Journal of Clinical Medicine

Research

13 pages, 244 KiB

Open AccessArticle

Mode of Delivery in Greece: A Study of Obstetricians’ Personal Preferences Regarding Delivery of Their Offspring

by Panagiotis Christopoulos, Ermioni Tsarna, Anna Eleftheriades, Ilias Korompokis, Grigorios Karampas and Nikos F. Vlachos

J. Clin. Med. 2025, 14(7), 2444; https://doi.org/10.3390/jcm14072444 - 3 Apr 2025

Viewed by 1398

Abstract

Background: In Greece, the cesarean section (CS) rate reached 62.15% in 2023. This study aims to document Greek obstetricians’ preferences and choices regarding the delivery mode of their own children. Methods: A questionnaire was emailed to Greek obstetricians, capturing demographics, preferred [...] Read more.

Background: In Greece, the cesarean section (CS) rate reached 62.15% in 2023. This study aims to document Greek obstetricians’ preferences and choices regarding the delivery mode of their own children. Methods: A questionnaire was emailed to Greek obstetricians, capturing demographics, preferred and actual delivery modes, regrets about delivery choices, and opinions on factors contributing to the high CS rate. Results: Of the 337 respondents, 78.8% preferred normal labor, but only 55.8% reported a vaginal delivery for their first child. Only 31% would opt for vaginal birth after CS. Male and married obstetricians were more likely to prefer vaginal birth, while those with more children or children born earlier were more likely to have delivered vaginally their first child. Partner preference influenced both the obstetrician’s choice and the actual delivery mode. According to Greek obstetricians, the primary reasons for the high CS rate are hostile medico-legal conditions (56.3%), advanced maternal age and in vitro fertilization (42.6%), and lack of training in instrumental deliveries (37.2%). Maternal request was cited by 25% of respondents. Conclusions: Although four in five Greek obstetricians favor normal labor for their own children, the CS rate among them mirrors that of the general population. Convenience scheduling does not appear to drive Greece’s high CS rate. Obstetricians suggest that legislative reforms, improved training, and public health strategies to reduce maternal CS requests are essential for lowering the CS rate. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

10 pages, 789 KiB

Open AccessArticle

Smoking Status in Pregnancy: A Retrospective Analysis in Northern Greece

by Kyriaki Mitta, Ioannis Tsakiridis, Smaragda Drizou, Georgios Michos, Ioannis Kalogiannidis, Apostolos Mamopoulos, Chryssi Christodoulaki, Periklis Panagopoulos and Themistoklis Dagklis

J. Clin. Med. 2025, 14(2), 431; https://doi.org/10.3390/jcm14020431 - 11 Jan 2025

Viewed by 660

Abstract

Background and Objectives: Smoking has adverse effects on both maternal and fetal health and its incidence varies among different countries. The aim of this study was to identify the prevalence of smoking during pregnancy and to identify factors associated with smoking. Materials and [...] Read more.

Background and Objectives: Smoking has adverse effects on both maternal and fetal health and its incidence varies among different countries. The aim of this study was to identify the prevalence of smoking during pregnancy and to identify factors associated with smoking. Materials and Methods: This was a retrospective study conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, during an 11-year period (2013–2023). All women receiving antenatal care in our unit were eligible to participate when they attended the prenatal unit for the first trimester nuchal translucency scan (11⁺⁰–13⁺⁶ weeks). Results: Of the 12,074 pregnant women included in the study, 5005 (41.5%) reported themselves as smokers before pregnancy; the smoking cessation rate due to pregnancy was 70.2% (3516/5005) and the prevalence of smoking in pregnancy was 12.3% (1489/12,074). Multiparity was associated with less odds of smoking before pregnancy (OR: 0.79; 95% CI: 0.73–0.85), whereas advanced maternal age (OR: 1.17; 95% CI: 1.07–1.27) and obesity (OR: 1.44; 95% CI: 1.29–1.6) were associated with higher odds of smoking before pregnancy. Smoking prevalence in pregnancy was lower in women that conceived via assisted reproductive techniques (ARTs) (OR: 0.52; 95% CI: 0.38–0.70) and higher in cases of multiparity (OR: 1.12; 95% CI: 1.008–1.26) and maternal obesity (OR: 1.55; 95% CI: 1.20–2.00). Conception via ARTs was associated with higher odds of smoking cessation (OR: 1.9; 95% CI: 1.38–2.69), whereas multiparous (OR: 0.7; 95% CI: 0.62–0.8) and obese women (OR: 0.72; 95% CI: 0.61–0.85) were less likely to quit smoking. Conclusions: Pregnancy is a strong motivator for women to quit smoking, especially in primiparous women and those undergoing ARTs. Our findings highlight the need for more consistent smoking prevention and health promotion strategies in Greece as a very high proportion of women smoke before pregnancy and a substantial proportion continue in pregnancy. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

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10 pages, 601 KiB

Open AccessArticle

Perinatal and Delivery Outcomes Following Amniocentesis: A Case-Control Study in the Polish Population

by Daniel Wolder, Anna Blazuk-Fortak, Agata Michalska, Karolina Detka, Grzegorz Świercz and Piotr Kaczmarek

J. Clin. Med. 2025, 14(2), 309; https://doi.org/10.3390/jcm14020309 - 7 Jan 2025

Viewed by 791

Abstract

Background: Amniocentesis is a widely used invasive prenatal diagnostic procedure, recognized for its high sensitivity and low risk of complications. This study aims to evaluate the association between amniocentesis and pregnancy outcomes, such as miscarriage, preterm rupture of membranes (PROM), and preterm birth, [...] Read more.

Background: Amniocentesis is a widely used invasive prenatal diagnostic procedure, recognized for its high sensitivity and low risk of complications. This study aims to evaluate the association between amniocentesis and pregnancy outcomes, such as miscarriage, preterm rupture of membranes (PROM), and preterm birth, as well as perinatal outcomes. Methods: A case-control study was conducted at the Regional Hospital in Kielce, Poland, from 2016 to 2022, involving 1834 patients, 225 of whom underwent amniocentesis, while 1609 did not receive any invasive diagnostics. Data were collected from medical records and included maternal factors such as age, BMI, delivery mode, complications, and newborn condition. Results: The study found no statistically significant differences between the study and the control groups regarding pregnancy or perinatal characteristics. Miscarriage occurred in 1.9% of the patients in the amniocentesis group, with no cases in the control group. Rates of preterm delivery were similar between groups (8.33% in the study group vs. 5.74% in the control group, p > 0.05). Postnatal outcomes, such as birth term, birth weight, and Apgar scores, were comparable across both groups. Fetal growth restriction was slightly more frequent in the study group (2.8% vs. 0.8%). One neonatal death was observed in each group. The relative risk of complications following amniocentesis was 1.69 (CI 0.38–7.24). Conclusions: Amniocentesis is a safe invasive prenatal procedure. It should be offered to every pregnant woman when necessary. Before the procedure, the patient should be clearly informed of the risk related to amniocentesis but at the same time reassured that the complication rate is very low. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

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10 pages, 410 KiB

Open AccessArticle

Validation of the Hungarian Version of the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS)

by Wesam A. Debes, Munseef Sadaqa, Alexandra Makai, Olívia Dózsa-Juhász, Nikolett Tumpek, Judit Kocsis, Pongrác Ács, Réka Laura Szűcs, Zsanett Németh, Viktória Prémusz and Marta Hock

J. Clin. Med. 2024, 13(23), 7389; https://doi.org/10.3390/jcm13237389 - 4 Dec 2024

Viewed by 934

Abstract

Objectives: Urinary incontinence (UI) is a prevalent condition that significantly impacts the quality of life. This study aimed to validate the Hungarian version of the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and assess its psychometric properties in the context [...] Read more.

Objectives: Urinary incontinence (UI) is a prevalent condition that significantly impacts the quality of life. This study aimed to validate the Hungarian version of the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and assess its psychometric properties in the context of the Hungarian population. Study design: A cross-sectional study involved 215 Hungarian-speaking women with a mean age of 67.6 ± 11.9 years. Main outcome measure: Participants were administered both the ICIQ-FLUTS and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The psychometric analysis included test–retest reliability, convergent validity, and internal consistency. Results: The Hungarian version of ICIQ-FLUTS demonstrated strong psychometric properties. The test–retest reliability analysis showed a high intraclass correlation coefficient (ICC = 0.921), indicating excellent agreement between measurements over a 14-day interval. Convergent validity was supported by a strong positive correlation between the total scores of ICIQ-FLUTS and ICIQ-SF (ρ = 0.686, p < 0.001), emphasizing shared underlying constructs. Furthermore, the ICIQ-FLUTS questionnaire exhibited good internal consistency, with a Cronbach’s α coefficient of 0.862. Conclusions: This study successfully validated the Hungarian version of the ICIQ-FLUTS questionnaire and demonstrated its robust psychometric properties. This tool will enable healthcare practitioners and researchers to effectively assess and address UI’s impact on their quality of life. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

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13 pages, 566 KiB

Open AccessArticle

Dysmenorrhea and Its Impact on Patients’ Quality of Life—A Cross-Sectional Study

by Mihaela Amza, Sebastian Findeklee, Bashar Haj Hamoud, Romina-Marina Sima, Mircea-Octavian Poenaru, Mihai Popescu and Liana Pleș

J. Clin. Med. 2024, 13(19), 5660; https://doi.org/10.3390/jcm13195660 - 24 Sep 2024

Cited by 2 | Viewed by 2791

Abstract

Background: Dysmenorrhea is a common condition that may have negative effects on social life, couples’ relationships and professional activities. The objectives of this study were to evaluate the prevalence, risk factors and characteristics of dysmenorrhea and its impact on patients’ quality of life [...] Read more.

Background: Dysmenorrhea is a common condition that may have negative effects on social life, couples’ relationships and professional activities. The objectives of this study were to evaluate the prevalence, risk factors and characteristics of dysmenorrhea and its impact on patients’ quality of life using a specific self-questionnaire named “DysmenQoL questionnaire”. We also checked the validity and reliability of this questionnaire in our population. Methods: We conducted a cross-sectional study that included 504 participants of reproductive age between 18 and 45 years of age. The data were collected with an original form divided into three sections. The last section (DysmenQoL questionnaire) included 20 statements scored from 1 (“never”) to 5 (“every time”) that evaluates the effects of menstrual pain on health and feelings, daily activities, relationships and professional activity. We calculated the sum of the scores for each statement and we called it the “DysmenQoL score”. Results: The prevalence of dysmenorrhea was 83.7%. The presence of dysmenorrhea was statistically significant associated with the degree of menstrual bleeding (p = 0.017), the presence of infertility (p = 0.034) and dyspareunia (p = 0.002), but also with the presence of premenstrual syndrome and a family history of dysmenorrhea (p < 0.001). Among the participants with dysmenorrhea, 73.9% considered that this symptom affected their quality of life, and this was correlated with pain intensity and the DysmenQoL score (p < 0.001). A significant difference regarding the DysmenQoL score depending on the pain intensity, frequency and duration of dysmenorrhea and the methods used to reduce the pain was observed. Conclusions: Dysmenorrhea had a high prevalence among the participants included in the study, and its presence was associated with a series of risk factors. Most women considered that dysmenorrhea affected their quality of life. The DysmenQoL questionnaire proved to be a reliable and valid method for evaluating the impact of dysmenorrhea on quality of life. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

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13 pages, 648 KiB

Open AccessArticle

An Evaluation of DNA Methylation Levels and Sleep in Relation to Hot Flashes: A Cross-Sectional Study

by Ipek Betul Ozcivit Erkan, Hasan Hakan Seyisoglu, Gulcin Benbir Senel, Derya Karadeniz, Filiz Ozdemir, Aysel Kalayci, Mehmet Seven and Neslihan Gokmen Inan

J. Clin. Med. 2024, 13(12), 3502; https://doi.org/10.3390/jcm13123502 - 15 Jun 2024

Viewed by 1412

Abstract

Objectives: We aimed to evaluate the DNA methylation levels in perimenopausal and postmenopausal women, measured through Long Interspersed Element-1 (LINE-1) and Alu, and the sleep parameters in relation to the presence of hot flashes (HFs). Methods: This cross-sectional study included 30 peri- or [...] Read more.

Objectives: We aimed to evaluate the DNA methylation levels in perimenopausal and postmenopausal women, measured through Long Interspersed Element-1 (LINE-1) and Alu, and the sleep parameters in relation to the presence of hot flashes (HFs). Methods: This cross-sectional study included 30 peri- or postmenopausal women aged between 45 and 55. The menopausal status was determined according to STRAW + 10 criteria and all participants had a low cardiovascular disease (CVD) risk profile determined by Framingham risk score. The sample was divided into two groups based on the presence or absence of HFs documented in their medical history during their initial visit: Group 1 (n = 15) with HFs present and Group 2 (n = 15) with HFs absent. The patients had polysomnography test and HFs were recorded both by sternal skin conductance and self-report overnight. Genomic DNA was extracted from the women’s blood and methylation status was analyzed by fluorescence-based real-time quantitative PCR. The quantified value of DNA methylation of a target gene was normalized by β-actin. The primary outcome was the variation in methylation levels of LINE-1 and Alu and sleep parameters according to the presence of HFs. Results: LINE-1 and Alu methylation levels were higher in Group 1 (HFs present), although statistically non-significant. LINE-1 methylation levels were negatively correlated with age. Sleep efficiency was statistically significantly lower for women in Group 1 (HFs present) (74.66% ± 11.16% vs. 82.63% ± 7.31%; p = 0.03). The ratio of duration of awakening to total sleep time was statistically significantly higher in Group 1 (HFs present) (22.38% ± 9.99% vs. 15.07% ± 6.93, p = 0.03). Objectively recorded hot flashes were significantly higher in Group 1 (4.00 ± 3.21 vs. 1.47 ± 1.46, p = 0.03). None of the cases in Group 2 self-reported HF despite objectively recorded HFs during the polysomnography. The rate of hot flash associated with awakening was 41.4% in the whole sample. Conclusions: Women with a history of hot flashes exhibited lower sleep efficiency and higher awakening rates. Although a history of experiencing hot flashes was associated with higher LINE-1 and Alu methylation levels, no statistical significance was found. Further studies are needed to clarify this association. This study was funded by the Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa. Project number: TTU-2021-35629. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

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Review

Jump to: Research, Other

14 pages, 926 KiB

Open AccessReview

Renal Function and the Role of the Renin–Angiotensin–Aldosterone System (RAAS) in Normal Pregnancy and Pre-Eclampsia

by Panagiotis Tsikouras, Konstantinos Nikolettos, Sonia Kotanidou, Nektaria Kritsotaki, Efthymios Oikonomou, Anastasia Bothou, Sotiris Andreou, Theopi Nalmpanti, Kyriaki Chalkia, Vlasios Spanakis, Nikolaos Tsikouras, Christina Pagkaki, George Iatrakis, Christos Damaskos, Nikolaos Garmpis, Nikolaos Machairiotis and Nikolaos Nikolettos

J. Clin. Med. 2025, 14(3), 892; https://doi.org/10.3390/jcm14030892 - 29 Jan 2025

Cited by 2 | Viewed by 1256

Abstract

Objective: Pre-eclampsia (PE) is a complex, advancing condition marked either by the recent emergence of hypertension and proteinuria or by the recent onset of hypertension accompanied by notable end-organ impairment, which may occur with or without proteinuria. PE usually appears in the postpartum [...] Read more.

Objective: Pre-eclampsia (PE) is a complex, advancing condition marked either by the recent emergence of hypertension and proteinuria or by the recent onset of hypertension accompanied by notable end-organ impairment, which may occur with or without proteinuria. PE usually appears in the postpartum phase or after the 20th week of gestation, though it might appear sooner in cases of molar pregnancy. Pathophysiology: This disorder is a serious multisystem condition during pregnancy that can lead to serious, life-threatening complications for both the mother and the fetus if it is not diagnosed and managed promptly. These changes result from widespread and intense vasoconstriction caused by renin, angiotensin II (Ang II), aldosterone, and catecholamines. The renin–angiotensin–aldosterone system (RAAS) and its sequence of signaling reactions demonstrate its crucial role in regulating blood pressure and electrolyte balance that diverges in PE from that observed in healthy pregnancies. However, it is widely recognized that the above description is incomplete for pre-eclampsia and further relationships should be analyzed. The purpose of this article is to review and synthesize alterations in renal function and the RAAS during normal pregnancy and pre-eclampsia. We aim to provide clinical gynecologists with a comprehensive understanding of how pregnancy-specific adaptations can impact renal function and the RAAS, as well as the deviations observed in pre-eclampsia. Conclusion: This information is essential to enhance clinical awareness, improve the accuracy of diagnosis, and support evidence-based decision-making in the management of pregnant patients, especially those complicated by pre-eclampsia. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

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19 pages, 612 KiB

Open AccessReview

Impact of Maternal Smoking on Obstetric and Neonatal Outcomes in Twin Pregnancies: A Narrative Review

by Cristina Juliá-Burchés, Alicia Martínez-Varea, José Morales-Roselló and Vicente Diago-Almela

J. Clin. Med. 2024, 13(23), 7329; https://doi.org/10.3390/jcm13237329 - 2 Dec 2024

Viewed by 1106

Abstract

Maternal smoking, including both traditional cigarettes and electronic ones, is a significant modifiable risk factor associated with adverse perinatal outcomes, especially in twin pregnancies. This narrative review aims to explore the impact of maternal smoking on obstetric and neonatal outcomes in twin pregnancies, [...] Read more.

Maternal smoking, including both traditional cigarettes and electronic ones, is a significant modifiable risk factor associated with adverse perinatal outcomes, especially in twin pregnancies. This narrative review aims to explore the impact of maternal smoking on obstetric and neonatal outcomes in twin pregnancies, which inherently carry a higher risk of complications. A literature search was conducted using the PubMed and EMBASE databases, selecting studies published between January 1994 and October 2024. The findings demonstrate a clear association between smoking and increased risks of preterm birth and fetal growth restriction (FGR) in twin pregnancies. These risks are exacerbated when smoking is combined with other factors, such as preeclampsia and elevated body mass index (BMI). Smoking was also associated with long-term post-natal complications, including respiratory problems like asthma, as well as cognitive and behavioral disorders. However, an association with preeclampsia was not found, and further studies are needed to clarify the relationship in the fields of preterm premature rupture of membranes (PPROM) and fetal death. The adverse effects of smoking are primarily due to reduced oxygen supply to the fetus, caused by nicotine-induced vasoconstriction and carbon monoxide exposure, leading to placental insufficiency and fetal hypoxia. These effects are amplified in twin pregnancies due to the increased physiological demands. The review highlights that smoking cessation interventions during pregnancy are crucial to mitigate these risks and improve maternal and neonatal health outcomes. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

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Graphical abstract

16 pages, 342 KiB

Open AccessReview

Visceral Leishmaniasis in a Twin Pregnancy: A Case Report and Review of the Literature

by Grigorios Karampas, Sevasti Koulouraki, George L. Daikos, Christina Nanou, Leon Aravantinos, Makarios Eleftheriades, Dimitra Metallinou and Panagiotis Christopoulos

J. Clin. Med. 2024, 13(8), 2400; https://doi.org/10.3390/jcm13082400 - 20 Apr 2024

Viewed by 1747

Abstract

Visceral leishmaniasis (VL), often referred to as kala-azar, is quite rare in developed countries during pregnancy. Only few studies have evaluated its impact on perinatal outcome. It is caused primarily by Leishmania donovani or Leishmania infantum and presents with a wide spectrum of [...] Read more.

Visceral leishmaniasis (VL), often referred to as kala-azar, is quite rare in developed countries during pregnancy. Only few studies have evaluated its impact on perinatal outcome. It is caused primarily by Leishmania donovani or Leishmania infantum and presents with a wide spectrum of clinical manifestations from cutaneous ulcers to multisystem disease. Differential diagnosis is challenging as symptoms and signs are insidious, mimicking other diseases. Misdiagnosis can result in severe adverse perinatal outcomes, even maternal/neonatal death. Early treatment with liposomal amphotericin-B (LAmB) is currently the first choice with adequate effectiveness. We report a rare case of VL in a twin pregnancy with onset at the second trimester, presenting with periodic fever with rigors, right flank pain, and gradual dysregulation of all three cell lines. The positive rK39 enzyme-linked immunosorbent assay test confirmed the diagnosis. Treatment with LAmB resulted in clinical improvement within 48 h and in the delivery of two late-preterm healthy neonates with no symptoms or signs of vertical transmission. The one-year follow-up, of the mother and the neonates, was negative for recurrence. To our knowledge, this is the first reported case of VL in a twin pregnancy, and consequently treatment and perinatal outcome are of great importance. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

Other

Jump to: Research, Review

16 pages, 579 KiB

Open AccessSystematic Review

New Evidence About Malignant Transformation of Endometriosis—A Systematic Review

by Alexandra Ioannidou, Maria Sakellariou, Vaia Sarli, Periklis Panagopoulos and Nikolaos Machairiotis

J. Clin. Med. 2025, 14(9), 2975; https://doi.org/10.3390/jcm14092975 - 25 Apr 2025

Viewed by 470

Abstract

Background: Endometriosis is a benign gynecologic condition that has the risk of malignant transformation in approximately 0.5–1% of cases, most of which develop into endometriosis-associated ovarian cancers (EAOCs), such as clear cell and endometrioid adenocarcinomas. The current systematic review aims to condense recent [...] Read more.

Background: Endometriosis is a benign gynecologic condition that has the risk of malignant transformation in approximately 0.5–1% of cases, most of which develop into endometriosis-associated ovarian cancers (EAOCs), such as clear cell and endometrioid adenocarcinomas. The current systematic review aims to condense recent information on the genetic and molecular mechanisms, clinical risk factors, and possible therapeutic targets of the malignant transformation of endometriosis. Methods: A systematic literature search of PubMed, Europe PMC, and Google Scholar was carried out according to PRISMA guidelines for articles published until December 2024. Following a screening of 44,629 titles, 43 full articles were included after meeting inclusion criteria. No case reports or reviews were included, and articles had to mention a malignant transformation of endometriosis and not just a diagnosis of cancer. The quality and risk of bias of studies were evaluated using ROBINS-I. Results: Malignant transformation of endometriosis is associated with genetic alterations, including ARID1A mutations, microsatellite instability, and abnormal PI3K/Akt and mTOR pathway activation. Increased oxidative stress, inflammation-driven mismatch repair deficiency, and epigenetic alterations like RUNX3 and RASSF2 hypermethylation are implicated in carcinogenesis. Clinical risk factors are advanced age (40–60 years), large ovarian endometriomas (>9 cm), postmenopausal status, and prolonged estrogen exposure. Imaging techniques like MR relaxometry and risk models based on machine learning are highly predictive for early detection. Conclusions: Endometriosis carcinogenesis is a multifactorial process driven by genetic changes, oxidative stress, and inflammatory mechanisms. Identification of high-risk individuals through molecular and imaging biomarkers may result in early detection and personalized therapy. Further research should aim at the development of more precise predictive models and exploration of precision medicine approaches to inhibit the emergence of EAOC. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

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19 pages, 2430 KiB

Open AccessSystematic Review

Low PAPPA and Its Association with Adverse Pregnancy Outcomes in Twin Pregnancies: A Systematic Review of the Literature and Meta-Analysis

by Ioakeim Sapantzoglou, Maria Giourga, Afroditi Maria Kontopoulou, Vasileios Pergialiotis, Maria Anastasia Daskalaki, Panagiotis Antsaklis, Marianna Theodora, Nikolaos Thomakos and George Daskalakis

J. Clin. Med. 2024, 13(22), 6637; https://doi.org/10.3390/jcm13226637 - 5 Nov 2024

Cited by 1 | Viewed by 1261

Abstract

Background: It is well established in the literature that pregnancy-associated plasma protein-A (PAPP-A) is linked to several adverse pregnancy outcomes, including pre-eclampsia (PE), fetal growth restriction (FGR), and preterm birth (PTB) in singleton pregnancies. However, data regarding such an association in twin [...] Read more.

Background: It is well established in the literature that pregnancy-associated plasma protein-A (PAPP-A) is linked to several adverse pregnancy outcomes, including pre-eclampsia (PE), fetal growth restriction (FGR), and preterm birth (PTB) in singleton pregnancies. However, data regarding such an association in twin pregnancies are lacking. The primary goal of this systematic review and meta-analysis was to assess the potential value of low PAPP-A levels in the prediction of the subsequent development of hypertensive disorders of pregnancy (HDPs), PTB, and small for gestational age (SGA)/FGR fetuses in twin pregnancies and investigate its association with the development of gestational diabetes, intrauterine death (IUD) of at least one twin, and birth weight discordance (BWD) among the fetuses. Methods: Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar databases were systematically searched from inception until 31 July 2024. All observational studies reporting low PAPP-A levels after the performance of the first-trimester combined test as part of the screening for chromosomal abnormalities with reported adverse pregnancy outcomes were included. Results: The current systematic review encompassed a total of 11 studies (among which 6 were included in the current meta-analysis) that enrolled a total of 3741 patients. Low PAPP-A levels were not associated with HDPs (OR 1.25, 95% CI 0.78, 2.02, I-square test: 13%). Low PAPP-A levels were positively associated with both the development of preterm birth prior to 32 (OR 2.85, 95% CI 1.70, 4.77, I-square test: 0%) and 34 weeks of gestational age (OR 2.09, 95% CI 1.34, 3.28, I-square test: 0%). Furthermore, low PAPP-A levels were positively associated with SGA/FGR (OR 1.58, 95% CI 1.04, 2.41, I-square test: 0%). Prediction intervals indicated that the sample size that was used did not suffice to support these findings in future studies. Conclusions: Our study indicated that low PAPP-A levels are correlated with an increased incidence of adverse perinatal outcomes in twin pregnancies. Identifying women at elevated risk for such adversities in twin pregnancies may facilitate appropriate management and potential interventions, but additional studies are required to identify the underlying mechanism linking PAPP-A with those obstetrical complications. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

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17 pages, 3271 KiB

Open AccessCase Report

Intrauterine Contraceptive Device Migrated in the Urinary Tract: Case Report and Extensive Literature Review

by Valentin Nicolae Varlas, Andreea Ioana Meianu, Andra Ioana Rădoi, Irina Balescu, Nicolae Bacalbasa and Roxana Georgiana Varlas

J. Clin. Med. 2024, 13(14), 4233; https://doi.org/10.3390/jcm13144233 - 19 Jul 2024

Cited by 4 | Viewed by 2244

Abstract

The migration or translocation of an intrauterine device (IUD) in the urinary tract is a rare event. Here, we present the case of a 55-year-old woman who accidentally discovered the ectopic presence of an IUD following a radiological examination for pelvic pain caused [...] Read more.

The migration or translocation of an intrauterine device (IUD) in the urinary tract is a rare event. Here, we present the case of a 55-year-old woman who accidentally discovered the ectopic presence of an IUD following a radiological examination for pelvic pain caused by a lumbar discopathy. Over the years, the patient had several IUDs inserted without being able to specify which one had migrated. The removal of the IUD was performed laparoscopically with the minimum resection of the bladder wall and the subsequent cystorrhaphy. The evolution of the patient was favorable. To better analyze these events, we conducted an all-time extensive electronic search of the PubMed database and identified 94 eligible articles, with a total of 115 cases. The literature analysis on the IUD migrations shows either the simultaneous existence of the second IUD or of a maximum number of up to two IUD insertions during the life of patients. Thus, in the presented case, we identified five IUD insertions over time, which explained the chronic inflammatory process by forming an important mass of adherents that included the urinary bladder, uterus, omentum, sigmoid colon, and abdominal wall. Therapeutic management must be adapted to each case depending on the intra/extravesical location of the migrated IUD evaluated by imaging. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Second Edition))

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