Journal of Clinical Medicine

Editorial

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4 pages, 172 KiB

Open AccessEditorial

Gynecologic and Obstetric Pathologies from Birth to Menopause: Unveiling the Journey and Charting the Future

by Panagiotis Christopoulos and Ermioni Tsarna

J. Clin. Med. 2024, 13(20), 6230; https://doi.org/10.3390/jcm13206230 - 18 Oct 2024

Viewed by 455

Abstract

Gynecologic and obstetric pathologies encompass a vast array of conditions that affect women’s health throughout their lives [...] Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

Research

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11 pages, 601 KiB

Open AccessArticle

Measurement of Calprotectin and PTH in the Amniotic Fluid of Early Second Trimester Pregnancies and Their Impact on Fetuses with Growth Disorders: Are Their Levels Related to Oxidative Stress?

by George Maroudias, Dionysios Vrachnis, Alexandros Fotiou, Nikolaos Loukas, Aimilia Mantzou, Vasileiοs Pergialiotis, George Valsamakis, Nikolaos Machairiotis, Sofoklis Stavros, Periklis Panagopoulos, Panagiotis Vakas, Christina Kanaka-Gantenbein, Petros Drakakis and Nikolaos Vrachnis

J. Clin. Med. 2024, 13(3), 855; https://doi.org/10.3390/jcm13030855 - 1 Feb 2024

Cited by 2 | Viewed by 1242

Abstract

Background: During the early stages of human fetal development, the fetal skeleton system is chiefly made up of cartilage, which is gradually replaced by bone. Fetal bone development is mainly regulated by the parathyroid hormone parathormone (PTH) and PTH-related protein, with specific [...] Read more.

Background: During the early stages of human fetal development, the fetal skeleton system is chiefly made up of cartilage, which is gradually replaced by bone. Fetal bone development is mainly regulated by the parathyroid hormone parathormone (PTH) and PTH-related protein, with specific calprotectin playing a substantial role in cell adhesion and chemotaxis while exhibiting antimicrobial activity during the inflammatory osteogenesis process. The aim of our study was to measure the levels of PTH and calprotectin in early second trimester amniotic fluid and to carry out a comparison between the levels observed among normal full-term pregnancies (control group) and those of the groups of embryos exhibiting impaired or enhanced growth. Methods: For the present prospective study, we collected amniotic fluid samples from pregnancies that underwent amniocentesis at 15 to 22 weeks of gestational age during the period 2021–2023. Subsequently, we followed up on all pregnancies closely until delivery. Having recorded fetal birthweights, we then divided the neonates into three groups: small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). Results: In total, 64 pregnancies, including 14 SGA, 10 LGA, and 40 AGA fetuses, were included in our study. Both substances were detected in early second trimester amniotic fluid in both groups. Concentrations of calprotectin differed significantly among the three groups (p = 0.033). AGA fetuses had a lower mean value of 4.195 (2.415–6.425) IU/mL, whereas LGA fetuses had a higher mean value of 6.055 (4.887–13.950) IU/mL, while SGA fetuses had a mean value of 5.475 (3.400–9.177) IU/mL. Further analysis revealed that only LGA fetuses had significantly higher calprotectin concentrations compared to AGA fetuses (p = 0.018). PTH concentration was similar between the groups, with LGA fetuses having a mean value of 13.18 (9.51–15.52) IU/mL, while SGA fetuses had a mean value of 14.18 (9.02–16.00) IU/mL, and AGA fetuses had similar concentrations of 13.35 (9.05–15.81) IU/mL. The differences in PTH concentration among the three groups were not statistically significant (p = 0.513). Conclusions: Calprotectin values in the amniotic fluid in the early second trimester were higher in LGA fetuses compared to those in the SGA and AGA categories. LGA fetuses can possibly be in a state of low-grade chronic inflammation due to excessive fat deposition, causing oxidative stress in LGA fetuses and, eventually, the release of calprotectin. Moreover, PTH concentrations in the amniotic fluid of early second trimester pregnancies were not found to be statistically correlated with fetal growth abnormalities in either LGA or SGA fetuses. However, the early time of collection and the small number of patients in our study should be taken into account. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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17 pages, 324 KiB

Open AccessArticle

Quality of Life and Sexual Satisfaction in the Early Period of Motherhood—A Cross-Sectional Preliminary Study

by Maria Florkiewicz-Danel, Kornelia Zaręba, Michał Ciebiera and Grzegorz Jakiel

J. Clin. Med. 2023, 12(24), 7597; https://doi.org/10.3390/jcm12247597 - 9 Dec 2023

Viewed by 1367

Abstract

The aim of the study was to assess the impact of breastfeeding-related fatigue and family support on the sexuality and quality of life of mothers during early motherhood. A cross-sectional preliminary study was conducted between 1 October 2021 and 15 May 2022 in [...] Read more.

The aim of the study was to assess the impact of breastfeeding-related fatigue and family support on the sexuality and quality of life of mothers during early motherhood. A cross-sectional preliminary study was conducted between 1 October 2021 and 15 May 2022 in 65 women being in early postpartum period. We used the authors’ questionnaire developed for the purposes of the study; the Sexual Satisfaction Scale for Women—SSS-W; the Mell–Krat scale for women; and the General Health Questionnaire—GHQ28. A significant negative correlation was found between the age of the patients and the reduction in somatic symptoms (GHQ28 questionnaire) (r = −0.315, p = 0.011). Women working professionally achieved significantly higher results in the SSS-W contentment category (r = 0.313, p = 0.014). Frequent sexual activity reduced disorders in social functioning (the GHQ28 questionnaire) (r = −0.107, p = 0.283). Women who breastfed up to 5 times a day (p = 0.033) reached significantly higher SSS-W scores in terms of communication. The partner’s help significantly contributed to higher sexual satisfaction in the aspect of compatibility (p = 0.004) and the overall level of satisfaction determined with the SSS-W questionnaire (p = 0.016). The presented study suggests that older mothers who are employed and supported by a partner have a higher level of contentment, sexual satisfaction and quality of life. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

11 pages, 768 KiB

Open AccessArticle

Detection of GSTM1-null Genotype in Women Undergoing IVF Treatment

by Ioannis Chrysanthopoulos, Angelos Petsavas, Despoina Mavrogianni, Anastasios Potiris, Nikolaos Machairiotis, Eirini Drakaki, Dionysios Vrachnis, Pavlos Machairoudias, Theodoros Karampitsakos, Paraskevas Perros, Christos Koratzanis, Peter Drakakis and Sofoklis Stavros

J. Clin. Med. 2023, 12(23), 7269; https://doi.org/10.3390/jcm12237269 - 23 Nov 2023

Viewed by 1276

Abstract

Background: Glutathione S-transferase (GST) M1 belongs to a family of detoxification enzymes and deficiency in enzyme activity is due to a homozygous deletion of the GSTM1 gene. Several studies reveal a possible correlation between female infertility and GSTM1 polymorphisms. The aim of this [...] Read more.

Background: Glutathione S-transferase (GST) M1 belongs to a family of detoxification enzymes and deficiency in enzyme activity is due to a homozygous deletion of the GSTM1 gene. Several studies reveal a possible correlation between female infertility and GSTM1 polymorphisms. The aim of this study is to investigate the effect of the GSTM1-null polymorphism in female infertility as well as in IVF parameters. Methods: In the study group 125 women were classified as infertile according to WHO and 49 women with at least one successful pregnancy and no miscarriages, as control group. Genomic DNA from blood samples was isolated and PCR amplification was applied to determine the presence of GSTM1-null genotype. Results: Data analysis demonstrated a statistically significant higher presence of GSTM1-null variant in the infertile group compared to the control group. In a subgroup analysis of the infertile group, the estradiol levels, the number of fertilized oocytes as well as the number and the quality of the cumulus-oocyte complex, were statistically significant higher in women detected with the wildtype of GSTM1 gene compared to those who had the GSTM1 null genotype (deletion). Conclusions: Our study results propose a possible involvement of GMST1 in female infertility and may help elucidate possible interactions between the microenvironment of oocytes and the oxidative stress. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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11 pages, 879 KiB

Open AccessArticle

Combined Hormonal Contraception during Breastfeeding—A Survey of Physician’s Recommendations

by Lior Segev, Gideon Weitzman, Goldie Katz-Samson, Abraham O. Samson, Guy Shrem and Naama Srebnik

J. Clin. Med. 2023, 12(22), 7110; https://doi.org/10.3390/jcm12227110 - 15 Nov 2023

Cited by 1 | Viewed by 1489

Abstract

Until breastfeeding is established, progesterone-only pill (POP) use is preferable over combined hormonal contraception (CHC), as the latter potentially reduces milk production. Yet, POPs are often associated with breakthrough bleeding (BTB), and irregular spotting is often a reason for their cessation. Conversely, CHC [...] Read more.

Until breastfeeding is established, progesterone-only pill (POP) use is preferable over combined hormonal contraception (CHC), as the latter potentially reduces milk production. Yet, POPs are often associated with breakthrough bleeding (BTB), and irregular spotting is often a reason for their cessation. Conversely, CHC is less associated with BTB but is not usually prescribed, even if breastfeeding has been established, despite its verified safety profile. Here, we surveyed physicians’ perception of CHC safety during breastfeeding through an online questionnaire (N = 112). Physicians were asked if they would prescribe CHC to a woman three months postpartum, breastfeeding fully, and suffering from BTB while using POPs. Half of the physicians responded they would, 28% would not until six months postpartum, while 14% would not during breastfeeding. Of the physicians that would prescribe CHC, 58% would without any reservation, 24% would only after discussing milk reduction with the patient, 9% would use a pill with a lower hormonal dose, and 9% would only prescribe CHC 3 months postpartum. The main risk associated with CHC during breastfeeding, as perceived by physicians, is a potential decrease in breast milk production (88%). While some physicians consider CHC unsafe during breastfeeding, most health organizations consider CHC compatible with breastfeeding 5–6 weeks after birth. Thus, there is a gap in the attitude and knowledge of physicians about the safety profile of CHC, and only half acknowledge that the risk of BTB justifies the use of CHC instead of POPs while breastfeeding three months postpartum. We highlight the importance of physician’s education, advocate CHC breastfeeding compatibility if breastfeeding has been established (i.e., 30 days postpartum), and underline the importance of discussing the option of CHC with patients in case POPs have unwanted side effects. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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11 pages, 532 KiB

Open AccessArticle

Association of GSTM1 Polymorphism and Redox Potential with Idiopathic Male Infertility

by Anastasios Potiris, Anastasia Voitse, Despoina Mavrogianni, Nikolaos Machairiotis, Eirini Drakaki, Myrto Papamentzelopoulou, Theodoros Karampitsakos, Athanasios Zikopoulos, Evangelini Evgeni, Peter Drakakis and Sofoklis Stavros

J. Clin. Med. 2023, 12(21), 6775; https://doi.org/10.3390/jcm12216775 - 26 Oct 2023

Cited by 3 | Viewed by 981

Abstract

Background: The aim of this case–control study is to investigate possible associations between GSTM1 polymorphism and redox potential with sperm parameters. Methods: The study group consisted of sperm samples from 51 infertile men according to the WHO guidelines. The control group included 39 [...] Read more.

Background: The aim of this case–control study is to investigate possible associations between GSTM1 polymorphism and redox potential with sperm parameters. Methods: The study group consisted of sperm samples from 51 infertile men according to the WHO guidelines. The control group included 39 samples from men with normal seminal parameters. DNA was extracted and genotyped for the detection of the GSTM1 polymorphism. An evaluation of the static redox potential (sORP) using the MiOXSYS^TM system was conducted. Results: The frequency of the GSTM1-null genotype was higher in infertile male individuals (60.78%) than in the controls (41.03%) and was associated with a 2.228-fold increased risk for male infertility. Fertile controls carrying the GSTM1-null genotype presented a lower percentage of typical sperm morphology and lower slow progressive motility. An excess of redox potential was observed in infertile males compared to fertile ones. In the control group higher sORP values had a positive correlation with immotility percentage and a negative correlation regarding total motility. In the study group sORP values had a negative correlation with total count, concentration, and slow progressive motility. Conclusions: The present study highlights that GSTM1 polymorphism and redox potential affect both fertile and in fertile males. Moreover, redox potential levels could be used as an additional indicator along with the routine semen analysis for a comprehensive screening between infertile and fertile men. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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11 pages, 2093 KiB

Open AccessArticle

Sexuality in Postmenopausal Women with Genital Prolapse

by Ana Cristina Fernández Rísquez, Antonio Carballo García, Jesús Joaquín Hijona Elósegui, Nicolás Mendoza Ladrón de Guevara and Jesús Carlos Presa Lorite

J. Clin. Med. 2023, 12(19), 6290; https://doi.org/10.3390/jcm12196290 - 29 Sep 2023

Viewed by 1774

Abstract

Background: One of the most common complaints among menopausal women concerns changes in sexual function. This is attributed to various factors, including anatomical defects in the genital tract, with pelvic organ prolapse (POP) being one of the most prevalent problems affecting women during [...] Read more.

Background: One of the most common complaints among menopausal women concerns changes in sexual function. This is attributed to various factors, including anatomical defects in the genital tract, with pelvic organ prolapse (POP) being one of the most prevalent problems affecting women during this stage of their lives. Additionally, symptoms resulting from gonadal hypofunction can also contribute to the development of sexual dysfunction during menopause. This research aimed to explore the way in which postmenopausal patients with POP experienced their sexuality in our setting. Methods: To achieve the proposed objective, we conducted a descriptive, cross-sectional study involving a total of 133 postmenopausal women with POP. Results: The results of our series are consistent with the scarce literature available in our setting and suggest a high rate of sexual dysfunction in postmenopausal patients with POP. Conclusions: We can conclude that POP is associated with the presence of female sexual dysfunction. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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12 pages, 270 KiB

Open AccessArticle

The Role of Diet during Pregnancy in Protecting against Gestational Diabetes Mellitus in a Population with Mediterranean Dietary Habits: A Cross-Sectional Study

by Ermioni Tsarna, Anna Eleftheriades, Efthymia Tsomi, Georgia Ziogou, Panagiotis Vakas, Theodoros Panoskaltsis and Panagiotis Christopoulos

J. Clin. Med. 2023, 12(5), 1857; https://doi.org/10.3390/jcm12051857 - 26 Feb 2023

Cited by 2 | Viewed by 2646

Abstract

Gestational diabetes mellitus (GDM) is a common metabolic disorder among pregnant women. Dietary habits during pregnancy might alter the risk of GDM development, and populations following the Mediterranean diet are relatively understudied. This was a cross-sectional, observational study of 193 low-risk women admitted [...] Read more.

Gestational diabetes mellitus (GDM) is a common metabolic disorder among pregnant women. Dietary habits during pregnancy might alter the risk of GDM development, and populations following the Mediterranean diet are relatively understudied. This was a cross-sectional, observational study of 193 low-risk women admitted to a private maternity hospital in Greece to give birth. Food frequency data on specific food categories, selected based on previous research, were analyzed. Logistic regression models, both crude and adjusted for maternal age, body mass index before pregnancy, and gestational weight gain, were fitted. We observed no association of carbohydrate-rich meals, sweets, soft drinks, coffee, rice, pasta, bread and crackers, potatoes, lentils, and juices with GDM diagnosis. Cereals (crude p = 0.045, adjusted p = 0.095) and fruits and vegetables (crude p = 0.07, adjusted p = 0.04) appeared to have a protective effect against GDM, while frequent tea consumption was linked to higher risk of GDM development (crude p = 0.067, adjusted p = 0.035). These results strengthen previously identified associations and underline the importance and potential impact of changing dietary habits even during pregnancy in adjusting one’s risk of metabolic pregnancy complications, such as GDM. The importance of healthy dietary habits is highlighted, with the goal of raising awareness amongst obstetric care specialists regarding the provision of systematic nutrition recommendations to pregnant women. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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Review

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11 pages, 247 KiB

Open AccessEditor’s ChoiceReview

Social Egg Freezing—A Trend or Modern Reality?

by Dimitra Katsani, Nefeli Paraschou, Eleni Panagouli, Ermioni Tsarna, Theodoros N. Sergentanis, Nikolaos Vlahos and Artemis Tsitsika

J. Clin. Med. 2024, 13(2), 390; https://doi.org/10.3390/jcm13020390 - 10 Jan 2024

Cited by 3 | Viewed by 3908

Abstract

Introduction: Egg freezing for social reasons is a process in which women who want to preserve their ability to fertilize their own oocytes at an older age freeze their eggs. With the help of in vitro fertilization, the cryopreservation of oocytes for future [...] Read more.

Introduction: Egg freezing for social reasons is a process in which women who want to preserve their ability to fertilize their own oocytes at an older age freeze their eggs. With the help of in vitro fertilization, the cryopreservation of oocytes for future use is achieved. The aim of this article is to study the reasons, the risks and the effectiveness of the method from a worldwide aspect. Methods: A literature search was conducted to evaluate pertinent studies, using data from the search engines PubMed, Google and UptoDate as well as the medical literature. Results: The reasons for delayed procreation are non-medical, with the lack of an appropriate partner for a family being first on the list. The success rate of this method differs with the age of the woman, the number of fertilized eggs and other factors. Like every medical procedure, this method carries risks that relate to the mother (being of advanced age), the embryo and the procedure of in vitro fertilization. The policies that apply in each country differ depending on respective social, economic, religious and cultural factors. Due to the high cost of the method, its selection remains a choice for only a few, reinforcing social inequality. The question of the medicalization of reproduction remains unanswered in the industry of assisted reproduction. Conclusions: In conclusion, egg freezing for social reasons is gradually becoming more widely known, with the United States of America and Israel being at the top the list. Unfortunately, there is no official data registry, and consequently, no statistical results are yet available for Greece, even though it is a method that more and more women are considering. Nevertheless, there is an imperative need for a universal legal framework for all countries with respect for the needs of every woman and different social conditions. More research and data from the literature are needed in relation to the effectiveness of the method from moral and social perspectives. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

13 pages, 393 KiB

Open AccessReview

Investigating the Association of Assisted Reproduction Techniques and Adverse Perinatal Outcomes

by Anastasios Potiris, Paraskevas Perros, Eirini Drakaki, Despoina Mavrogianni, Nikolaos Machairiotis, Antonios Sfakianakis, Theodoros Karampitsakos, Dionysios Vrachnis, Nikolaos Antonakopoulos, Periklis Panagopoulos, Peter Drakakis and Sofoklis Stavros

J. Clin. Med. 2024, 13(2), 328; https://doi.org/10.3390/jcm13020328 - 6 Jan 2024

Cited by 7 | Viewed by 2028

Abstract

Background: Infertility affects about 80 million individuals worldwide and 10–15% of couples at reproductive age will seek medical assistance. There is increasing evidence that pregnancies after Assisted Reproduction Techniques (ART) are associated with pre-term birth, low birthweight, congenital defects, and increased mortality rates. [...] Read more.

Background: Infertility affects about 80 million individuals worldwide and 10–15% of couples at reproductive age will seek medical assistance. There is increasing evidence that pregnancies after Assisted Reproduction Techniques (ART) are associated with pre-term birth, low birthweight, congenital defects, and increased mortality rates. The aim of this review is to assess all the published literature and provide an updated review on the effect of assisted conception and perinatal and neonatal outcomes. Methods: Comprehensive research on Pubmed/Medline, Scopus, and Google scholar electronic databases was conducted from July 2023 up to September 2023, using the terms assisted reproductive techniques, ART, in vitro fertilization, IVF, intracytoplasmic sperm injection, ICSI, preterm birth, PTB, low birth weight, LBW, chromosomal defects, congenital defects, and hypospadias. In total, 87 full text articles were retrieved and after a careful evaluation, 31 studies were selected for data extraction. Results: Our review demonstrated a higher risk of congenital and chromosomal defects, and a higher incidence of male genital tract defects and heart defects in ART pregnancies. Regarding pre-term birth, our results were contradictory. Conclusions: Although assisted reproduction techniques are associated with increased risks, they are safe regarding perinatal outcomes and couples should not be discouraged from utilizing them. Our results aim to alert clinicians to these specific outcomes and offer more personalized care and counseling to infertile couples and their children. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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21 pages, 679 KiB

Open AccessReview

Primary Hemostasis Disorders as a Cause of Heavy Menstrual Bleeding in Women of Reproductive Age

by Athanasios Kontogiannis, Alkis Matsas, Serena Valsami, Maria Effrosyni Livanou, Theodoros Panoskaltsis and Panagiotis Christopoulos

J. Clin. Med. 2023, 12(17), 5702; https://doi.org/10.3390/jcm12175702 - 1 Sep 2023

Cited by 1 | Viewed by 2935

Abstract

Heavy menstrual bleeding (HMB) is a common clinical condition affecting adolescent and adult women and compromising their quality of life. Primary hemostasis disorders, affecting platelet plug formation, can be the underlying cause of HMB. They comprise a heterogeneous group of diseases with Von [...] Read more.

Heavy menstrual bleeding (HMB) is a common clinical condition affecting adolescent and adult women and compromising their quality of life. Primary hemostasis disorders, affecting platelet plug formation, can be the underlying cause of HMB. They comprise a heterogeneous group of diseases with Von Willebrand disease (VWD) being the most commonly diagnosed; other disorders in this group that have been linked to HMB include (a) Glanzmann thrombasthenia, (b) Bernard–Soulier syndrome, (c) Hermansky–Pudlak syndrome, (d) immune thrombocytopenia (ITP), and (e) Ehlers–Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD). Diagnosing these diseases can be challenging, as the basic laboratory investigations can be within the normal range. Thus, identification of specific clinical features and a thorough hematologic workup can be very important, providing the correct diagnosis. Proper diagnosis of the underlying disorder is important, as management may vary accordingly. Although disease-specific management guidelines exist for some of these disorders such as VWD and ITP, due to the rarity of most primary hemostasis disorders, the best approach for the management of HMB in these women remains elusive. The goal of this study was to create an informative, comprehensive review of the primary hemostasis disorders that have been linked to HMB. This study provides a summary of the basic published information regarding epidemiology, pathophysiology, clinical phenotype, diagnosis, and treatment of HMB in those diseases and serves as a reference guide for further reading. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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26 pages, 1552 KiB

Open AccessReview

Recurrent Pregnancy Loss Etiology, Risk Factors, Diagnosis, and Management. Fresh Look into a Full Box

by Akbayan Turesheva, Gulzhanat Aimagambetova, Talshyn Ukybassova, Aizada Marat, Perizat Kanabekova, Lyazzat Kaldygulova, Ainur Amanzholkyzy, Svetlana Ryzhkova, Anastassiya Nogay, Zaituna Khamidullina, Aktoty Ilmaliyeva, Wassim Y. Almawi and Kuralay Atageldiyeva

J. Clin. Med. 2023, 12(12), 4074; https://doi.org/10.3390/jcm12124074 - 15 Jun 2023

Cited by 36 | Viewed by 10279

Abstract

Recurrent pregnancy loss is a complex health challenge with no universally accepted definition. Inconsistency in definitions involves not only the number of spontaneous abortions (two or three) that are accepted for recurrent pregnancy loss but the types of pregnancy and gestational age at [...] Read more.

Recurrent pregnancy loss is a complex health challenge with no universally accepted definition. Inconsistency in definitions involves not only the number of spontaneous abortions (two or three) that are accepted for recurrent pregnancy loss but the types of pregnancy and gestational age at miscarriage. Due to the heterogeneity of definitions and criteria applied by international guidelines for recurrent pregnancy loss, the true incidence of recurrent miscarriage, which is reported to range from 1% to 5%, is difficult to estimate. Moreover, the exact etiology of recurrent pregnancy loss remains questionable; thus, it is considered a polyetiological and multifactorial condition with many modifiable and non-modifiable factors involved. Even after thoroughly evaluating recurrent pregnancy loss etiology and risk factors, up to 75% of cases remain unexplained. This review aimed to summarize and critically analyze accumulated knowledge on the etiology, risk factors, relevant diagnostic options, and management approach to recurrent pregnancy loss. The relevance of various factors and their proposed roles in recurrent pregnancy loss pathogenesis remains a matter of discussion. The diagnostic approach and the management largely depend on the etiology and risk factors taken into consideration by a healthcare professional as a cause of recurrent miscarriage for a particular woman or couple. Underestimation of social and health consequences of recurrent pregnancy loss leads to compromised reproductive health and psychological well-being of women after miscarriage. Studies on etiology and risk factors for recurrent pregnancy loss, especially idiopathic, should be continued. The existing international guidelines require updates to assist clinical practice. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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13 pages, 1415 KiB

Open AccessReview

Giant Juvenile Fibroadenoma: Case Report and Review of the Literature

by Anna Eleftheriades, Ermioni Tsarna, Konstantina Toutoudaki, Eleni Paschalidou, Nikolaos Christopoulos, Ioannis Georgopoulos, Georgia Mitropoulou and Panagiotis Christopoulos

J. Clin. Med. 2023, 12(5), 1855; https://doi.org/10.3390/jcm12051855 - 26 Feb 2023

Cited by 5 | Viewed by 7524

Abstract

Fibroadenomas are common benign breast tumors. Fibroadenomas that exceed 5 cm in diameter, weigh more than 500 g, or replace more than four-fifths of the breast are characterized as giant. A fibroadenoma diagnosed in patients during childhood or adolescence is characterized as juvenile. [...] Read more.

Fibroadenomas are common benign breast tumors. Fibroadenomas that exceed 5 cm in diameter, weigh more than 500 g, or replace more than four-fifths of the breast are characterized as giant. A fibroadenoma diagnosed in patients during childhood or adolescence is characterized as juvenile. An extensive PubMed search of the literature in English up until August 2022 was performed. In addition, a rare case of a gigantic fibroadenoma in an 11-year-old premenarchal girl who was referred to our adolescent gynecology center is presented here. Eighty-seven cases of giant juvenile fibroadenomas have been reported in the literature along with our case. Patients with giant juvenile fibroadenoma presented at a mean age of 13.92 years and usually after menarche. Juvenile fibroadenomas are usually unilateral, occurring either in the right or the left breast; the majority of them are diagnosed when they are already more than 10 cm in size, and they are most frequently treated with total lump excision. Differential diagnosis includes phyllodes tumors and pseudo-angiomatous stromal hyperplasia. Conservative management is feasible, but surgical excision is recommended to patients with suspicious imaging features or when the mass grows rapidly. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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Other

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13 pages, 762 KiB

Open AccessStudy Protocol

Application of Biomarkers in Obese Infertile Women: A Genetic Tool for a Personalized Treatment

by Charalampos Voros, Kyriakos Bananis, Angeliki Papapanagiotou, Abraham Pouliakis, Konstantina Mavriki, Ioannis Gkaniatsos, Maria Anastasia Daskalaki, Ioannis Prokopakis, Charalampos Tsimpoukelis, Aristotelis-Marios Koulakmanidis, Menelaos Darlas, Sofia Anysiadou, Georgios Daskalakis and Ekaterini Domali

J. Clin. Med. 2024, 13(8), 2261; https://doi.org/10.3390/jcm13082261 - 13 Apr 2024

Viewed by 1016

Abstract

This study investigates links between CART and leptin gene expression, FSH receptor Asn680Ser polymorphism, and reproductive hormones in morbidly obese patients under 40 years old, facing infertility, and undergoing bariatric surgery. A total of 29 women were included in this study. A hormonal [...] Read more.

This study investigates links between CART and leptin gene expression, FSH receptor Asn680Ser polymorphism, and reproductive hormones in morbidly obese patients under 40 years old, facing infertility, and undergoing bariatric surgery. A total of 29 women were included in this study. A hormonal profile along with detection of CART and leptin gene expression was evaluated before and after bariatric surgery. Additionally, the presence or absence of Asn680Ser of the FSHR gene was studied. Following bariatric surgery, a mean reduction in BMI (16.03 kg/m²) was observed in all women. FSH levels preoperatively varied significantly among genotypes, with medians of 8.1, 9.5, and 10.3 for individuals without polymorphism, heterozygotes, and homozygotes, respectively (p = 0.0408). Post surgery, marginal differences in FSH levels were observed (5.8, 7.1, and 8.2, respectively) (p = 0.0356). E2 and LH levels exhibited no significant genotype-based differences pre and post surgery. Presurgical E2 levels were 29.6, 29.8, and 29.6, respectively (p = 0.91634), while postsurgical levels were 51.2, 47.8, and 47 (p = 0.7720). LH levels followed similar patterns. Our findings highlight bariatric surgery’s positive impact on BMI reduction and its potential connection to genetic markers, hormones, and infertility. This suggests personalized treatments and offers a valuable genetic tool for better fertility outcomes in obese individuals. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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16 pages, 2463 KiB

Open AccessSystematic Review

Maternal Blood Adipokines and Their Association with Fetal Growth: A Meta-Analysis of the Current Literature

by Ioakeim Sapantzoglou, Dimitrios-Efthymios Vlachos, Dimitrios Papageorgiou, Antonia Varthaliti, Kalliopi Rodolaki, Maria Anastasia Daskalaki, Alexandros Psarris, Vasilios Pergialiotis, Sofoklis Stavros, Georgios Daskalakis and Angeliki Papapanagiotou

J. Clin. Med. 2024, 13(6), 1667; https://doi.org/10.3390/jcm13061667 - 14 Mar 2024

Cited by 2 | Viewed by 1129

Abstract

Background: Assessing fetal growth constitutes a fundamental aim within the realm of prenatal care. Impaired prenatal growth increases the risk of perinatal mortality, morbidity, and poor newborn outcomes. Growth restriction increases the risk of premature birth problems, as well as the risk [...] Read more.

Background: Assessing fetal growth constitutes a fundamental aim within the realm of prenatal care. Impaired prenatal growth increases the risk of perinatal mortality, morbidity, and poor newborn outcomes. Growth restriction increases the risk of premature birth problems, as well as the risk of poor neurodevelopmental outcomes and future non-communicable disorders such as hypertension and metabolic syndrome as adults. The objective of this systematic review is to accumulate current literature evidence to assess the patterns of serum adipokine levels among women with growth-restricted fetuses and assess their potential alterations in those high-risk pregnancies. Methods: Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar databases were systematically searched from inception until 31 March 2023. All observational studies reporting serum adipokine values among women with appropriately grown and growth-restricted fetuses were held eligible. Results: The current systematic review encompassed a total of 20 studies, incorporating a patient population of 1850 individuals. Maternal blood leptin emerged as the adipokine most investigated, as evidenced by 13 studies encompassing a collective sample size of 1081 patients, all of which explored its potential correlation with intrauterine growth restriction. Elevated levels of leptin were detected in fetuses with intrauterine growth restriction, although the observed difference did not reach statistical significance. Furthermore, regarding adiponectin, the meta-analysis conducted indicated that there were not any statistically significant differences observed in the mean values of adiponectin. The available data on the remaining three adipokines were extremely limited, making it difficult for any solid conclusions to be extracted. Conclusions: Though limited and inconsistent, the existing data suggest that fetal growth restriction is not linked to leptin, adiponectin, visfatin, resistin, or RBP4. More substantial prospective studies are needed to comprehend the importance of established and novel adipokines. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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11 pages, 412 KiB

Open AccessStudy Protocol

Prospective Study on the Correlation between CART and Leptin Gene Expression, Obesity, and Reproductive Hormones in Individuals Undergoing Bariatric Surgery

by Charalampos Voros, Kyriakos Mpananis, Angeliki Papapanagiotou, Abraham Pouliakis, Despoina Mavrogianni, Konstantina Mavriki, Ioannis Gkaniatsos, Christina Karasmani, Ioannis Prokopakis, Menelaos Darlas, Sofia Anysiadou, George Daskalakis and Ekaterini Domali

J. Clin. Med. 2024, 13(4), 1146; https://doi.org/10.3390/jcm13041146 - 18 Feb 2024

Viewed by 1074

Abstract

Obesity, a global health concern affecting 650 million individuals of all ages worldwide, prompts health complications, including fertility issues. This research investigates the impact of bariatric surgery on morbidly obese females under 40, examining the relationship between CART and leptin gene expressions and [...] Read more.

Obesity, a global health concern affecting 650 million individuals of all ages worldwide, prompts health complications, including fertility issues. This research investigates the impact of bariatric surgery on morbidly obese females under 40, examining the relationship between CART and leptin gene expressions and reproductive hormones. Post-surgery, a significant reduction in BMI (16.03 kg/m², n = 29) was observed, accompanied by notable hormonal changes. FSH levels showed a mean difference of 3.18 ± 1.19 pre- and post-surgery (p < 0.001), LH levels exhibited a mean difference of 2.62 ± 1.1 (p < 0.001), E2 levels demonstrated a mean difference of 18.62 ± 5.02 (p < 0.001), and AMH levels showed a mean difference of 3.18 ± 1.19 (p < 0.001). High CART and leptin expressions before treatment correlated with lower expressions after treatment. These findings, rooted in statistically significant correlations (CART: rs = 0.51, p = 0.005; leptin: rs = 0.75, p < 0.001), shed light on potential molecular pathways connecting gene expressions with reproductive hormones post-bariatric surgery. Our study uniquely investigates the interplay between genetic markers, infertility, and bariatric surgery in women. It stands out by providing distinctive insights into the development of personalized treatment strategies for obesity-related infertility, contributing to a deeper understanding of this complex medical issue. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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10 pages, 1981 KiB

Open AccessSystematic Review

Chronic Stress in Pregnancy Is Associated with Low Birth Weight: A Meta-Analysis

by Alkis Matsas, Panagiota Panopoulou, Neofyta Antoniou, Alexandra Bargiota, Alexandros Gryparis, Nikolaos Vrachnis, George Mastorakos, Sophia N. Kalantaridou, Theodoros Panoskaltsis, Nikos F. Vlahos and Georgios Valsamakis

J. Clin. Med. 2023, 12(24), 7686; https://doi.org/10.3390/jcm12247686 - 14 Dec 2023

Cited by 3 | Viewed by 1874

Abstract

Background and objectives: Chronic activation of the stress system has cumulative effects on the body, and it places individuals at risk for adverse health outcomes. Chronic stress has been assessed by health questionnaires in pregnancy. During the perinatal period, mothers experience increased physical [...] Read more.

Background and objectives: Chronic activation of the stress system has cumulative effects on the body, and it places individuals at risk for adverse health outcomes. Chronic stress has been assessed by health questionnaires in pregnancy. During the perinatal period, mothers experience increased physical and emotional demands. Chronic stress interferes with hormonal functions in mothers and infants. This meta-analysis studies the effect of maternal chronic stress during pregnancy, as assessed by established stress questionnaires, on the birth weight of their full-term infants. Design and methods: According to our criteria and after research collection, we obtained 107 studies and we conducted two types of analyses: a logistic (N = 22,342) and linear regression analysis (N = 7431). Results: Our results show that chronic stress is associated with a statistically significant risk of low birth weight (OR = 1.50, CI 95% = [1.13; 1.99], p ≤ 0.02).Conclusions: Increased maternal chronic stress, as assessed by questionnaires, in pregnancy is associated with a low-birth-weight baby. The above meta-analysis indicates that maternal high chronic stress questionnaire scores could be used as a clinical tool in order to assess low-birth-weight risk. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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12 pages, 4776 KiB

Open AccessCase Report

Obstructed Hemivagina with Ipsilateral Renal Agenesis: A Challenging Case Report and a Management Flow Chart

by Ewelina Malanowska-Jarema, Andrzej Starczewski, Yana Osnytska, Mariola Krzyścin, Elżbieta Sowińska-Przepiera, Matteo Balzarro and Emanuele Rubilotta

J. Clin. Med. 2023, 12(23), 7227; https://doi.org/10.3390/jcm12237227 - 22 Nov 2023

Viewed by 1288

Abstract

We present here a case of complex uterine anomaly—obstructed hemivagina with ipsilateral renal agenesis (OHVIRA), also known as Herlyn-Werner-Wunderlich syndrome in a 13-year-old girl with a history of recurrent urinary tract infections (rUTI). In the emergency room, a trans-abdominal sonography revealed an ovarian [...] Read more.

We present here a case of complex uterine anomaly—obstructed hemivagina with ipsilateral renal agenesis (OHVIRA), also known as Herlyn-Werner-Wunderlich syndrome in a 13-year-old girl with a history of recurrent urinary tract infections (rUTI). In the emergency room, a trans-abdominal sonography revealed an ovarian cyst and renal agenesis, without any suspicion of vaginal obstruction. This led to a delay in the diagnosis of this uncommon anomaly. Finally, MRI findings confirmed the presence of OHVIRA syndrome. As the congenital anomalies of the kidney and urinary tract (CAKUT) are present in almost one third of cases associated with genital malformations, urologists should carefully screen patients with rUTI. The patient underwent simultaneous laparoscopy and vaginoscopy, which was in our opinion the most appropriate therapeutic decision. In this article, we are also going to discuss the role of laparoscopy in the management of OHVIRA syndrome, as well as other surgical techniques described in the literature. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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