Sarcomas and the conservative management of uterine fibroids: a cause for concern?

The introduction of conservative management options has further increased the choices available to clinicians treating women with symptomatic uterine fibroids. However, in the absence of a tissue diagnosis, the possibility of mismanaging an underlying uterine sarcoma is still present, placing these patients at potential risk of a delayed diagnosis of this serious pathology. Evidence suggests that 1 in 250-400 women presenting with what are thought to be symptomatic fibroids, will in fact have an underlying sarcoma, making this an important clinical issue. This paper therefore reviews the methods currently available for the assessment of women in whom conservative management of symptomatic fibroids is contemplated.     

An evaluation of the simultaneous use of the levonorgestrel-releasing intrauterine device (LNG-IUS, Mirena?) combined with endometrial ablation in the management of menorrhagia

The objective of our study was to document the efficacy and possible complications in women who were treated for menorrhagia with the simultaneous use of endometrial ablation and the levonorgestrel-releasing intrauterine device. Women were offered this combined treatment if they complained of menorrhagia and needed contraception. A structured questionnaire was mailed to 150 women who had undergone this combined treatment; 105 (70%) returned a completed questionnaire. The mean duration of follow-up was 25 months (range 6-54 months). Following treatment, 53 women (50.5%) described their periods as being lighter than normal and 49 (46%) had become amenorrhoeic. Overall, 101 (96%) stated that they were satisfied with the treatment. Of the women, 95 (90.5%) said that the treatment had been a 'complete success'; eight (7.6%) 'partly successful' and two women (1.9%) said the treatment had been a 'failure'. One woman subsequently required a hysterectomy. This observational study supports the hypothesis that combined endometrial ablation and insertion of a levonorgestrel-releasing intrauterine device is an effective treatment for menorrhagia and has some advantages when compared with the individual use of these treatments.     

Patients’ awareness of postoperative adhesions: results from a multi-centre study and online survey

Purpose  

To analyse and to compare how female patients are informed about adhesions and their related problems by surgeons preoperatively.     

ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate,results from a prospective observational study

Objective: To evaluate the diagnostic accuracy of different beta-human chorionic gonadotrophin (ß-hCG) levels measurement, for predicting success of medical treatment in cases diagnosed as tubal ectopic pregnancy (TEP).

Design: Five-year prospective observational study.

Setting: Prenatal Diagnosis Unit, Vall d'Hebron University Hospital – Barcelona.

Patients: TEP cases fulfilling criteria for medical treatment with Methotrexate.

Interventions: ß-hCG levels were measured on d 0, 4 and 7 of treatment. Results were compared by non-parametrical tests. A ROC curve was plotted to define cut-off points. Diagnostic accuracy of the different measurements was evaluated.

Main outcome measure: Failure of treatment defined as need for surgical treatment or persistence of high ß-HCG levels despite treatment.

Results: 126 women were diagnosed as TEP, eligible for medical treatment. There were no differences in parity, age, previous TEP, or adnexal mass size. Success rate was 88%. ß-HCG decreased significantly more, between days 0–7 and 4–7, in the successful cases. LR for success prediction was 6.2 and 7.8 for ß-HCG levels at days 4 and 7 respectively, 4.02 and 2.47 for decrement between days 0–7 (25%) and 4–7 (20%), respectively.

Conclusion: ß-hCG cutoff values have a potential for predicting a successful medical treatment of TEP.     

Characteristics of yoga and meditation users among older Australian women – results from the 45 and up study

Background and purposeYoga and meditation are predominantly utilised by healthy well-educated young women, but little is known about utilisation by older chronically ill women. Therefore, the purpose of this study was to investigate the characteristics of yoga and meditation use among middle-to-higher aged Australian women with chronic conditions.Materials and methodsThis is a sub-study of the 45 and Up Study including 1925 Australian women aged 53–95 years diagnosed with chronic conditions (asthma, depression, diabetes, osteoarthritis, and osteoporosis). Information on yoga and meditation use frequencies (categories: ‘no yoga’, ‘at least once daily’, ‘at least once weekly’, and ‘at least once monthly’), self-perceived effectiveness and communication with health care providers were assessed via self-report. Logistic regression analyses were conducted to identify independent predictors of yoga and meditation use, using SPSS 24.0.ResultsOverall 6.8% and 10.7% of women reported the use of yoga and meditation respectively. Meditation was rarely practiced supervised (11.7%), compared to significant higher rates in yoga (53.2%). Predictors for yoga and meditation use were marital status (married/in relationship > not married/in relationship), higher health related hardiness, and higher education, whereas obesity, and diabetes decreased likelihood of use. While the majority found yoga and meditation helpful for their condition, the use was rarely monitored by or discussed with health care practitioners.ConclusionThis study finds that yoga and meditation are used by middle-to-higher aged Australian women with chronic illnesses. The lack of communication with health care providers is concerning and might hinder coordinated and effective health care around chronic illness. Further research is necessary to help understand possible concurrent health care use and thereby help inform safe, effective and coordinate health seeking amongst those with chronic illness.     

Breastfeeding initiation and duration in France: The importance of intergenerational and previous maternal breastfeeding experiences — results from the nationwide ELFE study

ObjectiveTo assess the role of the mother's mother and mothers' previous personal experiences with breastfeeding and childcare in breastfeeding practices.Design and settingThe analysis included 13,774 mother–infant dyads from the French national birth cohort ELFE. Feeding practices were assessed by face-to-face interview in maternity wards in 2011, by phone interviews at months 2 and 12 post-partum and by Internet/paper questionnaires monthly from months 3–10. Sociodemographic, maternal and newborn-related factors were collected in the maternity unit and by postnatal phone interview at month 2. Multivariable logistic and linear regression was used to assess the association of mother's mother and mothers’ previous personal experiences with breastfeeding initiation and duration.FindingsPrevious breastfeeding experience (i.e., whether mothers had breastfed their previous children) was positively associated with both breastfeeding initiation and duration. Mothers who had been breastfed themselves as infants were more likely to initiate and continue breastfeeding than non-breastfed mothers. Conversely, non-breastfed mothers who had received care advice from their own mother were less likely to start and maintain breastfeeding. The effect of having been breastfed in infancy was especially important for primiparous mothers and to a lesser extent, multiparous mothers with no previous breastfeeding experience. Also, formal experience in childcare, in a professional context, was associated with breastfeeding initiation but not duration.Key conclusions and implications for practiceMother's mother and mother's previous breastfeeding experience have a strong influence on breastfeeding practices. Breastfeeding interventions should be tailored to the mother's level of experience and should provide extra support for multiparous mothers with no previous breastfeeding experience.     

Long-acting reversible contraception (LARC) with the intrauterine system with levonorgestrel (6 mcg/d): observational study on the acceptability,quality of life,and sexuality in Italian women

This observational study was conducted in healthy premenopausal women, who presented themselves for contraception with an intrauterine system (IUS) releasing LNG (6?mcg/d) (Jaydess®, Bayer, Germany) at the outpatient Family Planning Clinics of the Departments of Obstetrics and Gynaecology of the Universities of Cagliari and Sassari (CA/SS), University-Hospitals of CA/SS (Italy). After a screening visit, 31 women without contraindications to Jaydess® were included in the study. No difficulty in Jaydess® insertion (Ji) was found in 87% of subjects, with pelvic pain (PP) (visual analogic scale, VAS:5.33?±?2.54) reported by 27/31 subjects at the Ji. Pelvic pain was reported by 17/31 subjects on the first day (VAS: 3.07?±?3.1), 16/31 subjects on the second day (VAS:2.37?±?2.71), and 11/31 subjects on the third day (VAS:1.18?±?2.02) from Ji, with a significant (p?p?p?相似文献   

The effect of the levonorgestrel-releasing intrauterine system, Mirena® on mast cell numbers in women with endometriosis undergoing symptomatic treatment

Objectives

Mirena^® has been shown to improve symptoms in women with minimal to moderate endometriosis. The precise mechanisms for this have not been thoroughly investigated. We investigate here one possible mechanism—alteration in the number of mast cells in the endometriotic tissue.

Study design

Tissues (endometrial, endometriotic and normal peritoneal biopsies) prospectively collected from twenty-eight women with laparoscopically confirmed minimal to moderate endometriosis before and 6 months after treatment with Mirena^® were processed for immunohistochemistry for ER and PR expression followed by toluidine blue staining for mast cells. Photographs were obtained and the receptors and mast cells identified and quantified.

Results

The mean (± SEM) age of the twenty-eight women was 31 (±7.2) (range 18–42) years. Eight of the endometrial biopsies were in the proliferative phase and twenty in the secretory phase. Six months after Mirena^®, the number of mast cell expressed in the tissues decreased significantly in the eutopic (P = 0.0358) and ectopic endometrium (P = 0.0220) but not in the normal peritoneum (P > 0.05). There were no ERs or PRs found in mast cells.

Conclusion

Mirena^® causes a reduction in mast cell numbers in ectopic and eutopic endometrium in women undergoing symptomatic treatment of minimal to moderate endometriosis. This reduction could partly explain the efficacy of Mirena^® in modulating pain in these women.     

Women’s empowerment and experiences of mistreatment during childbirth in facilities in Lucknow,India: results from a cross-sectional study

Background

Recent evidence has found widespread reports of women experiencing abuse, neglect, discrimination, and poor interpersonal care during childbirth around the globe. Empowerment may be a protective mechanism for women against facility mistreatment during childbirth. The majority of previous research on mistreatment during childbirth has been qualitative in nature.

Methods

In this analysis, we use quantitative data from 392 women who recently gave birth in a facility in the slums of Lucknow, India, to explore whether measures of women’s empowerment are associated with their experiences of mistreatment at their last childbirth. We use the Gender Equitable Men (GEM) scale to measure women’s views of gender equality.

Results

We find that women who had more equitable views about the role of women were less likely to report experiencing mistreatment during childbirth. These findings suggest that dimensions of women’s empowerment related to social norms about women’s value and role are associated with experiences of mistreatment during childbirth.

Conclusions

This expands our understanding of empowerment and women’s health, and also suggests that the GEM scale can be used to measure certain domains of empowerment from a women’s perspective in this setting.

     

Prospective observational study to evaluate the efficacy and safety of the pollen extract Sérélys® in the management of women with menopausal symptoms

Safety concerns or contraindications to the use of hormones have resulted in a rise of the use of herbal medicinal products for the management of menopausal symptoms. The pollen extract Sérélys^® represents, due to its ingredients and mode of action, a new and innovative alternative for the management of these symptoms. The aim of the present study was to demonstrate the efficacy and safety of Sérélys^®. A prospective, open, observational, and multicentre study was performed on 104 menopausal women. The patients received over 3 months the pollen extract Sérélys^® containing the extracts PI82 and GC Fem in a dosage of twice 160?mg extract and 5?mg vitamin E. Using a validated menopausal rating score, the improvement of menopausal symptoms was recorded. A significant decrease of different menopausal symptoms was observed between the starting point of the study and after 12?weeks (p?<?.0001). Hot flashes were reduced by 48.5%, sleep disturbance by 50.1%, depressive mood by 51.2%, irritability by 47.9%, fatigue by 47.8%, vaginal dryness by 39.63% and muscles and joint pain by 27.4%. The pollen extract Sérélys^® reduced significant menopausal symptoms showing a very low side effect profile.     

COX-2 and Her-2/neu are overexpressed in Paget’s disease of the vulva and the breast: results of a preliminary study

Purpose Paget’s disease (PD) of the breast as well as the vulva is a rare condition that accounts for about 4% of breast neoplasms and 1% of vulvar malignancies. Recurrent disease after breast and vulvar surgery might be a challenge. To evaluate relevant molecules therapeutically, tissue from mammary and vulvar PD lesions was investigated immunohistochemically. Methods Histopathologic samples from 11 patients with mammary PD and eight patients with vulvar PD were stained with antibodies against estrogen and progesterone receptors, HER-2/neu and COX-2 followed by semiquantitative evaluation of the staining results. Results All tested mammary lesions as well as seven out of eight vulvar PD were negative for estrogen and progesterone receptors. Strong membranous staining for HER-2/neu (Score 3) was seen in all cases. Six out of 8 vulvar and 10 out of 11 mammary PD showed COX-2 overexpression. Conclusions PD of the breast and vulva are negative for estrogens and progesterons, therefore, anti-hormonal therapy is not indicated. The high frequency of Her-2/neu and COX-2 overexpression, however, suggests that these molecules could be therapeutically relevant in patients with PD. These results require further investigation.     

Prognostic factors and optimal therapy for stages I–II neuroendocrine carcinomas of the uterine cervix: A multi-center retrospective study

Purpose

We aimed to determine appropriate treatment guidelines for patients with stages I–II high-grade neuroendocrine carcinomas (HGNEC) of the uterine cervix in a multicenter retrospective study.

Trends and determinants of stillbirth in developing countries: results from the Global Network’s Population-Based Birth Registry

Background

Stillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations’ Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries.

Methods

From a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births of which 12,181 were stillbirths.

Results

The mean stillbirth rates for the sites were 21.3 per 1000 births for Africa, 25.3 per 1000 births for India, 56.9 per 1000 births for Pakistan and 19.9 per 1000 births for Guatemala. From 2010 to 2016, across all sites, the mean stillbirth rate declined from 31.7 per 1000 births to 26.4 per 1000 births for an average annual decline of 3.0%. Risk factors for stillbirth were similar across the sites and included maternal age < 20 years and age > 35 years. Compared to parity 1–2, zero parity and parity > 3 were both associated with increased stillbirth risk and compared to women with any prenatal care, women with no prenatal care had significantly increased risk of stillbirth in all sites.

Conclusions

At the current rates of decline, stillbirth rates in these sites will not reach the Every Newborn Action Plan goal of 12 per 1000 births by 2030. More attention to the risk factors and treating the causes of stillbirths will be required to reach the Every Newborn Action Plan goal of stillbirth reduction.

Trial registration

NCT01073475.

     

Women’s experiences of routine care during labour and childbirth and the influence of medicalisation: A qualitative study from Iran

Objectiveto understand women’s experiences of routine care during labor and childbirth in a medicalised context.Designtwenty-six in-depth interviews were conducted during the late postpartum period and thematic analysis was applied.Settingfour public hospitals in Tehran with a high rate of births, providing services to low and middle income families.Participantswomen who had a low risk pregnancies and gave a birth to a healthy infant by normal vaginal delivery.Findingstwo main themes emerged: ‘An ethos of medicalisation’ which indicates that women’s perception of childbirth was influenced by the medicalised context of childbirth. And ‘The reality of fostered medicalisation’ which illustrates the process by which interventions during labor affected women’s pathway through childbirth, and how the medicalisation resulted in a birth experience which often included a preference for Caesarean Section rather than vaginal birth with multiple interventions.Implications for practicecontextual factors such as legal issues, state’s regulations and the organisational framework of maternity services foster medicalised childbirth in Tehran public hospitals. These factors influence the quality of care and should be considered in any intervention for change. The aim should be a high quality birth experience with minimal interventions during normal vaginal delivery. A midwifery model of care combining scientific evidence with empathy may address this need for change.