Management of Interstitial Ectopic Pregnancy in a Bicornuate Uterus Simulating an Incomplete Abortion.

The presentation of a bicornuate uterus may include miscarriages and menstrual abnormalities. The diagnosis could be in an incident of caesarean delivery, miscarriage or hysteroscopy. The possibility of misdiagnosis to an ectopic pregnancy is real. There are sonographical similarities between a pregnant horn of a bicornuate uterus and an ectopic pregnancy. We present in this article a case of interstitial pregnancy in a woman with a bicornuate uterus simulating symptoms of miscarriage. Congenital abnormalities necessitate the availability of the best diagnostic tools at the disposal of the medical practitioners. Ultrasound scan is an important aid for practitioners to choose the best therapeutic approach.

Rescue Cervical Cerclage After 24 Weeks and Subsequent Childbirth After 34 Weeks of Gestation.

A defect in the structure or function of the cervix that causes it to fail to contain the fetus intrauterine creates the condition called cervical insufficiency. Typical symptoms are pressure in the area of the pelvis, premature membrane rupture, and cervical dilation without uterine contractions. Surgical treatment includes the technique of cervical cerclage. It is usually performed from week 12 to week 16 of pregnancy. This article presents a case of rescue cervical cerclage after 24 weeks gestation and the observance of the pregnancy that followed. The cerclage was successful in prolonging the gestation of the fetus and no post-operative complications occurred due to the operation. The outcome of the pregnancy was a live and healthy baby born at 34 weeks gestation.

Breaking Bad News During Prenatal Screening: The Role of Professional Obstetricians and Midwives in Greece.

INTRODUCTION: Breaking bad news is one of the most difficult responsibilities in medical practice. Although medical staff in clinical practice often encounter situations that necessitate the announcement of unpleasant news, there is a lack of training regarding their communication with patients and their families. Effective interaction between medical staff and pregnant women constitutes a crucial component of breaking down unpleasant news. This research aimed to investigate the knowledge and attitude of health professionals, particularly obstetricians, and midwives, regarding the announcement of bad news during prenatal screening. METHODS: The study was conducted between September 2017 and April 2018. One hundred professional obstetricians and midwives involved in fetal and prenatal medicine in Greece were part of the study. The study consisted of two parts: the first covered the emotional state of healthcare professionals during the announcement of unpleasant news, and the second covered the appropriate way to inform unpleasant results during prenatal testing. RESULTS: In this study, only 41% of the participants considered that they felt comfortable discussing issues related to the diagnosis of an unpleasant result during prenatal testing with the pregnant woman/patient, or her relatives, and 85% accepted that they had experienced feelings of sadness, anxiety, or guilt when announcing unpleasant results. Furthermore, 87% of the participants believed that the non-verbal communication component (eye contact, body language) plays an important role in breaking bad news. Finally, 65% considered that prolonged monitoring of the ultrasound screen during prenatal screening does not increase the anxiety of pregnant women when carried out for a better medical opinion. CONCLUSIONS: Delivering bad news during prenatal screening creates stress for the parents. As far as the ethical, cultural, psychological, and legal complicity of healthcare professionals is concerned, communicating unpleasant news has been a subject of discussion by many experts. It is important to understand the concerns of women regarding the risks of counseling.

Stress Response Assessment between First and Second Elective Caesarean Sections by Comparing Cortisol Levels.

OBJECTIVES: The aim of this study was to compare the stress response produced during elective CS for the first and second time. For that goal, cortisol blood levels before, during and after childbirth were measured. MATERIALS AND METHODS: We performed this prospective observational study during the period of September 2020 to September 2021. Blood samples were taken from all participants at three different stages. A statistical analysis was performed to compare the CS1 (first elective Caesarean) and CS2 (second elective Caesarean) groups. RESULTS: At every stage, the levels of cortisol were statistically higher in the CS1 group than in the CS2 group. Therefore, CS2 generates a significantly less stressful response than CS1. Between stages, in CS2 cortisol was lowered at a faster rate than in CS1, meaning the stress response initiated was present for a longer time period in the CS1 group. CONCLUSION: A second elective caesarean section is a safe procedure that does not place an unnecessary burden upon the mother. This is an important fact that practitioners can rely upon while designing the ideal management of a pregnant woman for the stressful environment of birth.

Unusual Case of a Parasitic Extra-Uterine Leiomyoma Presenting With Lower Abdominal Pain.

Parasitic fibroids are a rare type of extrauterine benign tumors that may be spontaneous or iatrogenic in origin and often difficult to diagnose due to their various presentations. We report an unusual case of a parasitic leiomyoma in a 33-year-old nulliparous woman with remote pelvic history who presented to our institution with sudden-onset lower abdominal pain. We performed an exploratory laparotomy, which revealed a 6.3x4.6 cm mass in the space of the adnexa of the right parametrium. Histopathological examination revealed features compatible with a leiomyoma. It is clear that physicians need to assess clinical findings and imaging techniques in order to establish a correct diagnosis of parasitic myomas, even when a history of myomectomy or a laparoscopic morcellation is absent.

Researching the Phenomenon of Poor Ovarian Responders and Management Strategies in IVF: A Narrative Review.

This narrative review aims to summarize all the latest studies published between 2015-2021 concerning the management protocols adopted for poor ovarian response (POR) cases. Patients defined as "poor responders" show minimal response to controlled ovarian hyperstimulation, although there is no standard definition for POR. Although infertility specialists are endeavoring to improve cycle outcomes in poor responders by adopting multiple management strategies, still the estimated risk of cycle cancellation is about 20%. All the studies performed during this study period were evaluated and their results were recorded. The latest published protocols to improve oocyte retrieval in poor responders include: anti-Mϋllerian hormone, clomiphene citrate, co-enzyme Q10, corifollitropin, dehydroepiandrosterone, double stimulation, Follicle Stimulation Hormone, Growth Hormone, Gonadotropin-releasing hormone agonists, letrozole, human chorionic gonadotropin, Luteinizing Hormone, progesterone and testosterone. CONCLUSION: Although many strategies have been suggested to manage POR, none has been proven superior to the others. Further large-scale randomized studies are needed to validate experimental techniques leading towards successful individualized treatment regimens.

Prenatal Ultrasound Screening and Women's Expectations: an Original Study.

Background: Prenatal screening offers crucial information about the pregnancy, although sometimes brings forth ethical issues and potentially difficult decisions for pregnant women. Ultrasound screening during pregnancy is both of particular importance and a great challenge. Objective: The objective of this study is to assess women's knowledge and expectations regarding prenatal ultrasound screening in Greece. Methods: The study was conducted between May 2019 and January 2020. Three hundred pregnant women >18 years of age with complete antenatal routine screening, were invited to participate. The questionnaire contained sociodemographic and obstetric history information and highlighted the background knowledge of pregnant women in prenatal screening. Results: In this study, women with university or technological education mentioned in a greater proportion the importance of prenatal screening regarding prevention and treatment of intrauterine diseases. The belief that the pain or sorrow to give birth to a disabled child or one with a genetic disorder might lead parents to the decision to terminate the pregnancy, was supported more by women with a higher educational level. Conclusion: Pregnant women place a great deal of trust in their physician, as a source of information for the fetal well-being. The majority consider prenatal testing mandatory for that matter. Finally, an association between women who abide with prenatal screening and their educational level was noted. Thus, it's more common women who have a higher educational level to seek prenatal screening, than those with lower education level.

Development of a predictive model for luteal phase oocyte retrieval in poor responders undergoing natural cycle IVF.

The aim of this study is the development of a prediction model indicating successful application of Oocyte Retrieval performed during the Luteal Phase (LuPOR) in poor responders, as defined by the retrieval of at least one MII oocyte. Recruitment included 1688 poor responders diagnosed as per Bologna Criteria, undergoing natural cycle ICSI between 2012 and 2020. Oocyte collections were performed during the follicular phase and during the luteal phase similarly. Antral Follicle Count (AFC), Estradiol (E2) levels evaluated on both trigger days prior to Follicular Phase Oocyte Retrieval (FoPOR) and LuPOR, and the number of small follicles 8-12 mm that were not aspirated during FoPOR were identified as predictive factors indicative of an efficient LuPOR practice with an Area Under the Curve (AUC) of 0.86, 0.86, 0.89 as well as 0.82 respectively. The combination of the above-mentioned characteristics into a prediction model provided an AUC of 0.88, specificity and a sensitivity of 0.73 and 0.94 respectively and an accuracy of 0.89. The model provided a positive predictive value (PPV) of 93.5% and a negative predictive value (NPV) of 46.8%. The clinical conclusion of the present study aims to be of added value to the clinician, by providing a prediction model defining the POR population benefiting from LuPOR. The high PPV of this model may renders this tool helpful for the practitioner that considers LuPOR.

The Cognitive Approach to Bioethical Issues in Perinatal Care in Greece.

BACKGROUND AND AIM: Current practice in prenatal diagnosis becomes challenging with new bioethics issues emerging constantly during daily clinical routine. Although fetal interventions are driven by a motivation to improve the health of the fetus, progress in fetal therapies raises issues of maternal autonomy. The objective of this article is to assess bioethics in prenatal diagnosis in Greece as well as bioethics education. METHODS: The study was conducted between October 2018 and December 2019. Two hundred and twenty eligible responders were involved in fetal and perinatal medicine in Greece. The questionnaire was developed as a Likert scale. Part 1 covered the participants' general opinion about bioethics. Part 2 covered ethical dilemmas likely to arise when routine screening presents a complicated result. RESULTS: In the study, 92.3% of the participants considered that the branch of bioethics is necessary in medical practice. Regarding challenging bioethics issues, only 86% of the participants consider that the miscarriage risk should be discussed after an invasive procedure. Furthermore, it is not clear for responders whether informed consent is a medical or legal obligation (43% vs 33%) and whether information should be provided orally or written (49% vs 46%). Finally, 32% of healthcare practitioners declare that they are not fully aware of the law concerning the rights of the fetus. CONCLUSIONS: Although healthcare professionals acknowledge the distinct role of bioethics, mismanagement of ethical dilemmas reveals that under-graduate teaching of this discipline is not addressed effectively. Identifying the parameters that would improve the learning process would make a significant contribution in the routine clinical practice.

Paracentesis of an Ovarian Cyst During Second-Trimester Pregnancy.

A common issue is that modern obstetricians are required to manage ovarian cysts during pregnancy. Most lesions are benign and will spontaneously resolve, with a few exceptions. Management practices include conservative observation or surgery. Asymptomatic women with an ovarian cyst larger than 5 cm should undergo serial ultrasounds up to 16 weeks of pregnancy and, if the mass does not regress, further management with imaging or surgery is to be considered. This article presents a case of an ovarian cyst sized 21 cm in a second-trimester pregnancy and its management. Paracentesis was performed due to persisting symptoms. The procedure was performed with no complications for the mother and no adverse effects for the fetus. The patient was discharged in good health.

Intraoperative Myomectomy during Caesarean Section.

OBJECTIVE: The aim of this article is to support intracaesarian myomectomy as an alternative method of treatment. CASE REPORT: This article presents a case of myomectomy during a caesarean section at 38+1 weeks' gestation, with a subserosal myoma on the left wall of the uterus. CONCLUSION: The postoperative period was free of complications, lending credit to the possibility that intracaesarean myomectomy can have a favourable outcome.

The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment.

Despite recent striking advances in assisted reproductive technology (ART), poor ovarian response (POR) diagnosis and treatment is still considered challenging. Poor responders constitute a heterogeneous cohort with the common denominator of under-responding to controlled ovarian stimulation. Inevitably, respective success rates are significantly compromised. As POR pathophysiology entails the elusive factor of compromised ovarian function, both diagnosis and management fuel an ongoing heated debate depicted in the literature. From the criteria employed for diagnosis to the plethora of strategies and adjuvant therapies proposed, the conundrum of POR still puzzles the practitioner. What is more, novel treatment approaches from stem cell therapy and platelet-rich plasma intra-ovarian infusion to mitochondrial replacement therapy have emerged, albeit not claiming clinical routine status yet. The complex and time sensitive nature of this subgroup of infertile patients indicates the demand for a consensus on a horizontally accepted definition, diagnosis and subsequent effective treating strategy. This critical review analyzes the standing criteria employed in order to diagnose and aptly categorize POR patients, while it proceeds to critically evaluate current and novel strategies regarding their management. Discrepancies in diagnosis and respective implications are discussed, while the existing diversity in management options highlights the need for individualized management.

Treating Infertility: Current Affairs of Cross-border Reproductive Care.

Infertility patients are willing to travel abroad to receive the medical treatment of choice. A 2010 study reported that approximately 25,000 couples travel abroad annually seeking infertility treatment. The purpose of this review is to analyze the criteria and risks related to cross-border reproductive care (CBRC) from the perspective of the patients and explore the issues raised regarding the country of origin and the destination country. A computerized search was performed in PubMed employing respective keywords. The total number of published articles provided by our PubMed search was 1905. Criteria for selecting the destination country include: the economic status, legislation, quality of care and anonymity. Despite the fact that CBRC is becoming a familiar concept, it raises concerns for the practitioner and issues of a social and bioethical nature. Most of them stem from the fact that health care acquires a commercialization aspect. Medical tourism entails several risks, such as misconceptions regarding the destination country, and legal issues arising from differences in the judiciary systems. Larger studies evaluating all aspects of CBRC are imperative. Quality assurance, a consensus and a common platform of practice, along with a system of international governance based on human rights, are a necessity for CBRC patients.