International Journal of Environmental Research and Public Health

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23 pages, 3165 KiB

Open AccessArticle

Trends and Determinants of Operative Vaginal Delivery at Two Academic Hospitals in Johannesburg, South Africa 2005–2019

by Afikile Dutywa, Gbenga Olorunfemi and Langanani Mbodi

Int. J. Environ. Res. Public Health 2022, 19(23), 16182; https://doi.org/10.3390/ijerph192316182 - 3 Dec 2022

Cited by 2 | Viewed by 1800

Abstract

Operative Vaginal delivery (OVD) can reduce perinatal and maternal morbidity and mortality especially in low resource setting such as South Africa. We evaluated the trends and determinants of OVD rates using join point regression at Charlotte Maxeke Johannesburg (CMJAH) and Chris Hani Baragwaneth [...] Read more.

Operative Vaginal delivery (OVD) can reduce perinatal and maternal morbidity and mortality especially in low resource setting such as South Africa. We evaluated the trends and determinants of OVD rates using join point regression at Charlotte Maxeke Johannesburg (CMJAH) and Chris Hani Baragwaneth (CHBAH) Academic Hospitals from 1 January 2005–31 December 2019 and conducted a comparative study of OVD (n = 179) and normal delivery (n = 179). Over the 15-year study period (2005–2019), 323,617 deliveries and 4391 OVDs were conducted at CHBAH giving an OVD rate of 1.36 per 100 births. In CMJAH, 74,485 deliveries and 1191 OVDs were conducted over an eleven-year period (2009–2019) with OVD rate of 1.60 per 100 births. OVD rate at CHBAH increased from 2005–2014 at 9.1% per annum and declined by 13.6% from 2014–2019, while OVD rates fluctuates at CMJAH. Of the 179 patients who had OVD, majority (n = 166,92.74%) had vacuum. Women who had OVDs were younger than those who vaginal delivery (p-value < 0.001). The prevalence of OVDs was higher among nulliparous women (p-value < 0.001), HIV negative women (p-value = 0.021), underweight (p-value < 0.001) as compared to normal delivery. The OVD rates has dramatically reduced over the study period This study heightens the need to further evaluate barriers to OVD use in our environment Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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12 pages, 1021 KiB

Open AccessArticle

Oral Contraceptive Use and Assessment of Breast Cancer Risk among Premenopausal Women via Molecular Characteristics: Systematic Review with Meta-Analysis

by Agnieszka Barańska

Int. J. Environ. Res. Public Health 2022, 19(22), 15363; https://doi.org/10.3390/ijerph192215363 - 21 Nov 2022

Cited by 3 | Viewed by 2341

Abstract

Breast cancer is divided into four molecular subtypes. Each one has distinct clinical features. The aim of this study was to assess individual breast cancer subtype risk in premenopausal women taking oral contraceptives (OCs). Databases (MEDLINE; PubMed, EMBASE, and the Cochrane Library) were [...] Read more.

Breast cancer is divided into four molecular subtypes. Each one has distinct clinical features. The aim of this study was to assess individual breast cancer subtype risk in premenopausal women taking oral contraceptives (OCs). Databases (MEDLINE; PubMed, EMBASE, and the Cochrane Library) were searched to January 2022 to identify case-control studies meeting the inclusion criteria. The influence of OCs intake on the risk of ER-positive breast cancer (ER+BC) was revealed to be non-significant with regard to reduction: OR = 0.9134, 95% CI: 0.8128 to 1.0265, p = 0.128. Assessment of ER-negative subtype breast cancer (ER−BC) risk indicated that OCs use significantly increased the risk: OR = 1.3079, 95% CI: 1.0003 to 1.7100, p = 0.050. Analysis for HER2-positive breast cancer (HER2+BC) risk showed that OCs use statistically non-significantly lowered the risk: OR = 0.8810, 95% CI: 0.5977 to 1.2984, p = 0.522. Meta-analysis with regard to Triplet-negative breast cancer (TNBC) risk showed non-statistically significant increased risk: OR = 1.553, 95% CI: 0.99 to 2.43, p = 0.055. The findings of the meta-analysis suggest that breast cancer risk in premenopausal women may vary with respect to molecular subtypes. Extensive scientific work is still necessary in order to understand the impact of OCs use on breast cancer risk in young women. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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12 pages, 364 KiB

Open AccessArticle

Impact of Physical Activity of Pregnant Women on Obstetric Outcomes

by Ksawery Goławski and Cezary Wojtyła

Int. J. Environ. Res. Public Health 2022, 19(19), 12541; https://doi.org/10.3390/ijerph191912541 - 1 Oct 2022

Cited by 6 | Viewed by 1802

Abstract

Regular and well-planned physical activity (PA) has a positive impact on pregnancy outcomes. In this study, we determine the impact of the PA of pregnant women on the occurrence of certain pregnancy outcomes, such as type of labor, duration of pregnancy, and birthweight. [...] Read more.

Regular and well-planned physical activity (PA) has a positive impact on pregnancy outcomes. In this study, we determine the impact of the PA of pregnant women on the occurrence of certain pregnancy outcomes, such as type of labor, duration of pregnancy, and birthweight. The study is based on the results of a Polish national survey performed between 2011 and 2017 on a group of 9170 women. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to estimate the PA of pregnant women. Light intensity PA accounts for the largest proportion of women’s total energy expenditure. Increase in women’s total energy expenditure was associated with an increase in the birthweight of a child. A similar relationship was observed in the case of light and moderate PA. Vaginal birth was more common among women with higher total energy expenditure. Mothers of preterm children showed lower energy expenditure for each type of PA compared to term pregnancies. There was also a correlation between moderate and vigorous PA and low birthweight. Our study indicates that PA undertaken by pregnant women has a positive impact on pregnancy outcomes. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

13 pages, 351 KiB

Open AccessArticle

Sexual Behavior and the Awareness Level of Common Risk Factors for the Development of Cervical, Anogenital and Oropharyngeal Cancer among Women Subjected to HR HPV DNA-Testing

by Agnieszka Wencel-Wawrzeńczyk, Piotr Lewitowicz, Angelika Lewandowska and Agnieszka Saługa

Int. J. Environ. Res. Public Health 2022, 19(15), 9580; https://doi.org/10.3390/ijerph19159580 - 4 Aug 2022

Cited by 3 | Viewed by 1664

Abstract

The human papillomavirus (HPV) is a significant health problem that increases the risk of developing precancerous lesions, cancer of the anogenital area, as well as mouth and throat cancers. The aim of the study was to analyze the awareness level of common risk [...] Read more.

The human papillomavirus (HPV) is a significant health problem that increases the risk of developing precancerous lesions, cancer of the anogenital area, as well as mouth and throat cancers. The aim of the study was to analyze the awareness level of common risk factors and the preferred sexual behavior of women aged 18–68, who underwent a molecular evaluation of common HR-HPV from material collected from the cervix. The study was conducted at the Jan Kochanowski University in Kielce, Collegium Medicum, in the period from December 2019 to August 2020 on a group of 201 women. A diagnostic survey and the HR-HPV molecular test were used in the research. All of the obtained samples were subjected to identification of and testing for the presence of HR-HPV by the Cobas 4800 platform (Roche Diagnostic^©, Basel, Switzerland). We presented the statistically significant relationships between the age of the respondents and the awareness of the impact. The women aged over 43 years old presented the widest spectrum of information concerning HPV-related lesions. Conclusion: Our study highlights the necessity of educating women about the prevention of sexually transmitted infections. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

11 pages, 470 KiB

Open AccessArticle

Retrospective Analysis of the Factors Affecting the Induction of Childbirth in 4350 Women from a Single Center in Warsaw, Poland

by Grażyna Bączek, Ewa Rzońca, Patryk Rzońca, Sylwia Rychlewicz, Margareta Budner and Agnieszka Bień

Int. J. Environ. Res. Public Health 2022, 19(15), 9540; https://doi.org/10.3390/ijerph19159540 - 3 Aug 2022

Cited by 1 | Viewed by 2439

Abstract

Labor induction is one of the most common procedures performed during childbirth, on average in 20–30% of all pregnant women. The aim of this paper was to perform a retrospective analysis of the factors influencing the induction of childbirth. The data provide population-based [...] Read more.

Labor induction is one of the most common procedures performed during childbirth, on average in 20–30% of all pregnant women. The aim of this paper was to perform a retrospective analysis of the factors influencing the induction of childbirth. The data provide population-based evidence for Poland (Masovian Voivodeship). The electronic patient records of a hospital in Warsaw were used to create an anonymous retrospective database of all deliveries from 2015 to 2020. The study included an analysis of two groups of patients. The study group consisted of patients with labor induction—4350 cases, and the control group of patients with spontaneous contractions—20,345. The factors influencing the lower frequency of labor induction in the study group were previous cesarean section (OR = 0.73, 95% CI: 0.64–0.84, p < 0.05) and a higher number of deliveries (OR = 0.74, 95% CI: 0.68–0.80, p < 0.05). It is necessary to conduct further research about obstetric procedures used during childbirth, such as induction of childbirth, to reduce the risk of complications and improve the perinatal care of the mother and the neonate. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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12 pages, 2911 KiB

Open AccessArticle

Environmental Toxicants and Preterm Birth: A Bibliometric Analysis of Research Trends and Output

by Manuel S. Vidal, Jr., Ramkumar Menon, Gracia Fe B. Yu and Melissa D. Amosco

Int. J. Environ. Res. Public Health 2022, 19(5), 2493; https://doi.org/10.3390/ijerph19052493 - 22 Feb 2022

Cited by 5 | Viewed by 2595

Abstract

Preterm birth remains a problem globally, as multiple factors contribute to its etiology and pathogenesis. One such factor is the exposure to environmental toxicants, in which recent literature has described contributory roles in disease progression. This study aims to show research trends and [...] Read more.

Preterm birth remains a problem globally, as multiple factors contribute to its etiology and pathogenesis. One such factor is the exposure to environmental toxicants, in which recent literature has described contributory roles in disease progression. This study aims to show research trends and collaborations in papers related to environmental toxicants and preterm birth through a bibliometric analysis to determine hot spots for research as well as to identify already established themes that can point to policy making and development. Using the Scopus database, we were able to identify 956 original research articles from 72 countries between 1955 and 2021; bibliographic information was exported, analyzed, and visualized using Bibliometrix and VOSviewer. There was an annual growth of research and reporting in this area, which significantly increased within the last two decades. The top countries that have published on this topic include the USA (n = 343), China (n = 103), and Australia (n = 43), with strong international collaboration in reports from China. Top journals for publication include Environmental Research (n = 53), Environmental Health Perspectives (n = 47), and Environment International (n = 46). Previous literature focused on establishing toxicants that are significantly associated with preterm birth, with current research focusing on molecular mechanisms of environmental toxicants. Overall, our bibliometric analysis gives a scoping view of the existing research landscape in terms of environmental health and preterm birth. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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17 pages, 554 KiB

Open AccessArticle

The Relationship between Social Support, Self-Efficacy and Characteristics of Women with Diabetes during Pregnancy

by Grażyna Iwanowicz-Palus, Marta Zarajczyk, Agnieszka Bień, Magdalena Korżyńska-Piętas, Justyna Krysa, Mansur Rahnama-Hezavah and Artur Wdowiak

Int. J. Environ. Res. Public Health 2022, 19(1), 304; https://doi.org/10.3390/ijerph19010304 - 28 Dec 2021

Cited by 6 | Viewed by 2313

Abstract

Background: One of the most common metabolic complications of pregnancy are carbohydrate metabolism disorders resulting in hyperglycemia. The aim of the study was the assessment of impact of socio-demographic variables on the levels of social support and self-efficacy and an investigation of whether [...] Read more.

Background: One of the most common metabolic complications of pregnancy are carbohydrate metabolism disorders resulting in hyperglycemia. The aim of the study was the assessment of impact of socio-demographic variables on the levels of social support and self-efficacy and an investigation of whether there is and how the relationship between social support and self-efficacy is shaped in pregnant women with gestational diabetes. In this study 339 pregnant women with diabetes during pregnancy and 337 healthy pregnant women took part. Methods: The Berlin Social Support Scales (BSSS), the Generalized Self-Efficacy Scale (GSES) and a standardized interview questionnaire were used. Results: The respondents rated Perceived Instrumental Support higher (M = 3.52) than Perceived Emotional Support (M = 3.39). In contrast, Actually Received Support (M = 3.53) was rated higher compared to Support Seeking (M = 2.99) and Need for Support (M = 2.95). The mean generalized self-efficacy score was M = 31.58 in women with diabetes during pregnancy and M = 31.85 in healthy pregnant women. Conclusions: The research results obtained prove the existence of a relationship between GSES and BSSS scores. In pregnant women with diabetes and healthy pregnant women, GSES increases with an increase in perceived support. Additionally, among pregnant women with diabetes, the level of GSES increases with an increase in actually received support. However, in the case of healthy pregnant women, a lower level of need for support is associated with higher level of generalized self-efficacy. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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9 pages, 539 KiB

Open AccessArticle

Women Aged over 40 with Twin Pregnancies Have a Higher Risk of Adverse Obstetrical Outcomes

by María De la Calle, Jose L. Bartha, Laura García, Marcos J. Cuerva and David Ramiro-Cortijo

Int. J. Environ. Res. Public Health 2021, 18(24), 13117; https://doi.org/10.3390/ijerph182413117 - 12 Dec 2021

Cited by 3 | Viewed by 3039

Abstract

Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 [...] Read more.

Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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10 pages, 320 KiB

Open AccessArticle

Suspected Miscarriage in the Experience of Emergency Medical Services Teams—Preliminary Study

by Ewa Rzońca, Agnieszka Bień, Grażyna Bączek, Patryk Rzońca, Michał Filip and Robert Gałązkowski

Int. J. Environ. Res. Public Health 2021, 18(23), 12305; https://doi.org/10.3390/ijerph182312305 - 23 Nov 2021

Cited by 3 | Viewed by 2128

Abstract

Vaginal bleeding and abdominal pain are symptoms indicative of a threat to pregnancy that prompt women to seek assistance from health care professionals. The purpose of the study was to present the characteristics of Emergency Medical Services (EMS) team interventions in cases of [...] Read more.

Vaginal bleeding and abdominal pain are symptoms indicative of a threat to pregnancy that prompt women to seek assistance from health care professionals. The purpose of the study was to present the characteristics of Emergency Medical Services (EMS) team interventions in cases of suspected miscarriage. The study involved a retrospective analysis of EMS team interventions in cases of suspected miscarriage carried out between January 2018 and December 2019 in Poland. Data obtained from Poland’s National Monitoring Center of Emergency Medical Services included emergency medical procedure records and EMS team dispatch records in electronic format. The mean patient age was 30.53 years. Most were primiparous (48.90%) and up to the 13th gestational week (76.65%). The most commonly reported symptom was vaginal bleeding (80.71%). EMS teams were most commonly dispatched in the winter (27.03%), between 7 A.M. and 6:59 P.M. (51.87%), in urban areas (69.23%), with urgency code 2 (55.60%), and in most cases, they transferred the patient to a hospital (97.53%). The present study addresses very important issues concerning the characteristics of Polish suspected miscarriage cases handled by different EMS team types, in different locations (urban vs. rural areas), and concerning patients in a different obstetric situation (gestational week, gravidity, parity). Our findings suggest a need for further studies in this field and for gestational health promotion activities to be implemented, specifically including actions to reduce the risk of vaginal bleeding during pregnancy. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

10 pages, 370 KiB

Open AccessArticle

Pharmacological Abortion in a Pandemic: An Italian Medico-Legal Perspective

by Clara Cestonaro, Anna Aprile, Matteo Bolcato, Daniele Rodriguez, Alessandro Feola and Giulio Di Mizio

Int. J. Environ. Res. Public Health 2021, 18(22), 12043; https://doi.org/10.3390/ijerph182212043 - 16 Nov 2021

Cited by 4 | Viewed by 2834

Abstract

The limitations caused by the spread of the SARS-CoV2 virus have had repercussions on the voluntary termination of pregnancy. During the pandemic, Italy issued updated guidelines regarding voluntary termination of pregnancy by means of mifepristone and prostaglandin. This included news concerning the time [...] Read more.

The limitations caused by the spread of the SARS-CoV2 virus have had repercussions on the voluntary termination of pregnancy. During the pandemic, Italy issued updated guidelines regarding voluntary termination of pregnancy by means of mifepristone and prostaglandin. This included news concerning the time limit and location in which this procedure could be accessed: updates partially recognize women’s needs, and they are into line with the European parliament’s recent exhortations. However, these updates do not change the previously provided responsibilities that lie with doctors. This article aimed to compare regulations concerning medical abortion in Italy and other countries, with a focus on recent Italian updates in the context of pandemic. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

20 pages, 2399 KiB

Open AccessArticle

Exploring Readiness for Birth Control in Improving Women Health Status: Factors Influencing the Adoption of Modern Contraceptives Methods for Family Planning Practices

by Adnan Muhammad Shah, KangYoon Lee and Javaria Nisa Mir

Int. J. Environ. Res. Public Health 2021, 18(22), 11892; https://doi.org/10.3390/ijerph182211892 - 12 Nov 2021

Cited by 4 | Viewed by 5853

Abstract

Background: Pakistan is the world’s sixth most populated country, with a population of approximately 208 million people. Despite this, just 25% of legitimate couples say they have used modern contraceptive methods. A large body of literature has indicated that sexual satisfaction is a [...] Read more.

Background: Pakistan is the world’s sixth most populated country, with a population of approximately 208 million people. Despite this, just 25% of legitimate couples say they have used modern contraceptive methods. A large body of literature has indicated that sexual satisfaction is a complex and multifaceted concept, since it involves physical and cultural components. The purpose of this study is to investigate the impact of influencing factors in terms of contraceptive self-efficacy (CSE), contraceptive knowledge, and spousal communication on the adoption of modern contraceptive methods for family planning (FP) under the moderating role of perceived barriers. Methods: Data were collected using an adopted questionnaire issued to married women of reproductive age belonging to the Rawalpindi and Neelum Valley regions in Pakistan. The sample consisted of 250 married women of reproductive age. SPSS was used to analyze the respondents’ feedback. Results: The findings draw public attention towards CSE, contraceptive knowledge, and spousal communication, because these factors can increase the usage of modern methods for FP among couples, leading to a reduction in unwanted pregnancies and associated risks. Regarding the significant moderation effect of perceived barriers, if individuals (women) are highly motivated (CSE) to overcome perceived barriers by convincing their husbands to use contraceptives, the probability to adopt modern contraceptive methods for FP practices is increased. Conclusions: Policymakers should formulate strategies for the involvement of males by designing male-oriented FP program interventions and incorporating male FP workers to reduce communication barriers between couples. Future research should address several other important variables, such as the desire for additional child, myths/misconceptions, fear of side effects, and partner/friend discouragement, which also affect the adoption of modern contraceptive methods for FP practices. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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11 pages, 497 KiB

Open AccessArticle

Determinants of Psychosocial Resilience Resources in Obese Pregnant Women with Threatened Preterm Labor—A Cross-Sectional Study

by Agnieszka Bień, Ewa Rzońca, Joanna Grzesik-Gąsior, Agnieszka Pieczykolan, Ewa Humeniuk, Małgorzata Michalak, Grażyna Iwanowicz-Palus and Artur Wdowiak

Int. J. Environ. Res. Public Health 2021, 18(20), 10590; https://doi.org/10.3390/ijerph182010590 - 10 Oct 2021

Cited by 5 | Viewed by 2398

Abstract

Background: The purpose of the study was to assess the level of such psychosocial resilience resources as self-efficacy, dispositional optimism, and health locus of control in pregnant women with obesity with threatened premature labor. Methods: The study was performed in the years [...] Read more.

Background: The purpose of the study was to assess the level of such psychosocial resilience resources as self-efficacy, dispositional optimism, and health locus of control in pregnant women with obesity with threatened premature labor. Methods: The study was performed in the years 2017–2020 in a group of 328 pregnant women hospitalized due to threatened preterm labor and diagnosed with obesity before the pregnancy. The following instruments were applied: the Life Orientation Test, the Generalized Self-Efficacy Scale, and the Multidimensional Health Locus of Control Scale. Results: Obese pregnant women with threatened premature labor have a moderate level of generalized self-efficacy (28.02) and a moderate level of dispositional optimism (16.20). Out of the three health locus of control dimensions, the highest scores were recorded in the “internal control” subscale (26.08). Statistically significant predictors for the self-efficacy variable model included: satisfactory socio-economic standing (ß = 0.156; p = 0.004), being nulliparous (ß = –0.191; p = 0.002), and the absence of comorbidities (ß = –0.145; p = 0.008). Higher levels of dispositional optimism were found in women who were married (ß = 0.381; p = 0.000), reported a satisfactory socio-economic standing (ß = 0.137; p = 0.005), were between 23 and 27 weeks pregnant (ß = –0.231; p = 0.000), and had no comorbidities (ß = –0.129; p = 0.009). Conclusions: Generalized self-efficacy in obese women with threatened preterm labor is associated with satisfactory socio-economic standing, being nulliparous, and the absence of chronic disease. Dispositional optimism in obese pregnant women with threatened preterm labor is determined by their marital status, socio-economic standing, gestational age, and the absence of comorbidities. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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9 pages, 1882 KiB

Open AccessArticle

Interstitial Ectopic Pregnancy: The Role of Mifepristone in the Medical Treatment

by Guglielmo Stabile, Federico Romano, Giulia Zinicola, Ghergana Alexandrova Topouzova, Giovanni Di Lorenzo, Francesco Paolo Mangino and Giuseppe Ricci

Int. J. Environ. Res. Public Health 2021, 18(18), 9781; https://doi.org/10.3390/ijerph18189781 - 17 Sep 2021

Cited by 20 | Viewed by 5669

Abstract

Interstitial pregnancy is defined as the presence of a gestational sac in the most proximal section of the fallopian tube. Management of interstitial pregnancy remains a debated topic. Depending on hemodynamic stability, size of pregnancy, depth of surrounding myometrium, and desires for future [...] Read more.

Interstitial pregnancy is defined as the presence of a gestational sac in the most proximal section of the fallopian tube. Management of interstitial pregnancy remains a debated topic. Depending on hemodynamic stability, size of pregnancy, depth of surrounding myometrium, and desires for future fertility, interstitial pregnancy can be managed medically or surgically. We reviewed the literature in December 2020 using keywords “interstitial pregnancy”, “medical treatment”, “methotrexate”, and “mifepristone”. Articles published from January 1991 until 2020 were obtained from databases EMBASE, SCOPUS, and PUBMED. We describe the case of a patient with an interstitial pregnancy that was managed with a total medical approach in August 2020 at Burlo Garofolo Hospital. The patient was asymptomatic and hemodynamically stable, with a high level of serum β-hCG (22,272 mUi/mL). We used the combination of methotrexate (MTX) and mifepristone. Medical therapy was effective leading to interstitial pregnancy resolution in 51 days without collateral effects for the patient. We found seven previous cases reported in the literature. Our purpose is to underline the efficacy of medical therapy with systemic multidose MTX associated with a single oral dose of mifepristone and also folinic acid when is present a viable fetus and a high serum β-hCG level. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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8 pages, 1528 KiB

Open AccessFeature PaperArticle

Clinical Risk Factors for Uterine Cervical Elongation among Women with Pelvic Organ Prolapse

by Yi-Yin Liu, Chiu-Lin Wang, Zi-Xi Loo, Kun-Ling Lin and Cheng-Yu Long

Int. J. Environ. Res. Public Health 2021, 18(17), 9255; https://doi.org/10.3390/ijerph18179255 - 2 Sep 2021

Cited by 5 | Viewed by 3150

Abstract

Background: Cervical elongation is commonly associated with pelvic organ prolapse (POP). It was an identified risk for recurrent prolapse after hysteropexy, requiring additional surgeries. The aim of the study is to investigate the risk factors for uterine cervical elongation among women with POP. [...] Read more.

Background: Cervical elongation is commonly associated with pelvic organ prolapse (POP). It was an identified risk for recurrent prolapse after hysteropexy, requiring additional surgeries. The aim of the study is to investigate the risk factors for uterine cervical elongation among women with POP. Methods: In this single-center retrospective cohort study, women who underwent vaginal total hysterectomy for POP between 2014 and 2016 were collected. The cervical and total uterine lengths were measured by pathologists, while the ratio of cervical length to total uterine length were calculated. The cervical elongation is defined as corpus/cervix ratio ≤ 1.5. Results: A total of 133 patients were enrolled in this study. Among these patients, 43 women had cervical elongation and 90 women had normal length of uterine cervix. We found that age > 65 years old (67.4% vs. 42.2%, p = 0.007), total vaginal length ≥ 9.5 cm (65.1% vs. 45.6%, p = 0.035), uterine weight < 51 gm (72.1% vs. 52.2%, p = 0.03), and Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6) ≥ 12 (30.2% vs. 14.4%, p = 0.032) were associated with the risk of cervical elongation. There were no significant differences on preoperative urodynamic parameters in the two groups. Conclusion: The patient age > 65 years old, the total vaginal length of POP-Q system ≥ 9.5 cm, uterine weight < 51 g, and POPDI-6 ≥ 12 are independent risk factors of cervical elongation in women with POP. For women scheduled for pelvic reconstructive hysteropexy, concomitant cervical amputation should be considered. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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12 pages, 1091 KiB

Open AccessArticle

Pro- and Anti-Inflammatory Cytokines in the First Trimester—Comparison of Missed Miscarriage and Normal Pregnancy

by Maciej Kwiatek, Tomasz Gęca and Anna Kwaśniewska

Int. J. Environ. Res. Public Health 2021, 18(16), 8538; https://doi.org/10.3390/ijerph18168538 - 12 Aug 2021

Cited by 10 | Viewed by 3274

Abstract

The advantage in response of Th2 over Th1 is observed in normal pregnancy in peripheral blood. A disturbance of this balance can lead to symptoms of miscarriage and pregnancy loss. The aim of this study was to evaluate the pro- and anti-inflammatory cytokines [...] Read more.

The advantage in response of Th2 over Th1 is observed in normal pregnancy in peripheral blood. A disturbance of this balance can lead to symptoms of miscarriage and pregnancy loss. The aim of this study was to evaluate the pro- and anti-inflammatory cytokines in sera of women who were diagnosed with missed miscarriage in the first trimester and to compare this systemic immune response to the response in women with normal pregnancy. The study group consisted of 61 patients diagnosed with missed miscarriage. In total, 19 healthy women with uncomplicated first trimester created the control group. Cytokines were determined in the maternal serum by ELISA. The analysis included INF-γ, TNF-α, Il-1β, Il-4, Il-5, Il-6, Il-9, Il-10, Il-13 and TGF-β1. Th1 cytokine levels in the study group reached slightly higher values for INF-γ, Il-1β and slightly lower for IL-6 and TNF-α. In turn, Th2 cytokine levels in the study group were slightly higher (Il-9, Il-13), significantly higher (Il4, p = 0.015; Il-5, p = 0.0003) or showed no differences with the control group (Il-10). Slightly lower concentration involved only TGF-β1. Analysis of the correlation between levels of pro- and anti-inflammatory cytokines resulted in some discrepancies, without showing predominance of a specific immune response. The results did not confirm that women with missed miscarriage had an advantage in any type of immune response in comparison to women with normal pregnancy. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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10 pages, 534 KiB

Open AccessArticle

Preterm Labor Using Tocolysis as a Possible Risk Factor for Postpartum Depression: A 14-Year Population-Based Study in Taiwan

by Jui-Ming Liu, Chien-Yu Liu, Ren-Jun Hsu and Fung-Wei Chang

Int. J. Environ. Res. Public Health 2021, 18(13), 7211; https://doi.org/10.3390/ijerph18137211 - 5 Jul 2021

Cited by 2 | Viewed by 2907

Abstract

Postpartum depression (PPD) is associated with negative physical and mental health outcomes for the mother and infant. Women often experience elevated symptoms of PPD, and the incidence of PPD has increased in recent years. There were lack of studies to investigate the effects [...] Read more.

Postpartum depression (PPD) is associated with negative physical and mental health outcomes for the mother and infant. Women often experience elevated symptoms of PPD, and the incidence of PPD has increased in recent years. There were lack of studies to investigate the effects of medications during pregnancy. Herein, we focused on the most common obstetric medical therapies used in labor and determined whether the medical therapies cause mental stress in pregnant women. This 14-year retrospective population-based nationwide study was based on the National Health Insurance Research Database. Univariate and multivariate logistic regression analyses were used to evaluate unadjusted and adjusted odds ratios and 95% confidence intervals for each tocolytic and uterotonic treatments during pregnancy and common medical illnesses. In comparing the effects of tocolytic and uterotonic medications on maternal PPD, tocolysis with the injection form of ritodrine resulted in a significantly higher risk of PPD based on multivariate analysis. This study supports existing research demonstrating an association between tocolysis with ritodrine and PPD. Ritodrine treatment for preterm labor was a significant risk factor for PPD, especially the injection form. This information provides obstetricians and health policy providers to pay attention to maternal mental health outcomes among high-risk pregnant women. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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11 pages, 682 KiB

Open AccessArticle

Increased Incidence of Premenstrual Syndrome in Females with Palmar Hyperhidrosis

by Chun-An Cheng, Yu-Cheng Liang, Yin-Han Chang, Chun-Gu Cheng, Chi-Hsiang Chung and Wu-Chien Chien

Int. J. Environ. Res. Public Health 2021, 18(9), 4697; https://doi.org/10.3390/ijerph18094697 - 28 Apr 2021

Cited by 1 | Viewed by 2859

Abstract

Background: Premenstrual syndrome (PMS) is a common disorder affecting the quality of life of women of reproductive age. In a previous study, sex hormone imbalances and alterations in autonomic function were present in PMS, with parasympathetic dysfunction and sympathetic overactivity during the late [...] Read more.

Background: Premenstrual syndrome (PMS) is a common disorder affecting the quality of life of women of reproductive age. In a previous study, sex hormone imbalances and alterations in autonomic function were present in PMS, with parasympathetic dysfunction and sympathetic overactivity during the late luteal phase. Palmar hyperhidrosis (PH) presents with oversweating, heat and emotional stimulation, sympathetic hyperactivity and parasympathetic hypofunction. We hypothesized that the incidence of PMS is increased in females with PH. Methods: Data were retrieved from the Taiwanese National Health Insurance Database. The patients with PH were identified by the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) disease code 780.8. Female patients matched by age and index day were used as the control group. The incidence of PMS was considered an outcome by the ICD-9-CM disease code 625.4. The factors related to PMS were analyzed by Cox regression. Results: The adjusted hazard ratio for the incidence of PMS was 1.276 (95% confidence interval: 1.05–1.488) in females with PH. Conclusions: This study found a positive correlation between PMS and female PH patients. Patients and physicians must understand the relationship of PMS with autonomic function alterations and other risk factors to prevent this problematic disorder. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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13 pages, 524 KiB

Open AccessArticle

Risk Factors for Postpartum Hemorrhage in a Thai–Myanmar Border Community Hospital: A Nested Case-Control Study

by Waraporn Thepampan, Nuchsara Eungapithum, Krittai Tanasombatkul and Phichayut Phinyo

Int. J. Environ. Res. Public Health 2021, 18(9), 4633; https://doi.org/10.3390/ijerph18094633 - 27 Apr 2021

Cited by 3 | Viewed by 6077

Abstract

Postpartum hemorrhage (PPH) is a common complication of pregnancy and a global public health concern. Even though PPH risk factors were extensively studied and reported in literature, almost all studies were conducted in non-Asian countries or tertiary care centers. Our study aimed to [...] Read more.

Postpartum hemorrhage (PPH) is a common complication of pregnancy and a global public health concern. Even though PPH risk factors were extensively studied and reported in literature, almost all studies were conducted in non-Asian countries or tertiary care centers. Our study aimed to explore relevant risk factors for PPH among pregnant women who underwent transvaginal delivery at a Thai–Myanmar border community hospital in Northern Thailand. An exploratory nested case-control study was conducted to explore risk factors for PPH. Women who delivered transvaginal births at Maesai hospital from 2014 to 2018 were included. Two PPH definitions were used, which were ≥ 500 mL and 1000 mL of estimated blood loss within 24 h after delivery. Multivariable conditional logistic regression was used to identify significant risk factors for PPH and severe PPH. Of 4774 women with vaginal births, there were 265 (5.55%) PPH cases. Eight factors were identified as independent predictors for PPH and severe PPH: elderly pregnancy, minority groups, nulliparous, previous PPH history, BMI ≥ 35 kg/m², requiring manual removal of placenta, labor augmentation, and fetal weight > 4000 gm. Apart from clinical factors, particular attention should be given to pregnant women who were minority groups as PPH risk significantly increased in this population. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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13 pages, 1119 KiB

Open AccessArticle

Assessment of Quality of Life in Infertility Treated Women in Poland

by Artur Wdowiak, Agnieszka Anusiewicz, Grzegorz Bakalczuk, Dorota Raczkiewicz, Paula Janczyk and Marta Makara-Studzińska

Int. J. Environ. Res. Public Health 2021, 18(8), 4275; https://doi.org/10.3390/ijerph18084275 - 17 Apr 2021

Cited by 16 | Viewed by 3623

Abstract

The aim of this study was to assess the quality of life (QoL) of infertility treated women as it can affect the effectiveness of therapy. This cross-sectional study was conducted with Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF), Fertility Quality of [...] Read more.

The aim of this study was to assess the quality of life (QoL) of infertility treated women as it can affect the effectiveness of therapy. This cross-sectional study was conducted with Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF), Fertility Quality of Life tool (FertiQoL) and an author’s questionnaire. The study included 1200 women treated for infertility without the use of assisted reproductive technology (non-ART), intrauterine insemination (IUI), or in vitro fertilization (IVF). The control group was 100 healthy women who had children. The time to conceive did not significantly differ between study groups and was 3.1–3.6 years, on average. The quality of life in the WHOQOL-BREF questionnaire data significantly differed between study groups and the control (physical domain p < 0.001, psychological p = 0.009; social p = 0.004; environmental p < 0.001). A significant effect was found in 4 FertiQoL subscales: emotional, biological, partnership, and attitude towards treatment; depending on the method of treatment. Women who received non-ART treatment evaluated their QoL in significantly more negative terms in these 4 subscales, compared to those treated with IVF. The quality of life depends on reproductive problems, methods of infertility treatment, age, place of residence, and education level. Prolongation of the duration of treatment unfavourably affects the quality of life. The quality of life of women undergoing infertility treatment differs according to the mode of work and having children from a previous relationship. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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11 pages, 338 KiB

Open AccessArticle

The Influence of Abortion Law on the Frequency of Pregnancy Terminations—A Retrospective Comparative Study

by Kornelia Zaręba, Stanisław Wójtowicz, Jolanta Banasiewicz, Krzysztof Herman and Grzegorz Jakiel

Int. J. Environ. Res. Public Health 2021, 18(8), 4099; https://doi.org/10.3390/ijerph18084099 - 13 Apr 2021

Cited by 7 | Viewed by 3760

Abstract

Abortion law is one of the main factors influencing the number of abortions performed in a country. The study aimed to assess the influence of abortion law on the number of performed terminations with particular attention paid to pregnancy terminations due to fetal [...] Read more.

Abortion law is one of the main factors influencing the number of abortions performed in a country. The study aimed to assess the influence of abortion law on the number of performed terminations with particular attention paid to pregnancy terminations due to fetal defects. The retrospective comparative analysis of statistical data included on the governmental websites of Poland and the UK was performed. The average of 190,733.1 terminations were performed in the United Kingdom in the years 2009–2018 with the average of 2820.9 due to fetal defects. At the same time the average of 858.6 terminations were performed in Poland with 820.7 due to fetal defects. Population size is the only significant predictor of the number of terminations in the United Kingdom. The increase in the number of deliveries and population in Poland was not linked to the increase in the overall number of terminations or terminations due to fetal defects. It might be due to the unavailability of pregnancy terminations in many places. The radicalization of abortion law exerts no influence on the decrease in the number of terminations due to fetal indications. The liberalization of abortion law promotes the increase in the number of terminations due to social indications. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

Review

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10 pages, 376 KiB

Open AccessReview

Future Perspectives of Ectopic Pregnancy Treatment—Review of Possible Pharmacological Methods

by Milena Leziak, Klaudia Żak, Karolina Frankowska, Aleksandra Ziółkiewicz, Weronika Perczyńska, Monika Abramiuk, Rafał Tarkowski and Krzysztof Kułak

Int. J. Environ. Res. Public Health 2022, 19(21), 14230; https://doi.org/10.3390/ijerph192114230 - 31 Oct 2022

Cited by 14 | Viewed by 5067

Abstract

Ectopic pregnancy, that is, a blastocyst occurring outside the endometrial cavity of the uterus, affects nearly 2% of pregnancies. The treatment of ectopic pregnancy is surgical or pharmacological. Since surgical management is associated with numerous serious side effects, conservative treatment is sought. The [...] Read more.

Ectopic pregnancy, that is, a blastocyst occurring outside the endometrial cavity of the uterus, affects nearly 2% of pregnancies. The treatment of ectopic pregnancy is surgical or pharmacological. Since surgical management is associated with numerous serious side effects, conservative treatment is sought. The treatment of choice in the majority of cases is based on pharmacotherapy with methotrexate (MTX) in a single- or multi-dose regimen. Although the efficacy of methotrexate reaches between 70 and 90%, its use requires specific conditions regarding both the general condition of the patient and the characteristic features of the ectopic pregnancy. Moreover, MTX can cause severe adverse effects, including stomatitis, hepatotoxicity and myelosuppression. Therefore, clinicians and researchers are still looking for a less toxic, more effective treatment, which could prevent surgeries as a second-choice treatment. Some studies indicate that other substances might constitute a good alternative to methotrexate in the management of ectopic pregnancies. These substances include aromatase inhibitors, especially letrozole. Another promising substance in EP treatment is gefitinib, an inhibitor of EGFR tyrosine domain which, combined with MTX, seems to constitute a more effective alternative in the management of tubal ectopic pregnancies. Other substances for local administration include KCl and absolute ethanol. KCl injections used in combination with MTX may be used when foetal heart function is detected in cervical ectopic pregnancies, as well as in heterotopic pregnancy treatment. Absolute ethanol injections proved successful and safe in caesarean scar pregnancies management. Thus far, little is known about the use of those substances in the treatment of ectopic pregnancies, but already conducted studies seem to be promising. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

13 pages, 850 KiB

Open AccessReview

Evaluation of the Risk of Birth Defects Related to the Use of Assisted Reproductive Technology: An Updated Systematic Review

by Dawid Serafin, Beniamin Oskar Grabarek, Dariusz Boroń, Andrzej Madej, Wojciech Cnota and Bartosz Czuba

Int. J. Environ. Res. Public Health 2022, 19(8), 4914; https://doi.org/10.3390/ijerph19084914 - 18 Apr 2022

Cited by 7 | Viewed by 3141

Abstract

Fertility problems constitute a serious medical, social, and demographic problem. With this review, we aim to critically appraise and evaluate the existing literature surrounding the risk of birth defects in offspring conceived using techniques based on assisted reproductive technology (ART). Based on searches [...] Read more.

Fertility problems constitute a serious medical, social, and demographic problem. With this review, we aim to critically appraise and evaluate the existing literature surrounding the risk of birth defects in offspring conceived using techniques based on assisted reproductive technology (ART). Based on searches of the literature in PubMed and ScienceDirect, we obtained a total of 2,003,275 works related to the topic. Ultimately, 11 original papers published in the last 10 years qualified for inclusion in the study. Based on five studies included in this analysis, it was shown that ART significantly increases the risk of congenital malformations in associated newborns. Due to the specifics of given studies, as well as potential confounding risk factors, this influence cannot be ignored. Therefore, considering the information contained in the articles included in this systematic review, it was determined that the risk of birth defects is not directly related to the use of ART itself but also depends on the age of partners, causes of infertility, comorbidities, and the number of fetuses during a pregnancy, as well as many other factors not covered in the literature. It is thus necessary to impress upon infertile couples who wish to have offspring that the use of ART is not risk-free but that the benefits outweigh the risks. Further education in this field, as well as social understanding, is also required. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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12 pages, 370 KiB

Open AccessReview

Changes in the Oral Cavity in Menopausal Women—A Narrative Review

by Aleksandra Ciesielska, Aida Kusiak, Agata Ossowska and Magdalena Emilia Grzybowska

Int. J. Environ. Res. Public Health 2022, 19(1), 253; https://doi.org/10.3390/ijerph19010253 - 27 Dec 2021

Cited by 23 | Viewed by 5939

Abstract

Oral health awareness during the menopausal period is essential to minimize the inevitable inconveniences which may occur due to hormonal changes. The decrease in estrogen hormone concentration impacts the oral mucosa in a similar way to the vaginal mucosa due to the presence [...] Read more.

Oral health awareness during the menopausal period is essential to minimize the inevitable inconveniences which may occur due to hormonal changes. The decrease in estrogen hormone concentration impacts the oral mucosa in a similar way to the vaginal mucosa due to the presence of estrogen receptors in both of these structures. An estrogen deficiency also affects the maturation process of the oral mucosal epithelium and can lead to its thinning and atrophy, making it more susceptible to local mechanical injuries, causing a change in pain tolerance and problems in the use of removable prosthetic restorations. Mucosal epithelium during the menopausal period is more vulnerable to infections, candidiasis, burning mouth syndrome, oral lichen planus (OLP), or idiopathic neuropathy. Moreover, salivary glands are also hormone-dependent which leads to changes in saliva secretion and its consistency. In consequence, it may affect teeth and periodontal tissues, resulting in an increased risk of caries and periodontal disease in menopausal women. Due to the large variety of complaints and symptoms occurring in the oral cavity, menopausal women constitute a significant group of patients who should receive special preventive and therapeutic care from doctors and dentists in this particular period. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

13 pages, 4326 KiB

Open AccessReview

Scar Tissue after a Cesarean Section—The Management of Different Complications in Pregnant Women

by Aleksandra Stupak, Adrianna Kondracka, Agnieszka Fronczek and Anna Kwaśniewska

Int. J. Environ. Res. Public Health 2021, 18(22), 11998; https://doi.org/10.3390/ijerph182211998 - 15 Nov 2021

Cited by 10 | Viewed by 10239

Abstract

The definition of a cesarean scar pregnancy (CSP) is the localization of the gestational sac (GS) in the cicatrix tissue, which is created in the front wall of the uterus after a previous cesarean section (CS). The worldwide prevalence of CSP has been [...] Read more.

The definition of a cesarean scar pregnancy (CSP) is the localization of the gestational sac (GS) in the cicatrix tissue, which is created in the front wall of the uterus after a previous cesarean section (CS). The worldwide prevalence of CSP has been growing rapidly. However, there are no general recommendations regarding prophylaxis and treatment of the abnormalities of the anterior wall of the uterus discovered in a non-pregnant myometrium, or how to deal with existing cases of CSP. We present the latest knowledge, a holistic approach to the biology, histology, imaging, and management concerning post-CS scars based on our cases, which were treated in the Department of Pregnancy and Pathology of Pregnancy in the Medical University of Lublin, Poland. In our study, we present images of tissue samples of areas with a cicatrix in the uterus, and ultrasound and MRI images of CSP. We discuss the advances in the biology of the post-CS scar tissue, the prevention techniques used to repair the scar defect (niche) before the pregnancy, and the treatment of different complications of CSP, such as the rupture of the gravid uterus or the dehiscence of the myometrium. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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10 pages, 615 KiB

Open AccessReview

Vaginal Aging—What We Know and What We Do Not Know

by Jacek K. Szymański, Aneta Słabuszewska-Jóźwiak and Grzegorz Jakiel

Int. J. Environ. Res. Public Health 2021, 18(9), 4935; https://doi.org/10.3390/ijerph18094935 - 6 May 2021

Cited by 4 | Viewed by 5882

Abstract

The aging of the organism is a complex and multifactorial process. It can be viewed in the context of the whole organism, but also of individual tissues and organs. The problem of vaginal aging and the related genitourinary syndrome of menopause significantly reduces [...] Read more.

The aging of the organism is a complex and multifactorial process. It can be viewed in the context of the whole organism, but also of individual tissues and organs. The problem of vaginal aging and the related genitourinary syndrome of menopause significantly reduces the quality of women’s lives. The aging process of the vagina includes estrogen deficiencies, changes in the microbiome, and changes at the genetic level associated with DNA methylation. During the menopause, the number of Lactobacillus colonies decreases, and the number of pathological bacteria colonies increases. The decrease in estrogen levels results in a decrease in vaginal epithelial permeability, perfusion, and elastin levels, resulting in vaginal dryness and atrophy. Changes at the molecular level are the least clear. It can also be assumed that, similarly to the tissues studied so far, there are changes in cytosine methylation and TET (ten-eleven translocation) expression. The interrelationships between DNA methylation, hormonal changes, and the vaginal microbiome have not yet been fully elucidated. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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26 pages, 37500 KiB

Open AccessReview

Use of Oral Contraceptives as a Potential Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis of Case-Control Studies Up to 2010

by Wiesław Kanadys, Agnieszka Barańska, Maria Malm, Agata Błaszczuk, Małgorzata Polz-Dacewicz, Mariola Janiszewska and Marian Jędrych

Int. J. Environ. Res. Public Health 2021, 18(9), 4638; https://doi.org/10.3390/ijerph18094638 - 27 Apr 2021

Cited by 23 | Viewed by 7883

Abstract

Despite numerous studies evaluating the risk of breast cancer among oral contraception users, the effect of oral contraceptive on developing breast cancer remains inconclusive. Therefore, we conducted a systematic review of literature with meta-analysis in order to quantitative estimate this association. The bibliographic [...] Read more.

Despite numerous studies evaluating the risk of breast cancer among oral contraception users, the effect of oral contraceptive on developing breast cancer remains inconclusive. Therefore, we conducted a systematic review of literature with meta-analysis in order to quantitative estimate this association. The bibliographic database MEDLINE and EMBASE, and reference lists of identified articles were searched, with no language restrictions, from the start of publication to August 2010. We performed a reanalysis and overall estimate of 79 case-control studies conducted between 1960–2010, including a total of 72,030 incidents, histologically confirmed cases of breast cancer and 123,650 population/hospital controls. A decrease was observed in cancer risk in OC users before age 25 years (0.91, 0.83–1.00). However, the use of OCs before the first full-term pregnancy had a significant increased risk of breast cancer (OR, 1.14, 1.01–1.28, p = 0.04), as did OC use longer than 5 years (1.09, 1.01–1.18, p = 0.02). Pooled crude odds ratios of breast cancer in ever-users of oral contraceptives was 1.01 [95% confidence interval (CI), 0.95–1.07], compared with never-users. There was no significant increase in risk among premenopausal women (1.06, 0.92–1.22), postmenopausal women (0.99, 0.89–1.10), or nulliparous women (1.02, 0.82–1.26). Oral contraceptives do not appear to increase the risk of breast cancer among users. However, OC use before a first full-term pregnancy or using them longer than 5 years can modify the development of the breast cancer. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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11 pages, 7078 KiB

Open AccessReview

Fowler’s Syndrome—The Cause of Urinary Retention in Young Women, Often Forgotten, but Significant and Challenging to Treat

by Jacek K. Szymański, Aneta Słabuszewska-Jóźwiak and Grzegorz Jakiel

Int. J. Environ. Res. Public Health 2021, 18(6), 3310; https://doi.org/10.3390/ijerph18063310 - 23 Mar 2021

Cited by 4 | Viewed by 6352

Abstract

Urinary retention in young women is a relatively rare clinical problem and is often underdiagnosed. In particular, functional causes of urinary retention pose a diagnostic challenge. One of them is Fowler’s syndrome, which is associated with impaired urethral relaxation. Fowler’s syndrome is characterized [...] Read more.

Urinary retention in young women is a relatively rare clinical problem and is often underdiagnosed. In particular, functional causes of urinary retention pose a diagnostic challenge. One of them is Fowler’s syndrome, which is associated with impaired urethral relaxation. Fowler’s syndrome is characterized by a large bladder capacity, reduced sensation, increased maximal urethral closure pressure, and detrusor underactivity. Several hypotheses have arisen to explain the cause of urethral relaxation disorders: hormonal changes characteristic of Polycystic Ovary Syndrome (PCOS), causing abnormal stabilization of the muscle membrane, primary failure of relaxation of the striated muscle of the urethra sphincter, and increased urethral afferent activity, inhibiting the bladder afferent signals from reaching the brain by potentiating a spinal mechanism of urinary continence. Currently, sacral neuromodulation is the only intervention that can restore an atypical voiding pattern in women with Fowler’s syndrome. The therapeutic effectiveness exceeds 70%, although the revision rate is relatively high, exceeding 50%. Well-designed, long-term prospective studies comparing sacral neuromodulation (SNM) with other therapies such as pelvic floor muscle physiotherapy are warranted to offer the best patient-tailored treatment. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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Other

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5 pages, 298 KiB

Open AccessProtocol

Cervicovaginal Microbiome after Cervical Intraepithelial Neoplasia Treatment. A Protocol for Systematic Review and Meta-Analysis

by Marta Janicka-Kośnik, Beata Sarecka-Hujar, Grzegorz Jakiel and Aneta Słabuszewska-Jóźwiak

Int. J. Environ. Res. Public Health 2021, 18(17), 9050; https://doi.org/10.3390/ijerph18179050 - 27 Aug 2021

Cited by 2 | Viewed by 2358

Abstract

(1) Background: The microbiome consists of microorganisms from various kingdoms with numerous physical and chemical properties Lactobacillus species constitute the highest percentage of healthy cervical and vaginal microbiota. Dysbiosis may cause adverse outcomes, e.g., bacterial vaginosis, pelvic inflammatory disease and pregnancy complications. The [...] Read more.

(1) Background: The microbiome consists of microorganisms from various kingdoms with numerous physical and chemical properties Lactobacillus species constitute the highest percentage of healthy cervical and vaginal microbiota. Dysbiosis may cause adverse outcomes, e.g., bacterial vaginosis, pelvic inflammatory disease and pregnancy complications. The cervicovaginal microbiome might contribute to the development of a persistent HPV infection—the main risk factor of cervical cancer—and influence progression to malignancy The aim is to perform a systematic review of current literature and a meta-analysis regarding microbiome changes after cervical intraepithelial neoplasia treatment. (2) Methods: We will search PubMed, Scopus, Google Scholar and Embase Database and trace citations in the reference sections. Randomized and non-randomized controlled studies, case–control and cohort studies published between January 2000 and May 2021 will be included in the study protocol. The following keywords will be used: ‘microbiome’, ‘vaginal microbiome’, ‘cervical microbiome’, ‘cervical neoplasia treatment’, ’conization’, ‘electroconization’, and ‘electrosurgical treatment’. Statistical analyses will be performed using RevMan 5.4. (3) Results: The results will be published as a peer-reviewed article. (4) Conclusions: The study will show which forms of intraepithelial neoplasia treatment change the cervicovaginal microbiome. Finding the best form of treatment by studying the cervicovaginal microbiome after various forms of treatment is essential. Patients would benefit not only from the treatment of the initial disease but also the management of dysbiosis, which might underlie other pathologies. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)

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