Myeloid-derived suppressor cells as a potential biomarker for recurrent pregnancy loss and recurrent implantation failure: Increased levels of MDSCs in recurrent reproductive failure.

PROBLEM: Recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) represent distinct clinical conditions with established definitions, both of which have been linked to an underlying pro-inflammatory state. This study aimed to explore the levels of monocytic-myeloid-derived suppressor cells (M-MDSCs) and regulatory T cells (TReg ) in a cohort of RPL and RIF women and their potential contribution to RPL and RIF. METHOD OF STUDY: One hundred and eight non-pregnant women were evaluated: 40 RPL, 41 RIF, and 27 fertile healthy controls (HC). A multiparametric flow cytometry approach was utilized to measure and quantify the frequency of M-MDSCs and TReg cells. Cytokine levels in plasma samples were evaluated through a multiplex assay. M-MDSCs levels were significantly higher in RPL and RIF patients compared to HC. RESULTS: M-MDSCs levels were significantly higher in RPL (9.4% [7-11.6]) and RIF (8.1% [5.9-11.6]) patients compared to HC (6% [4.2-7.6]). An optimal cut-off of 6.1% for M-MDSCs disclosed a sensitivity of 75.6% and 89.7% and a specificity of 57.7% and 57.7% in RIF and RPL groups, respectively. A significant negative correlation was observed between M-MDSCs and TReg (p = .002, r = -.51). CONCLUSIONS: Our preliminary data allowed us to build a predictive model that may aid as a potential diagnostic tool in the clinic. These findings could provide a better understanding of these pathologies and a better definition of patients that could benefit from personalized treatments to promote pregnancy. Additional exploration and confirmation in distinct study groups are needed to fully assess the diagnostic capabilities of this biomarker.

Quality of Life in Women after Deep Endometriosis Surgery: Comparison with Spanish Standardized Values.

The quality of life (QoL) of women who have been surgically treated for endometriosis may be severely impaired. Therefore, QoL can be a determining factor in the recovery of these patients. The aims of this study were to evaluate if the QoL of women surgically treated for deep endometriosis differs from a healthy age-matched population from Catalonia (Spain) and to analyze the QoL of these women considering concomitant events. This is an observational cross-sectional study, where 112 women (between 18 and 48 years old), with endometriosis treated by surgery at Hospital Universitario La Paz (Madrid, Spain), were enrolled to assess the QoL using the second version of the 12-item short form (SF-12) questionnaire. The QoL in these women were tested against a reference population of healthy women using a standardized one-sample comparison method. In addition, the QoL was compared according to the pathophysiology and type of surgery. In women with endometriosis, the physical health component, but not mental health component, was positively correlated with age (r = 0.19; p-Value = 0.048). In addition, physical (20.3 ± 29.2) and social functions (29.7 ± 38.3) and the overall physical health component (37.8 ± 19.4) were significantly lower than the reference population. On the contrary, the body pain (64.1 ± 41.2), emotional role (62.5 ± 42.2), mental health (54.4 ± 26.0), vitality (59.3 ± 31.2), and the overall mental health component (59.4 ± 26.6) had significantly higher scores than the reference. The anatomical compartment of endometriosis, reintervention, bowel nodule resection, and fertility preservation did not show statistical differences in QoL. Women with deep endometriosis had worse physical and social functions, and the overall physical health, compared to the norm in Spanish women. Bodily pain, emotional role, vitality, and the overall mental health improved. These areas could be considered protective factors in this disease. Considering the importance of QoL in adjustments in mental and physical health, it would be necessary to improve these areas of QoL in women surgically treated for deep endometriosis.

Immunophenotyping of peripheral blood monocytes could help identify a baseline pro-inflammatory profile in women with recurrent reproductive failure.

Recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) are two well-defined clinical entities, but the role of the monocytes in their pathophysiology needs to be clarified. This study aimed to evaluate the role of the three monocyte subsets (classical, intermediate, and non-classical) and relevant cytokines/chemokines in a cohort of RPL and RIF women to better characterize a baseline proinflammatory profile that could define inflammatory pathophysiology in these two different conditions. We evaluated 108 non-pregnant women: 53 RPL, 24 RIF, and 31 fertile healthy controls (HC). Multiparametric flow cytometry was used to quantify the frequency of surface chemokine receptors (CCR2, CCR5, and CX3CR1) on the monocyte subsets. Cytokines were assessed in plasma samples using a multiplex assay. The CX3CR1+ and CCR5+ intermediate monocytes were significantly higher in RPL and RIF compared to HC. A significant positive correlation was observed between CX3CR1+ intermediate monocytes and IL-17A (P = .03, r = 0.43). The Boruta algorithm followed by a multivariate logistic regression model was used to select the most relevant variables that could help define RPL and RIF: in RPL were CX3CR1 non-classical monocytes, TGF-ß1, and CCR5 intermediate monocytes; in RIF: CCR5 intermediate monocytes and TGF-ß3. The combination of these variables could predict RPL and RIF with 90 % and 82 %, respectively. Our study suggests that a combination of specific blood monocyte subsets and cytokines could aid in identifying RPL and RIF women with a pro-inflammatory profile. These findings could provide a more integrated understanding of these pathologies. Further investigation and validation in independent cohorts are warranted.

Deep Learning to Measure the Intensity of Indocyanine Green in Endometriosis Surgeries with Intestinal Resection.

Endometriosis is a gynecological pathology that affects between 6 and 15% of women of childbearing age. One of the manifestations is intestinal deep infiltrating endometriosis. This condition may force patients to resort to surgical treatment, often ending in resection. The level of blood perfusion at the anastomosis is crucial for its outcome, for this reason, indocyanine green (ICG), a fluorochrome that green stains the structures where it is present, is injected during surgery. This study proposes a novel method based on deep learning algorithms for quantifying the level of blood perfusion in anastomosis. Firstly, with a deep learning algorithm based on the U-Net, models capable of automatically segmenting the intestine from the surgical videos were generated. Secondly, blood perfusion level, from the already segmented video frames, was quantified. The frames were characterized using textures, precisely nine first- and second-order statistics, and then two experiments were carried out. In the first experiment, the differences in the perfusion between the two-anastomosis parts were determined, and in the second, it was verified that the ICG variation could be captured through the textures. The best model when segmenting has an accuracy of 0.92 and a dice coefficient of 0.96. It is concluded that segmentation of the bowel using the U-Net was successful, and the textures are appropriate descriptors for characterization of the blood perfusion in the images where ICG is present. This might help to predict whether postoperative complications will occur during surgery, enabling clinicians to act on this information.

COVID-19 and Pregnancy: Citation Network Analysis and Evidence Synthesis.

BACKGROUND: COVID-19 spread quickly around the world shortly after the first outbreaks of the new coronavirus disease at the end of December 2019, affecting all populations, including pregnant women. OBJECTIVE: The aim of this study was to analyze the relationship between different publications on COVID-19 in pregnancy and their authors through citation networks, as well as to identify the research areas and to determine the publication that has been the most highly cited. METHODS: The search for publications was carried out through the Web of Science database using terms such as "pregnancy," "SARS-CoV-2," "pregnant," and "COVID-19" for the period between January and December 2020. Citation Network Explorer software was used for publication analysis and VOSviewer software was used to construct the figures. This approach enabled an in-depth network analysis to visualize the connections between the related elements and explain their network structure. RESULTS: A total of 1330 publications and 5531 citation networks were identified in the search, with July being the month with the largest number of publications, and the United States, China, and England as the countries with the greatest number of publications. The most cited publication was "Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records" by Chen and colleagues, which was published in March 2020. Six groups identified as being close in the citation network reflect multidisciplinary research, including clinical characteristics and outcomes in pregnancy, vertical transmission, delivery mode, and psychological impacts of the pandemic on pregnant women. CONCLUSIONS: Thousands of articles on COVID-19 have been published in several journals since the disease first emerged. Identifying relevant publications and obtaining a global view of the main papers published on COVID-19 and pregnancy can lead to a better understanding of the topic. With the accumulation of scientific knowledge, we now know that the clinical features of COVID-19 during pregnancy are generally similar to those of infected nonpregnant women. There is a small increase in frequency of preterm birth and cesarean birth, related to severe maternal illness. Vaccination for all pregnant women is recommended. Several agents are being evaluated for the treatment of COVID-19, but with minimal or no information on safety in pregnancy. These results could form the basis for further research. Future bibliometric and scientometric studies on COVID-19 should provide updated information to analyze other relevant indicators in this field.

Human leukocyte antigen-C and killer immunoglobulin-like receptors in reproductive medicine. / Antígeno leucocitario humano C y receptores tipo inmunoglobulina en medicina reproductiva.

Proper communication between natural killer cells and the human leukocyte antigens of the embryonic trophoblast at the maternal-fetal interface during pregnancy is essential for successful reproduction. However, specific combinations of embryonic human leukocyte antigen-C with killer immunoglobulin-like receptors on decidual natural killer cells (the immunological code of pregnancy) can be associated with obstetric morbidity and pregnancy loss. This article presents an updated review of the mechanisms underlying the interaction between embryonic human leukocyte antigen-C and maternal killer immunoglobulin-like receptors and their relevance to the physiology and pathophysiology of human reproduction.

Una adecuada comunicación entre las células asesinas naturales en la interfase materno-fetal con las moléculas de los antígenos de histocompatibilidad del trofoblasto embrionario es clave en el éxito de la reproducción. Sin embargo, combinaciones de determinados antígenos leucocitarios humanos tipo C embrionarios con los receptores tipo inmunoglobulina presentes en las células asesinas naturales deciduales (el código inmunológico del embarazo), pueden asociarse con morbilidad obstétrica y pérdidas gestacionales. En este artículo se presenta una revisión actualizada de los mecanismos subyacentes a la interacción entre el antígeno de histocompatibilidad tipo C embrionario y los receptores tipo inmunoglobulina maternos, y su relevancia tanto en la fisiología como en la fisiopatología de la reproducción humana.

Biomarkers in Ovarian Pathology: From Screening to Diagnosis. Review of the Literature.

BACKGROUND: Ovarian cancer has a low incidence, but high mortality due to a habitual diagnosis in advanced cancer stages. Currently, used biomarkers have good sensitivity, but low specificity. AIM: To determine the usefulness of the biomarkers and algorithms used up to now in the screening, diagnosis, response to treatments and identification of recurrence in patients with ovarian masses. METHODOLOGY: Systematic search of publications in English in the Medline-PubMed database with the terms: "biomarkers", "tumour", "tumour biomarkers", "marker", "tumour marker", "ovarian cancer", "ovarian", "Neoplasms", "cancer", CA-125 Antigen; Human Epididymis-specific Protein E4; Risk of Malignancy Index (RMI); Risk of Ovarian Malignancy Algorithm (ROMA); Ovarian Neoplasms. Original articles, clinical trials, reviews, systematic reviews and meta-analyses, published between January 2000 and November 2020, were selected to determine the usefulness (among others) of CA 125 and HE4 antigen in ovarian cancer. RESULTS: Finally, 39 transcendental publications were selected to write this article to determine the usefulness of tumour markers and algorithms in ovarian cancer. CONCLUSIONS: The usefulness of the tumour markers antigen CA125 and antigen HE4 individually or as a basis for decision-making algorithms has low specificity; however, there is little evidence that confirms their usefulness as markers in ovarian cancer screening.

Functional NK surrogate biomarkers for inflammatory recurrent pregnancy loss and recurrent implantation failure.

PROBLEM: Expansion of circulating NK cells has been related to pregnancy complications. This study aims at investigating several surface NK cell markers to identify a baseline inflammatory profile in women with recurrent pregnancy loss (iRPL) and recurrent implantation failure (iRIF). METHOD OF STUDY: Expression of NKp30, TIGIT, NKp46, and DNAM-1 on total peripheral blood NK subsets, regulatory (CD56bright CD16neg ), and cytotoxic (CD56dim CD16pos/neg ) NK cells was measured. RESULTS: Eighty-three women were recruited and classified into two groups, 58 women with RPL and 25 with RIF. A control group of 31 fertile women was included. Expression of NKp30 on cytNK was significantly higher in RPL (p = .019) and RIF (p < .001) than HC. TIGIT on cytNK cells was also higher in both RPL (p < .001) and RIF (p < .01). An optimal cutoff of 70% for NKp30+ cytNK disclosed a sensitivity of 82%, a specificity of 55%, and 83% PPV for RPL diagnosis. A cutoff level of 83% for TIGIT+ cytNK was chosen to discriminate between healthy controls and RPL women, with PPV of 84%. CONCLUSION: Our preliminary data on this RPL and RIF cohorts suggest a simple diagnostic tool by combining NKp30 and TIGIT on cytNK cells to better identify a subgroup of RPL and RIF patients with a baseline inflammatory profile. A more rigorous selection of these patients through phenotyping peripheral cytNK cells may better define patients that could benefit from an immunomodulatory treatment to prevent further pregnancy losses. The performance of these biomarkers requires further investigation and validation in independent cohorts.

Validación de la versión española del cuestionario Síntomas y Calidad de Vida en los Miomas Uterinos en mujeres con miomatosis uterina / Validation of the Spanish version of the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire in women with uterine myomatosis

OBJETIVO: Validar la versión española de Síntomas y Calidad de Vida en los Miomas Uterinos (SCdV-MU) en mujeres con miomatosis uterina para evaluar la gravedad de los síntomas y su impacto en la calidad de vida relacionada con la salud. MATERIALES Y MÉTODOS: Las participantes fueron reclutadas en consultas de ginecología. El cuestionario SCdV-MU consta de 37 ítems, 8 de los cuales evalúan la gravedad de los síntomas, mientras que los 29 restantes evalúan la calidad de vida relacionada con la salud en 6 subescalas. Se determinaron la consistencia interna, la validez concurrente y discriminante, la fiabilidad test-retest y la sensibilidad al cambio de la escala. RESULTADOS: Un total de 619 pacientes con miomatosis uterina y 57 mujeres sin miomatosis participaron en el estudio. El coeficiente alfa de Cronbach fue de 0,97 y la fiabilidad test-retest de 0,90 para la escala global. El cuestionario SCdV-MU no solo discriminó entre pacientes y controles normales sino también entre pacientes con distintos grados de miomatosis uterina. La escala respondió a los cambios tras el tratamiento, con un tamaño de efecto de 1,2. CONCLUSIONES: La versión española del cuestionario SCdV-MU, administrada en una muestra de la población española, ha demostrado ser una herramienta válida y fiable para diferenciar las pacientes con miomatosis uterina con diferentes grados de síntomas y valorar el impacto de la gravedad de estos síntomas en la calidad de vida relacionada con la salud. Además, el SCdV-MU ha demostrado ser sensible a los cambios generados por el tratamiento de la miomatosis

AIM: To validate the Spanish version of the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire in women with uterine myomatosis, in order to assess severity of symptoms, and their impact on health-related quality of life. MATERIALS AND METHODS: The participants were recruited in gynaecology clinics. The UFS-QoL questionnaire comprises 37 items, 8 of which assess severity of symptoms, and the remaining 29 assess health-related quality of life in 6 subscales. Internal consistency, concurrent and discriminant validity, test-retest reliability, and the scale's sensitivity to change were evaluated. RESULTS: A total of 619 patients with uterine myomatosis, and 57 women without myomatosis, took part in the study. Cronbach's alpha was 0.97, and the test-retest reliability was 0.90 for the overall scale. The UFS-QoL not only discriminated between patients and healthy controls but also between patients with different degrees of uterine myomatosis. The scale responded to changes after treatment with an effect size of 1.2. CONCLUSIONS: The Spanish version of the UFS-QoL questionnaire, used in a sample of the Spanish population, proved a valid and reliable tool to differentiate patients with uterine myomatosis and different grades of symptoms, and to evaluate the impact of the severity of these symptoms on health-related quality of life. In addition, the UFS-QoL proved sensitive to the changes generated by myomatosis treatment

WITHDRAWN: Diagnostic evaluation of uterine myomas.

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Validation of the Spanish version of the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire in women with uterine myomatosis. / Validación de la versión española del cuestionario Síntomas y Calidad de Vida en los Miomas Uterinos en mujeres con miomatosis uterina.

AIM: To validate the Spanish version of the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire in women with uterine myomatosis, in order to assess severity of symptoms, and their impact on health-related quality of life. MATERIALS AND METHODS: The participants were recruited in gynaecology clinics. The UFS-QoL questionnaire comprises 37 items, 8 of which assess severity of symptoms, and the remaining 29 assess health-related quality of life in 6 subscales. Internal consistency, concurrent and discriminant validity, test-retest reliability, and the scale's sensitivity to change were evaluated. RESULTS: A total of 619 patients with uterine myomatosis, and 57 women without myomatosis, took part in the study. Cronbach's alpha was 0.97, and the test-retest reliability was 0.90 for the overall scale. The UFS-QoL not only discriminated between patients and healthy controls but also between patients with different degrees of uterine myomatosis. The scale responded to changes after treatment with an effect size of 1.2. CONCLUSIONS: The Spanish version of the UFS-QoL questionnaire, used in a sample of the Spanish population, proved a valid and reliable tool to differentiate patients with uterine myomatosis and different grades of symptoms, and to evaluate the impact of the severity of these symptoms on health-related quality of life. In addition, the UFS-QoL proved sensitive to the changes generated by myomatosis treatment.

Vacunas terapéuticas del virus del papiloma humano: revisión de la evidencia actual / Therapeutic vaccines of the human papilloma virus: current evidence review

Resumen: OBJETIVO: Evaluar la inmunogenicidad de los distintos tipos de vacunas terapéuticas y de su efecto en las lesiones causadas por el virus del papiloma humano (VPH) después de su aplicación. Además, analizar los estudios de seguridad y las perspectivas de las vacunas terapéuticas contra el VPH. METODOLOGÍA: Estudio retrospectivo efectuado mediante la búsqueda bibliográfica sistemática en la base de datos PubMed, sin restricción de fecha de publicación. Criterio de inclusión: ensayos clínicos aleatorizados (metanálisis y revisiones sistemáticas). Criterios de exclusión: ensayos clínicos en fase preclínica del desarrollo y publicaciones en idiomas distintos al inglés o español. RESULTADOS: Se seleccionaron 30 artículos publicados entre 2000 y 2020. Entre ellos, 5 ensayos clínicos aleatorizados con vacunas terapéuticas que ya han finalizado o aún están en estudio. Las 25 publicaciones restantes incluyen: metanálisis y revisiones sistemáticas de aspectos seleccionados con objetivos primarios y secundarios. CONCLUSIONES: Las vacunas terapéuticas contra VPH se encuentran en fase experimental; hasta ahora se han conseguido resultados prometedores con algunas de ellas. Si bien existen distintos tipos de vacunas terapéuticas, los mejores resultados se han conseguido con las basadas en ADN. Las vacunas VGX-3100 y TS, en fase III, han demostrado diferencias significativas en el aclaramiento viral y la regresión de las lesiones de alto grado en pacientes vacunadas. Una vacuna terapéutica efectiva tendría una repercusión inmediata en la morbilidad y mortalidad por lesiones asociadas al virus.

Abstract: OBJECTIVE: To assess the immunogenicity of different types of therapeutic vaccines and their effect on human papillomavirus (HPV) lesions after application. In addition, to analyze the safety studies and prospects of therapeutic HPV vaccines. METHODOLOGY: Retrospective study based on a systematic literature search of the PubMed database, with no publication date restrictions. Inclusion criteria: randomized clinical trials (meta-analyses and systematic reviews). Exclusion criteria: clinical trials in the pre-clinical phase of development and publications in languages other than English or Spanish. RESULTS: 30 articles published between 2000 and 2020 were selected. Among them, 5 randomized clinical trials with therapeutic vaccines that have already been completed or are still under study. The remaining 25 publications include: meta-analyses and systematic reviews of selected aspects with primary and secondary objectives. CONCLUSIONS: Therapeutic HPV vaccines are in the experimental phase; so far promising results have been achieved with some of them. Although different types of therapeutic vaccines exist, the best results have been achieved with DNA-based vaccines. The VGX-3100 and TS vaccines, in phase III, have demonstrated significant differences in viral clearance and regression of high-grade lesions in vaccinated patients. An effective therapeutic vaccine would have an immediate impact on morbidity and mortality from virus-associated lesions.

Use of contraception by Spanish women after delivery / Hábitos anticonceptivos tras el parto en las mujeres españolas

Objective: To study peripartum use of contraception in women taking long-acting reversible contraceptives (LARCs). Material and methods: Observational, cross-sectional, multicenter, nationwide study of women of reproductive age (18-49 years) attending a gynecology clinic to request LARCs for the first time or to restart treatment. Results: The study population comprised 1,660 patients (1,657 evaluable), with a mean (SD) age of 38.6 (5.7) years. Most already had children (1.9 [0.7] children/patient). During the previous 5 years, 44% of the patients had been pregnant; this was unintended in 10.3% of cases. The main contraceptive method used during the first year after the last delivery was the condom (42.7%), followed by oral contraceptives (16.2%), levonorgestrel-releasing intrauterine devices (7.5%), and the vaginal ring (6.5%). We found that 14.4% of women did not use any contraceptive method during the first year after delivery. Conclusions: LARCs, which are highly effective and easy to apply, continue to be underused after delivery in Spain

Objetivo: estudio de los hábitos anticonceptivos alrededor del embarazo en mujeres que utilizan métodos anticonceptivos reversibles de larga duración. Material y métodos: estudio observacional, transversal, multicéntrico y nacional, en mujeres en edad reproductiva (18-49 años) que acudían a la consulta ginecológica solicitando anticoncepción de larga duración por primera vez o para reiniciar tratamiento. Resultados: se incluyeron 1.660 mujeres (1.657 válidas), con una edad de 38,6 +/- 5,7 años, la mayoría de las cuales ya tenía hijos (1,9 +/- 0,7 hijos/mujer). Un 44% de las pacientes tuvieron un embarazo en los últimos 5 años de los que el 10,3% no fue planificado. El principal método anticonceptivo utilizado durante el primer año después del último parto fue el preservativo (42,7%), seguido de los anticonceptivos orales (16,2%), el dispositivo intrauterino liberador de levonorgestrel (7,5%) y el anillo vaginal (6,5%). Un 14,4% de las mujeres no utilizaron ningún método anticonceptivo durante el primer año posparto. Conclusiones: el uso de métodos anticonceptivos reversibles de larga duración, métodos de mayor efectividad y comodidad, están infrautilizados tras el parto

Barriers to the use of intrauterine devices among healthcare professionals: Evidence against misconceptions / Barreras al uso de los dispositivos intrauterinos entre los profesionales sanitarios: evidencia frente a creencias erróneas

Long-acting reversible contraception (LARC) refers to highly effective methods that are suitable for most women. Despite being the best known long-acting reversible contraception methods, the copper intrauterine device (Cu-IUD) and the hormonal (levonorgestrel) device (LNG-IUD) are used by only 6.9% of women of childbearing age in Spain who use any method of contraception. This may be a consequence of barriers to the use of IUDs among health professionals that affect young and/or nulliparous women in particular. The present review addresses available scientific evidence regarding the main factors creating barriers to the use of intrauterine devices. These factors include possible difficulties during insertion and associated pain, the risk of perforation during the insertion or of expulsion once inserted, the effects on dysmenorrhoea and on menstrual bleeding pattern, the risk of ectopic pregnancy or of pelvic inflammatory disease, the speed of recovery of fertility after removal, the impact of price, and the cost-benefit ratio of intrauterine devices. It also addresses the barrier that results from possible rejection of intrauterine devices by women owing to misconceptions

Los anticonceptivos reversibles de larga duración o LARC (por sus siglas en inglés Long-Acting Reversible Contraception) son métodos altamente efectivos aptos para la mayoría de las mujeres. El dispositivo intrauterino de cobre (DIU-Cu) y el hormonal, con levonorgestrel (DIU-LNG), pese a ser los anticonceptivos reversibles de larga duración más conocidos, son usados en España por el 6,9% de las mujeres en edad fértil que usa algún método. Se cree que esto responde a barreras al uso de dispositivos intrauterinos existentes entre los profesionales sanitarios que afectarían especialmente a mujeres jóvenes y/o nulíparas. En la presente revisión se aborda la evidencia disponible sobre los principales aspectos que generan una barrera al uso de los dispositivos intrauterinos. Estos aspectos incluyen las posibles dificultades durante su inserción y el dolor que esta puede causar, el riesgo de perforación durante la inserción o de expulsión una vez insertado, el efecto sobre la dismenorrea y el patrón de sangrado menstrual, el riesgo de embarazo ectópico o de enfermedad inflamatoria pélvica, la rapidez de recuperación de la fertilidad tras la retirada, el impacto del precio y la relación coste-beneficio de estos métodos. Igualmente, se aborda la barrera que puede suponer el posible rechazo al uso del dispositivo intrauterino por parte de la mujer a consecuencia de creencias erróneas

Influence of intrauterine dispositive in human papillomavirus clearance.

INTRODUCTION: An important inverse relation between IUD use and risk of cervical cancer has been proved. Women who used IUD had half the risk of developing cervical cancer. The mechanism how IUD is a protector factor is still unknown. Could be improving the clearance of HPV infection or stopping progression to cancer from preneoplasic lesion. The aim of the study is to check if IUD increases HPV clearance, that is, checking if after 1 year HPV infection disappears in more patients using IUD than those not using it. STUDY DESIGN: This is a cohort case-control prospective study, carried out in Universitary Hospital La Zarzuela in Madrid, Spain, performed between October 2015 and April 2018. No pregnant women between 25-50 years old, with HPV cervical infection were enrolled. We separated the participants into two groups: an IUD group, with women starting using IUD and non IUD group, with women using any other contraceptive method or none. HPV genotyping of cervical cytology samples were performed initially on enrolment day and one year after. RESULTS: 254 participants were enrolled at the beginning of the study, 85 in the IUD group and 169 in the control group (non IUD). 179 participants completed the study, 54 (31%) in IUD group and 120 participants in non IUD group (69%). 38 women from IUD group cleared HPV infection (69.5%) and 65 women from control group cleared it (54.2%) (p = 0.044). An association in logistic regression was observed in HPV clearance with different factors. Firstly, higher percentage of patients with IUD clear the HPV infection than those in control group significantly associated (OR = 0.698, CI 95%; 0.251-0.998, p = 0.046). Clearance was higher in patients with low-risk HPV infection comparing with high risk HPV (OR = 1.078, CI 95%; 1.126-4.6.281, p = 0.026) and in patients with only one HPV type than those with more than one (OR = 0.194, CI 95%; 0.084-0.403, p < 0.001). CONCLUSIONS: In Spanish women with HPV infection, the HPV clearance between IUD and non IUD groups show results with statistical significance, patients with IUD have higher clearance rates. There were differences also between suffering one HPV type or more than one, and having low-risk HPV or high-risk HPV infection.

Use of the levonorgestrel-releasing intrauterine device in Spain / Uso del dispositivo intrauterino liberador de levonorgestrel (DIU-LNG) en España

Objective: To assess sociodemographic characteristics and the reasons for choosing the 52-mg levonorgestrel-releasing intrauterine device (LNG-IUD) for birth control among Spanish women. Material and methods: Observational, cross-sectional, multicenter, nationwide study women of reproductive age (18-49 years) attending a gynecological clinic to request long-acting reversible contraception (LARC). Results: The study population comprised 1612 women with a mean age of 38.6±5.7 years. Most women (91.7%) were primi/multiparous (1.9±0.7 children/woman), and 78.9% no longer wished to become pregnant. Women had no experience of LARC methods. The gynecologist was the main source of information (67.1%). The main reasons for choosing LARC were contraceptive efficacy (94.0%), long duration of action (62.5%), ease of use (61.3%), and safety (59.9%). Conclusions: Women who choose the LNG-IUD are mainly older than 38 years and primi/multiparous, with no previous experience in the use of LARC. They particularly appreciate contraceptive efficacy, long duration of action, ease of use, and safety

Objetivo: determinar las características sociodemográficas y los motivos de elección del dispositivo intrauterino liberador de levonorgestrel 52mg (DIU-LNG) como método anticonceptivo entre mujeres españolas. Material y métodos: estudio observacional, transversal, multicéntrico y nacional, en mujeres en edad reproductiva (18-49 años) que acudían a consulta ginecológica solicitando anticoncepción de larga duración (LARC). Resultados: la edad media de las mujeres del estudio fue de 38,6±5,7 años, primi/multiparas (91,7%) (1,9±0,7 hijos/mujer), con deseo genésico finalizado (78,9%), sin experiencia en los métodos LARC y el ginecólogo fue la principal fuente de información (67,1%). Los principales motivos de elección fueron la eficacia anticonceptiva (94,0%), larga duración (62,5%), comodidad de uso (61,3%) y seguridad (59,9%). Conclusiones: las mujeres que eligen el DIU-LNG son principalmente mayores de 38 años y primi/multíparas, sin experiencia previa en el uso de los LARC. Valoran principalmente la eficacia anticonceptiva, larga duración, comodidad y seguridad

Updated approaches for management of uterine fibroids.

Uterine anatomy and uterine fibroids (UFs) characteristics have been classically considered as almost a unique issue in gynecology and reproductive medicine. Nowadays, the management of UF pathology is undergoing an important evolution, with the patient's quality of life being the most important aspect to consider. Accordingly, surgical techniques and aggressive treatments are reserved for only those cases with heavy symptomatology, while the clinical diagnostic based on size and number of UFs remains in a second plane in these situations. Moreover, the development of several noninvasive surgical techniques, especially the appearance of ulipristal acetate as a medical etiological treatment, has substantially changed the clinical indications. As a consequence, after almost 2 decades without relevant updates, it has been necessary to update the protocols for the management of UFs in the Spanish Society of Gynecology and Obstetrics twice. Accordingly, we believe that it is necessary to translate our experience to protocolize the medical care for patients with UFs, incorporating these new therapeutic options, and selecting the best treatment for them. We highlight the importance of achieving the patient's goals and decisions by improving the clinical diagnosis for these type of pathologies, allowing enhanced personalized treatments, as well as the reduction of potential risks and unnecessary surgeries.

One year quality of life measured with SEC-QoL in levonorgestrel 52 mg IUS users.

OBJECTIVES: The present study aims to prospectively evaluate quality of life (QoL) of women using 52-mg levonorgestrel intrauterine system (LNG-IUS) for contraception determined through the Sociedad Española de Contracepción (Spanish contraception Society) (SEC)-QoL, a questionnaire specifically designed to assess the impact of contraceptive methods on QoL of fertile women. STUDY DESIGN: We conducted a prospective observational multicenter study of 201 reproductive age women who initiated the LNG-IUS for contraception. Sociodemographic and clinical data were collected at baseline and 12 months afterwards. Participants filled in the SEC-QoL questionnaire at both visits. SEQ-QoL scores range from 0 (worst QoL) to 100 (best QoL). RESULTS: Participants claimed an increased QoL 12 months after insertion in all five dimensions of SEC-QoL due to its high contraceptive efficacy and its capability to reduce other menstrual symptoms (e.g., heavy menstrual bleeding or dysmenorrhoea), overall exerting a positive impact on user's satisfaction. SEC-QoL general overall score went from a mean (S.D.) score of 46.3 (17.3) at baseline to 72.2 (14.8) 12 months afterwards (p<.001). Overall, 94.6% of women claimed having found additional benefits other than contraception. No pregnancies were reported during the 12 months of study duration, and only 14 women discontinued use of LNG-IUS (only two of them due to an adverse event), representing a continuation rate of 93%. CONCLUSIONS: Women using LNG-IUS for contraception have an increased QoL after 12 months of use, demonstrated by the increased score in all dimensions of the SEC-QoL questionnaire. IMPLICATIONS: The present study prospectively evaluated QoL of women using LNG-IUS for contraception through the SEC-QoL questionnaire. Participants claimed increased QoL 12 months afterwards, implying that women using LNG-IUS for contraception in usual clinical practise also benefit from the reduction of period-related symptoms, overall leading to very low discontinuation rates.

The new LNG-releasing IUS: a new opportunity to reduce the burden of unintended pregnancy.

Unintended pregnancies still remain a worldwide public health problem. They have received much attention in adolescents given the strong impact they have on their present and future lives. Young women wishing to delay maternity are also especially vulnerable to unintended pregnancies. Studies have revealed a pattern of use of contraceptive methods that is likely to increase this risk. Methods of long-acting reversible contraception (LARC), among which copper and levonorgestrel-releasing intrauterine devices (IUD and IUS) are the most common, have been widely recommended to avoid unintended pregnancy at any age. Despite this, the use of these devices is very limited. Several barriers to their wide spread use have been identified, which specially affect a higher use by nulliparous women. A new levonorgestrel-releasing IUS containing only 13.5mg of levonorgestrel (IUS12) recently marketed as Jaydess® in Europe, has a smaller size, provides a shorter duration of action, and a lower hormonal content compared to Mirena®, along with a similar efficacy and safety profile, may offer a long-term option that better addresses the needs of nulliparous women. Evidence on the risk of unintended pregnancies in young women--with a special emphasis in Europe, barriers associated with a lower-than-desirable use of LARC methods--especially intrauterine devices (IUD and IUS), and the potential benefits of the new IUS12 including changes in bleeding pattern, safety and user satisfaction--especially with respect to nulliparous and adolescents--are reviewed here. Evidence supports that IUS12 may offer a LARC option that better addresses the needs of these women.