Adverse events and complications after magnetic resonance-guided focused ultrasound (MRgFUS) therapy in uterine fibroids - a systematic review and future perspectives.

OBJECTIVES: The aim of this review was to analyze and summarize the most common adverse events (AEs) and complications after magnetic resonance-guided focused ultrasound (MRgFUS) therapy in uterine fibroids (UFs) and to establish the risk factors of their occurrence. METHODS: We searched for original research studies evaluating MRgFUS therapy in UFs with outcomes containing AEs and/or complications in different databases (PubMed/MEDLINE, SCOPUS, COCHRANE) until March 2022. Reviews, editorials, opinions or letters, case studies, conference papers and abstracts were excluded from the analysis. The systematic literature search identified 446 articles, 43 of which were analyzed. RESULTS: According to available evidence, the overall incidence of serious complications in MRgFUS therapy is relatively low. No AEs/complications were reported in 11 out of 43 analyzed studies. The mean occurrence of all AEs in the analyzed material was 24.67%. The most commonly described AEs included pain, skin burns, urinary tract infections and sciatic neuropraxia. Major AEs, such as skin ulcerations or deep vein thrombosis, occurred in 0.41% of cases in the analyzed material. CONCLUSION: MRgFUS seems to be safe in UF therapy. The occurrence of AEs, especially major ones, is relatively low in comparison with other methods. The new devices and more experience of their users seem to reduce AE rate. The lack of unification in AE reporting and missing data are the main issues in this area. More prospective, randomized studies with unified reporting and long follow-up are needed to determine the safety in a long-term perspective.

Introducing and Implementing Genetic Assessment in Cardio-Obstetrics Clinical Practice: Clinical and Genetic Workup of Patients with Cardiomyopathy.

Cardiovascular disease (CVD) during pregnancy varies significantly worldwide, influenced by factors such as access to healthcare, delayed diagnosis, causes, and risk factors. Our study sought to explore the spectrum of CVD present in pregnant women in the United Arab Emirates to better understand this population's unique needs and challenges. Central to our study is an emphasis on the importance of implementing a multidisciplinary approach that involves the collaboration of obstetricians, cardiologists, geneticists, and other healthcare professionals to ensure that patients receive comprehensive and coordinated care. This approach can also help identify high-risk patients and implement preventive measures to reduce the occurrence of adverse maternal outcomes. Furthermore, increasing awareness among women about the risk of CVD during pregnancy and obtaining detailed family histories can help in the early identification and management of these conditions. Genetic testing and family screening can also aid in identifying inherited CVD that can be passed down through families. To illustrate the significance of such an approach, we provide a comprehensive analysis of five women's cases from our retrospective study of 800 women. The findings from our study emphasize the importance of addressing maternal cardiac health in pregnancy and the need for targeted interventions and improvements in the existing healthcare system to reduce adverse maternal outcomes.

Regulation of antral follicular growth by an interplay between gonadotropins and their receptors.

Knowledge of the growth and maturation of human antral follicles is based mainly on concepts and deductions from clinical observations and animal models. To date, new experimental approaches and in vitro data contributed to a deep comprehension of gonadotropin receptors' functioning and may provide new insights into the mechanisms regulating still unclear physiological events. Among these, the production of androgen in the absence of proper LH levels, the programming of follicular atresia and dominance are some of the most intriguing. Starting from evolutionary issues at the basis of the gonadotropin receptor signal specificity, we draw a new hypothesis explaining the molecular mechanisms of the antral follicular growth, based on the modulation of endocrine signals by receptor-receptor interactions. The "heteromer hypothesis" explains how opposite death and life signals are delivered by gonadotropin receptors and other membrane partners, mediating steroidogenesis, apoptotic events, and the maturation of the dominant follicle.

Prevalence and associated psychological risk factors of postpartum depression: a cross-sectional study.

This cross-sectional study aimed to evaluate the prevalence of postpartum depression and the associated risk factors in a sample of Italian women at three months after delivery. Eighty women were screened by completing the Edinburgh Postnatal Depression Scale (EPDS). Women with a score ≥10 were evaluated as positive and other variables were detected through the administration of the Postpartum Depression Predictors Inventory.The prevalence of postpartum depression in the sample was 11.25% (EPDS score >10). A statistically significant relationship was found between the predisposition to postnatal depression and various risk factors such as prenatal depression, stressful life experiences marital problems. Furthermore, strong emotional and instrumental support from the partner and a good economic status can represent protective factors. It is essential to promote an integrated approach to postpartum affective disorders in which psychosocial risk factors are taken into account, and adequate screening programs are implemented.Impact StatementWhat is already known on this subject? Pregnancy can cause emotional stress for women with consequent development, in some cases, of mood disorders such as postpartum depression.What do the results of this study add? According to this study, women suffering from postpartum depression showed a significant tendency to anxiety and depression, low perceived support from the partner, and low socio-economic status.What are the implications of these findings for clinical practice and/or further research? It would be desirable to promote an integrated approach to postpartum affective disorders in which psychosocial risk factors are taken into account and adequate screening programs are implemented.

The Medical Training Evaluation Questionnaire (MeTrE-Q): a multidimensional self-report instrument for assessing the quality of midwifery students' education.

This study aims to understand the factors that can hinder Italian midwifery students' educational process, what messages are given to students during their clinical practice, and how students interact with tutors and other professionals. Seven hundred and eighty Italian students of midwifery were asked to answer an Internet-based questionnaire regarding their own opinions concerning their theoretical-practical formative path. For male Italian students, satisfaction is lower than female students as well as for students from Southern than Northern Italy. Students are dissatisfied with the quality of their academic and practical training, particularly regarding recognising their professional role and their relationship with tutors. Based on these data, it is essential to design a formative path for midwives that considers students' opinions and the positive experiences of other countries.Impact StatementWhat is already known on this subject? Several studies underscore the poor preparation of students for learning in clinical settings. The current reality of the Italian academic path in most universities disregards midwifery students' expectations and formative needs.What do the results of this study add? For male Italian students, satisfaction is lower than for female students and students from Southern than Northern Italy. Students are dissatisfied with the quality of their academic and practical training, particularly regarding recognising their professional role and their relationship with tutors.What are the implications of these findings for clinical practice and/or further research? It is essential to design a formative path for midwives that considers students' opinions and other countries' positive experiences.

Religiosity among women undergoing pregnancy termination for medical reasons: the experiences and views of Polish women.

OBJECTIVES: The study aimed to determine the influence of religious and moral beliefs on contraceptive use, assisted reproduction and pregnancy termination in Polish women requesting a termination of pregnancy for medical reasons. METHODS: Between 1 June 2014 and 31 May 2016, women deemed eligible for a termination of pregnancy for medical reasons at a Polish tertiary care centre received an anonymous questionnaire comprising 65 items. A total of 150 completed questionnaires were collected. RESULTS: Of the respondents, 95% described themselves as Catholics, including 60% practising Catholics. The study revealed a discrepancy between respondents' beliefs and the teachings of the Catholic Church: an overwhelming majority of respondents used contraception, and 79% were in favour of in vitro fertilisation and believed the treatment should be refunded by the state. Interestingly, 66% of the respondents who attended confession did not perceive abortion as sinful. CONCLUSION: The study detected a considerable discrepancy between declared religiosity and individual interpretations of the commandments and teachings of the Catholic Church. Despite stating they were Catholics, most women did not perceive abortion as sinful and did not follow the teachings of the Catholic Church regarding the sacraments for deceased children.

Perceptions of attending medical staff by women accessing pregnancy termination in Poland: a qualitative study.

OBJECTIVES: Polish society is strongly influenced by the Catholic Church and Poland has one of the most restrictive abortion laws in Europe. We attempted to gather information by questionnaire from women considering termination of pregnancy (TOP). Women were asked about their perceptions of the attending medical staff and whether they felt they had been fully informed of their rights, as well as about conduct of the procedure itself in light of physicians' use of the 'conscience clause'. METHODS: Between June 2014 and May 2016 all women deemed eligible for TOP for medical reasons were asked to complete an anonymous questionnaire (n = 240). A total of 150 questionnaires (62.5%) were returned and analysed. RESULTS: Most respondents (95%) lived in a town or city, and a significant number (40%) lived outside the area where the study centre was located. The main reason for such a large group of out-of-region respondents (53%) was the lack of centres offering TOP in the area where the women lived. Only one attending obstetrician did not support a decision to abort the pregnancy. Although 65% of treating physicians supported the woman's decision, only 8% were willing to perform the procedure themselves. CONCLUSION: Most regional centres offer no access to TOP, despite the legal right of women to abort their pregnancy in the event of a severe fetal defect. Some physicians refuse to perform abortions, citing conscientious objection. Double standards among treating physicians have been detected, as many support the decision of their patient but refuse to perform the procedure themselves.

Vitamin D and Uterine Fibroids-Review of the Literature and Novel Concepts.

This article provides a detailed review of current knowledge on the role of vitamin D and its receptor in the biology and management of uterine fibroids (UFs). Authors present ideas for future steps in this area. A literature search was conducted in PubMed using the following key words: "uterine fibroid" and "vitamin D". The results of the available studies, published in English from January 2002 up to April 2018, have been discussed. Vitamin D is a group of steroid compounds with a powerful impact on many parts of the human body. This vitamin is believed to regulate cell proliferation and differentiation, inhibit angiogenesis, and stimulate apoptosis. Nowadays, hypovitaminosis D is believed to be a major risk factor in the development of UFs. In many studies vitamin D appears to be a powerful factor against UFs, resulting in inhibition of tumor cell division and a significant reduction in its size, however, the exact role of this compound and its receptor in the pathophysiology of UFs is not fully understood. According to available studies, vitamin D and its analogs seem to be promising, effective, and low-cost compounds in the management of UFs and their clinical symptoms, and the anti-tumor activities of vitamin D play an important role in UF biology. The synergy between vitamin D and selected anti-UF drugs is a very interesting issue which requires further research. Further studies about the biological effect of vitamin D on UF biology are essential. Vitamin D preparations (alone or as a co-drugs) could become new tools in the fight with UFs, with the additional beneficial pleiotropic effect.

[WSPÓLCZESNA DIAGNOSTYKA NOWOTWORÓW NEUROENDOKRYNNYCH Current diagnostics of neuroendocrine tumors].

Neuroendocrine tumors (NEN) are rarely diagnosed neoplasms, which frequency is estimated on about 35 cases/100 000. During last 30 years the number of NEN's new diagnosis increased five-times and nowadays reaches 5,86/100 000/year. It is partially associated with increasing detectability of these tumors. Such diagnostic methods as capsule endoscopy and positron emission tomography are becoming increasingly widely accessible. Though, one should bear in mind that in case of patients diagnosed with NEN cooperation between specialists in different fields of medicine, such as endocrinology, nuclear medicine, oncology, radiology, internal medicine and surgery is needed.

Genitourinary syndrome of menopause - is the problem solved? State of the art 2018.

Vulvovaginal atrophy accompanied by lower urinary tract dysfunction related to low levels of estrogen and androgens is labeled as genitourinary syndrome of menopause (GSM). Although this condition affects most postmenopausal women worldwide, it seems to be underdiagnosed and undertreated. Women should be properly advised to choose an adequate treatment modality to improve their quality of life, sexual relationships and social activity. The aim of this article to is increase knowledge of GSM. The current treatment options, both hormonal and non-hormonal, are reviewed. Topical estrogen therapy still remains the gold standard, but the demand for individually tailored therapy is growing. New treatment modalities are continuously included in clinical practice. They should consider the whole personality of a woman as well as cultural and social factors. Further studies on GSM and on the effectiveness of various treatment options are necessary to achieve this purpose.

Moral dilemmas of women undergoing pregnancy termination for medical reasons in Poland.

OBJECTIVES: We explored the religious views and dilemmas of Polish women making the decision to terminate a pregnancy. The article discusses the highly restrictive legislation and significant influence of the Church on the lives of Polish citizens. METHODS: This study was designed to investigate the effect of religious and political beliefs, social and moral conditioning and professional support on the decision to abort a fetus. A 65-item questionnaire was administered to 60 participants at the time of their pregnancy termination. RESULTS: Pregnancy termination was performed outside the resident county in 32% of cases. Approximately 88% of respondents declared themselves Catholic, but only 22% intended to admit to the pregnancy termination during confession. Five percent of respondents feared the reaction of the priest, while the remaining respondents did not perceive termination of pregnancy for medical reasons as a sin. Of the women who had previously opposed pregnancy termination, 27% changed their mind once they were personally involved. CONCLUSIONS: The decision to abort a pregnancy for medical reasons is sensitive to religious and social determinants, especially in the current political situation in which abortion may become prohibited in Poland. The high response rate (100%) was probably the result of the patients' attitudes: they repeatedly emphasised they were thankful for the help and empathy of the medical personnel and for being allowed to undergo the procedure. In Poland, the majority of centres use conscience clauses to justify their refusal to terminate a pregnancy.

Biopsychosocial Predictors of Postpartum Depression: Protocol for Systematic Review and Meta-Analysis.

During the postpartum period, psychological disorders may emerge. Aims and objectives: With the current study, we aim to explore the biological determinants that act on women during labor and incur the risk for postpartum depression (PPD). To reach the aim, we will perform the following tasks: (i) identify biological peripartum risk factors and calculate pooled prevalence of PPD for each of them; (ii) explore the strength of the relationship between peripartum risk factors and PPD; (iii) rank the predictors by their prevalence and magnitude of association with PPD. The knowledge obtained will support the development and implementation of early diagnostic and preventive strategies. Methods and analysis: We will systematically go through peer-reviewed publications available in the PubMed search engine and online databases: Scopus, Web of Science, EMBASE. The scope of the review will include articles published any time in English, Arabic, or Polish. We will deduplicate literature sources with the Covidence software, evaluate heterogeneity between the study results, and critically assess credibility of selected articles with the Joanna Briggs Institute's bias evaluation tool. The information to extract is the incidence rate, prevalence, and odds ratio between each risk factor and PPD. A comprehensive analysis of the extracted data will allow us to achieve the objectives. The study findings will contribute to risk stratification and more effective management of PPD in women.

Intensification of anxiety, symptoms of depression, and level of social support among women in pathological pregnancy - a cross-sectional preliminary study.

INTRODUCTION AND OBJECTIVE: Women in pathological pregnancy are a group of patients especially exposed to the risk of occurrence of psychological complications. The aim of the study was assessment of the risk of depressive and anxiety disorders, and the relationship between the intensity of symptoms and social support. MATERIAL AND METHODS: The study group were 300 patients hospitalized in the Department of Pathology of Pregnancy. The study was conducted using the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS), the Inventory of Socially Supportive Behaviours (ISSB), and an author-constructed socio-demographic questionnaire. RESULTS: The level of State Anxiety (STAI) was higher in respondents from the study group, compared to the control group. The level of anxiety (HADS-A) was higher in the control group than in women from the study group. The level of social informational support was higher in those from the control group, compared to those from the study group. The level of emotional support was lower in respondents from the study group, compared to those from the control group. Instrumental support negatively correlated with the symptoms of depression among women in physiological pregnancy. The lack of evaluative support statistically significantly correlated with anxiety among women hospitalized before labour. CONCLUSIONS: The results obtained suggest the necessity for the substantive preparation of medical and psychological staff employed in departments of pathology of pregnancy to provide proper emotional and informational support for hospitalized women.

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

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.

Stigma, Social Support, and Decision Satisfaction in Terminations of Pregnancy for Medical Reasons.

Objective: Existing abortion stigma research has rarely isolated the reason for termination; thus, the consequences of termination for medical reasons (TFMR) are poorly understood. We aimed to understand the association of stigma and social support with decision satisfaction in TFMR. Methods: We performed a cross-sectional study on the experiences of 132 individuals who had a TFMR in the second or third trimester. We recruited participants via Facebook. Most participants were non-Hispanic White (85.6%), between 31 and 40 years old (72.7%), highly educated (84.1% with a 4-year degree), and married (89.4%). Participants completed an online demographic data questionnaire, including questions about stigma and social support, and an adapted satisfaction with decision survey. We used t-tests to explore the connection of stigma and social support with decision satisfaction. Results: Results did not reveal an association between stigma and decision satisfaction, but showed that higher social support is associated with higher decision satisfaction. Decision satisfaction was higher in participants who experienced more than one source of support [t(130) = 2.527, p = 0.01], compared with those reporting only one source of support, and in those who experienced support from a relative [t(130) = 1.983, p = 0.049] and physician [t(130) = 2.357, p = 0.020] than in those who did not. Discussion: Social support can alleviate the suffering related to TFMR. Exploring how different forms of social support, including therapy groups, can impact decision satisfaction might help develop interventions to improve postabortion outcomes. Practice Implications: Provider training must encourage providers to (1) support patients having a TFMR and (2) connect patients with other sources of support.

Perceptions of Patient-Centered Care and Their Association With Patient Satisfaction in Abortions for Medical Reasons.

OBJECTIVE: Abortions for medical reasons, which happen in the event of fetal abnormalities or maternal life endangerment, are highly politicized and understudied given their prevalence. Our objective was to understand the health care experiences of U.S. individuals who had an abortion of a wanted pregnancy for medical reasons in the second or third trimester. METHODS: Participants were recruited on Facebook and completed surveys with their demographic information, their perception of their health provider's cultural sensitivity, their patient satisfaction, and their satisfaction with their decision to proceed with an abortion for medical reasons. RESULTS: Participants were 132 women who were mostly between the ages of 31 and 40 (72.7%), highly educated (84.1% had at least a 4-year college degree), and non-Hispanic White (85.6%). There was no statistically significant difference in patients' rated highest average item score on their providers' Competence or Sensitivity; however, average item scores of providers' Competence and Sensitivity were both higher than Respect scores. Linear regression results show that experiencing patient-centered care significantly predicted patient satisfaction (ß = .73, t(131) = 12.03, p < .001) and decision satisfaction (ß = .37, t(131) = 4.63, p < .001). CONCLUSION: Our findings underscore the importance of training providers to deliver patient-centered care that empowers patients to adapt to challenging situations, such as the diagnosis of medical concerns during pregnancy. Providers understanding and supporting the complex process of an abortion for medical reasons can ameliorate the emotional impact of this procedure.

Risk of sexual dysfunctions in breastfeeding females: protocol for a systematic review and meta-analysis.

BACKGROUND: Epidemiological studies do not provide accurate statistics on the percentage of breastfeeding women experiencing sexual dysfunctions and restraining from sexual activity. The data vary between 40% and 83% in the first group and 20-50% in the second one. Despite excessive studies on contributors to intimacy changes, breast feeding received little attention from researchers. The relationship between lactation and postpartum sexual dysfunctions remains unclear. This systematic review and meta-analysis will synthesise available data and establish the link between breast feeding and sexuality problems. METHODS AND ANALYSIS: A comprehensive literature search will be performed in biomedical databases PubMed/Medline, Scopus, Web of Science, EMBASE and CINAHL. We will extract peer-reviewed original studies written in English, Arabic or Polish from 2000 to June 2023. We will also search for reports from international health organisations and local health authorities. The preliminary search was performed on 04 April 2023. The studies must provide data on dysfunction prevalence/incidence and the strength of the relationship between breast feeding and sexuality in generally healthy women. The Covidence software will be used to perform literature screening, data extraction and quality assessment of individual studies. We will use a random-effects model meta-analysis to calculate pooled weighted frequency measures and effect size. Between-study heterogeneity will be assessed with the I2 test. ETHICS AND DISSEMINATION: This meta-analysis does not require ethical approval because it synthesises data from previously published original studies. The final work will be published in a peer-reviewed journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42023411053.

The role of microbiota in the pathophysiology of uterine fibroids - a systematic review.

For a long time, the uterus had been considered a sterile organ, meaning that under physiological conditions the uterus would not be colonized by bacteria. Based on available data, it may be concluded that the gut and uterine microbiome are related, and that the role of this microbiome is greater than expected. Despite being the most common pelvic neoplasms in women of reproductive age, uterine fibroids (UFs) are still poorly understood tumors whose etiology has not been fully determined. This systematic review presents the relationship between intestinal and uterine dysbiosis and uterine fibroids. A systematic review of three medical databases was carried out: the MEDLINE/PubMed, Scopus and Cochrane. In this study, 195 titles and abstracts were reviewed, including only original articles and clinical trials of uterine microbiome criteria. Finally, 16 studies were included to the analysis. In recent years, researchers dealing with reproduction in a broad sense have focused on the microbiome in various locations to study its role in the pathogenesis and, consequently, the prevention and treatment of diseases of the genital organ. Conventional microbial detection methods are not suitable for identifying bacteria, which are difficult to culture. Next-generation sequencing (NGS) provides an easier and faster and more informative analysis of bacterial populations. It seems that gut microbiota dysbiosis has the potential to be a risk factor for uterine fibroids or affect the disease process. Some changes were shown in many types of bacteria, such as Firmicutes, Proteobacteria, Actinobacteria and Verrucomicrobia detected in fecal samples in patients with uterine fibroids. In view of the few results on the link between the microbiome and uterine fibroids, further intensive studies in humans and animal models are necessary, including the possible use of different microbiome modulations in the prevention or treatment of uterine fibroids.

Perinatal Outcomes in Foetuses with Increased Nuchal Translucency and Normal Karyotype: A Retrospective Cohort Study from the United Arab Emirates.

This retrospective case-controlled study analysed the outcome of pregnancies with first-trimester enlarged nuchal translucency (NT) and a normal karyotype. A total of 479 pregnancies with first-trimester NT measurements were grouped as control (370 cases; normal NT) and study (109 cases; enlarged NT, ≥95th percentile; with normal karyotype). Adverse outcomes included miscarriage, intrauterine foetal death, termination of pregnancy, neonatal death, and structural/chromosomal/genetic abnormalities. The study was conducted between June 2016 and June 2022 at the Foetal Maternal Unit of Kanad Hospital, UAE. Overall, the live birth rate in the study group was significantly lower (74.3%) compared to the control (94.1%, p < 0.001). All pregnancy outcomes of this group significantly differed compared to the control. The observed miscarriage level was 9.2% (vs. 1.1%, p < 0.001), intrauterine foetal death was 2.8% (vs. 0%, p = 0.001), spontaneous preterm birthwas 11% (vs. 4.9%, p = 0.020), and termination of pregnancy was 3.7% (vs. 0%, p < 0.001). The presence of foetal abnormalities was also significantly higher in the enlarged NT group at 21% (vs. 3.3%, p < 0.001). Results indicate that enlarged NT is associated with adverse pregnancy outcomes even when the karyotype is normal. Based on these results, a comprehensive review of the guidelines for counselling and managing pregnancies with enlarged NT and a normal karyotype is recommended.