Interstitial Ectopic Pregnancy-Case Reports and Medical Management.

The term intramural (interstitial) ectopic pregnancy refers to a pregnancy developing outside the uterine cavity, with a gestational sac implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium. The prevalence rate of interstitial pregnancy (IP) is 2-4% of all ectopic pregnancies. Surgery is the primary treatment for interstitial ectopic pregnancy; the pharmacological management of ectopic pregnancy, including IP, in asymptomatic patients includes systemic administration of methotrexate. In this report, we present two cases of this rare pregnancy type, reviewing our management technique and treatment ways presented in the literature. In our patients, the management was initially conservative and included methotrexate, administered as intravenous bolus injection, regular beta-human chorionic gonadotropins (ß-HCG) level measurements in peripheral blood, and monitoring of the patient's general condition. Due to signs of intra-abdominal bleeding in patient A and inadequate ß-HCG level reduction in patient B, both patients eventually underwent laparoscopic cornual resection. Pregnancy, implanted into the interstitial part of the Fallopian tube and surrounded by myometrial tissue with myometrial invasion of the trophoblast, poses a serious diagnostic challenge to modern gynecology due to particularly low sensitivity and specificity of symptoms, and may require both pharmacological and surgical treatment.

Women's Healthcare Services since the COVID-19 Pandemic Outbreak in Poland.

The COVID-19 pandemic had a direct impact on the extent of guaranteed healthcare services. Many gynecologists', obstetricians', and midwives' offices were closed, laboratories suspended their activities, the collection of necessary tests was delayed, and women had to wait much longer for test results than they had to previously. General women's healthcare prophylactic programs were suspended or delayed. In 2020, screening financed by public funds covered less than one-seventh of the female population in Poland. As medical teams, professionals, clinicians, and scientists, we have been facing a challenge to help, protect, and care for one of the most vulnerable population groups, pregnant women. A significant part of that challenge has been in preventing the spread of severe COVID-19, along with other preventable diseases, among women who are pregnant, who are in labor, or who have recently given birth.

Novel markers in the diagnostics of endometriomas: Urocortin, ghrelin, and leptin or leukocytes, fibrinogen, and CA-125?

OBJECTIVE: CA-125 protein is used as a marker in clinical practice for the diagnosis of endometriomas. The aim of this study was to determine whether endometriomas are accompanied by an increased level of urocortin, ghrelin, and leptin, as well as the increased parameters of blood cell count, fibrinogen, and CA-125. MATERIALS AND METHODS: The study included 86 women aged 18-38 years who had been treated laparoscopically for lesions in the adnexa with the characteristics of endometriomas and mature teratoma, during the period September 2009 to November 2012. The statistical analysis was performed using the nonparametric Mann-Whitney U test and the Spearman rank correlation coefficients (p ≤ 0.05). RESULTS: The medians were 105.31 pg/mL versus 120.84 pg/mL for urocortin, 7.16 pg/mL versus 9.13 pg/mL for leptin and 584.33 pg/mL versus 657.82 pg/mL for ghrelin (p > 0.05), respectively. Analyzing the parameters of blood cell count, statistically significant differences were shown in the respective groups for leucocyte level (5.35 × 10(9)/L vs. 6.7 × 10(9)/L; p = 0.029), fibrinogen level (3.12 mg% vs. 2.57 mg%; p = 0.001), and CA-125 (36.50 U/mL vs. 15.08 U/mL; p = 0.001). CONCLUSION: In conclusion, the prognostic values for CA-125, leukocytes, and fibrinogen may prove a very useful tool for the diagnosis of lesions in the adnexa of the type endometriomas.

Assessment of pain and stress intensity among women with ovarian endometriomas versus teratomas.

BACKGROUND: In recent years, numerous studies have considered endometriosis to be a subclinical, local inflammatory process in the pelvic peritoneum, the main symptom of which is pain. OBJECTIVES: To assess pain intensity and pain-related stress in women with ovarian endometriomas versus teratomas. METHODS: In total, 860 women (18 to 38 years of age) treated laparoscopically for lesions in the adnexa between September 2006 and November 2013 were included in the present study. After an intraoperative review of their histopathological lesions, the patients were divided into two study groups: group E (n=480), with histopathologically confirmed ovarian endometriomas; and group T (n=380), after laparoscopic treatment of ovarian teratomas. A questionnaire was generated for the study and completed by each group. Statistical analysis was performed using the Mann-Whitney U test (P≤0.05). RESULTS: Median pain scores for group E versus group T were as follows: pain during menstruation, 6 versus 3 (P=0.001); pain outside of menstruation (in professional life), 2 versus 2 (P=0.014); and pain during sexual intercourse, 3 versus 1 (P=0.006). Pain-related stress scores were higher in group T versus group E (5 versus 3; P=0.007). CONCLUSION: Ovarian endometriomas caused more pain than ovarian teratomas, likely due to the endometrial tissue component and not a mass effect. The assessment of pain and pain-related stress associated with the pelvis minor showed a high level of pain intensity and lower level of pain-related stress among patients with ovarian endometriomas.

The role of chemokine and non-chemokine factors in pain-related complaints in patients with endometrial cysts.

OBJECTIVES: Endometriosis is a chronic disease manifested as peritoneal endometrial implants and adhesions, as well as endometrial cysts, with pain as the dominant component. THE AIM: The aim of the study was to evaluate the role of chemokine (MCP-1, MCP-2, MIP-1, MIP-1 and RANTES) and non-chemokine (urocortin, ghrelin, and leptin) factors in the intensity of pelvic pain in women with endometrial cysts. MATERIAL AND METHODS: A total of 86 women, aged 18-38, treated laparoscopically between September 2009 and November 2012, due to adnexal changes, i.e. endometrial cysts and mature teratomas, were recruited for the study. On a numeric rating scale, i.e. PSS (Pain Sensation Scale--according to Johnson), the patients rated pain intensity. The level of pain-related stress was investigated with the Pain Distress Scale (PDS, according to Johnson). RESULTS: Medians for MCP-1, MCP-2, MIP-1, MIP-1 and RANTES concentrations were not statistically significantly different. The respondents rated pain intensity during menses as 6 and 3 points in the E and T groups, respectively (6 vs. 3 points; p=0.001). Statistically significant differences were also observed for pain intensity during work (apart from menses), (2 vs. 2 points, p=0,014) and during sexual intercourse (apart from menses) (3 vs. 1 points, p=0.006). Pain-related stress levels were higher in the T group as compared to the E group (3 vs. 5 points; p=0.007). CONCLUSIONS: It seems safe to conclude that chemokines and leptin may play a significant role in the occurrence of pain complaints among women with endometrial cysts. Further research might result in implementation of new treatment methods for pain management, especially in terms of pharmacotherapy.

Do inflammatory factors play a significant role in etiopathogenesis of endometrial cysts? Part 1.

UNLABELLED: Endometriosis is an estrogen-related chronic condition which consists in the implantation and growth of endometrial cells outside the uterine cavity. It has an immune and inflammatory background, and to-date the precise etiopathogenesis of endometrial cysts has not been unequivocally defined. The objective of the study was evaluation of the indicators of the inflammatory state, including RANTES and the levels of C-reactive protein, leukocytes, fibrinogen and iron in the blood serum of patients with endometrial cysts (n=48) and benign ovarian tumours of mature teratoma type (n=38). Statistical analysis was performed using the Mann-Whitney Rank Sum Test. The p values p<0.05 were considered statistically significant. RESULTS: While comparing the results, respectively in groups, the mean levels in blood serum were as follows: RANTES 31,429.79 pg/ml (from 26,576.6-99,605.00) vs. 26,988.72 pg/ml (from 26,013.58-113,435.00) for p=0.428; CRP and WBC 2.13 vs. 1.54 mg/l; p=0.076 and 5.35 vs. 6.7; p=0.029; fibrinogen 3.12 vs. 2.57 mg%; p<0.001); iron level 87.20 vs. 78.01 ug/dl for p=0.430, and CA-125 36.50 vs. 15.08 U/ml; p<0.001). CONCLUSIONS: Statistically significant differences were observed in the levels of WBC, fibrynogen and CA-125 in blood serum. Therefore, the role of the inflammatory factor in the etiopathogenesis of endometrial cysts still remains unexplained, and the presented study may emerge as pioneer investigations in the area of etiology of endometriosis.