic fluid: the variant of the PSAT1 gene, associated with NLS (Neu–Laxova syndrome) 2 in homozygosis. Moreover, there was a second pregnancy with a fetus carrying the same mutation in heterozygosis. In addition, we have carried out a review of published literature about this disease up to the present time. Full article
(This article belongs to the Special Issue Diagnosis and Management for Obstetric and Gynecologic Diseases 2.0)
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Other

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10 pages, 8129 KiB  
Case Report
Successful Full-Term Delivery via Selective Ectopic Embryo Reduction Accompanied by Uterine Cerclage in a Heterotopic Cesarean Scar Pregnancy: A Case Report and Literature Review
by Hyoeun Kim, Ji Hye Koh, Jihee Lee, Yeongeun Sim, Sang-Hun Lee, Soo-Jeong Lee, Jun-Woo Ahn, Hyun-Jin Roh and Jeong Sook Kim
Diagnostics 2022, 12(3), 762; https://doi.org/10.3390/diagnostics12030762 - 21 Mar 2022
Cited by 1 | Viewed by 5603
Abstract
Heterotopic cesarean scar pregnancy (HCSP) is a combination of cesarean scar pregnancy (CSP) and intrauterine pregnancy (IUP). Cesarean scar pregnancy is accompanied by life-threatening complications, such as uterine rupture and massive bleeding. Herein, we present a case of HCSP treated with selective potassium [...] Read more.
Heterotopic cesarean scar pregnancy (HCSP) is a combination of cesarean scar pregnancy (CSP) and intrauterine pregnancy (IUP). Cesarean scar pregnancy is accompanied by life-threatening complications, such as uterine rupture and massive bleeding. Herein, we present a case of HCSP treated with selective potassium chloride injection into the CSP under ultrasonography in association with uterine cerclage to control vaginal bleeding; this led to a successful IUP preservation and full-term delivery. Additionally, we will review several previous reports on HCSP management, including our case. Full article
(This article belongs to the Special Issue Diagnosis and Management for Obstetric and Gynecologic Diseases 2.0)
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Graphical abstract

5 pages, 1397 KiB  
Case Report
Pregnancy in a Non-Communicating Rudimentary Horn of Unicornuate Uterus
by Yi-Cih Ma and Kim-Seng Law
Diagnostics 2022, 12(3), 759; https://doi.org/10.3390/diagnostics12030759 - 21 Mar 2022
Cited by 4 | Viewed by 4037
Abstract
We report a rare case of non-communicating rudimentary horn pregnancy (RHP). The patient presented with lower abdominal pain and underwent laparoscopic surgery in which the gestational tissue was removed without excision of the rudimentary horn and ipsilateral fallopian tube. Unicornuate uteri often coexist [...] Read more.
We report a rare case of non-communicating rudimentary horn pregnancy (RHP). The patient presented with lower abdominal pain and underwent laparoscopic surgery in which the gestational tissue was removed without excision of the rudimentary horn and ipsilateral fallopian tube. Unicornuate uteri often coexist with rudimentary horns, most of which are non-communicating. RHP is rare, and symptomatic women tend to complain of abdominal pain. Once RHP is suspected, the clinician should monitor the patient for signs of hypovolemic shock, such as hypotension, because the RHP can rupture owing to the poorly developed musculature. Early surgical intervention with removal of the rudimentary horn along with the ipsilateral fallopian tube is generally suggested to prevent future ectopic pregnancy. The theory of sperm transmigration from the contralateral oviduct has been hypothesized in non-communicating RHP. Full article
(This article belongs to the Special Issue Diagnosis and Management for Obstetric and Gynecologic Diseases 2.0)
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