Body Mass Index (BMI) is an informative factor on body fatness which has been associated to higher levels of Perinatal Depression (PD) and complications during pregnancy. We aimed to explore the ...impact of pre-pregnancy and postnatal BMI on the risk of Perinatal Depression and pregnancy outcomes among women recruited at their third trimester of pregnancy.
We report on findings from a large multi-centre study conducted in the South of Italy and involving 1611 women accessing three urban gynaecological departments from July to November 2020. Pregnant women were assessed at their third trimester of pregnancy (T0) and after the childbirth (T1) ;The Edinburgh Postnatal Depression Scale (EPDS) has been employed for the screening of PD over time (T0 and T1) as well as other standardized measures for neuroticism, resilience, and quality of life at baseline. BMI (T0 and T1) and other socio-demographic and clinical characteristics have been collected.
Over-weight and obesity (higher levels of BMI) were associated with higher risk of PD (higher scores of EPDS), higher neuroticism and poorer subjective psychological well-being among enrolled women. Also, obesity and over-weight were associated with lower education, higher number of physical comorbidities, medical treatments and complications during pregnancy.
Over-weight and obesity may impact on mental health and pregnancy outcome of women enrolled. Psycho-educational interventions aimed to improve the management of physical and emotional issues may reduce the risk of PD and complications during pregnancy.
Introduction
Perinatal depression (PD) is a cluster of clinical depressive symptoms occurring globally during pregnancy or after childbirth, with a prevalence of 11.9%. Risk factors for PD among ...pregnant women may include personality traits of neuroticism, low personal resilience, higher anxiety, avoidance in close relationships, as well as dysfunctional coping strategies.
Methods
We report on descriptive findings of a screening/prevention program aimed to detect depressive symptoms and associated risk factors in a large sample of women (
N
= 1,664) accessing the gynecological departments of the Regione Puglia (South of Italy) from July to November 2020. Pregnant women were assessed in their third trimester of pregnancy (T0), after childbirth (T1), and those at risk for PD within 1 year from delivery (T2–T4); The Edinburgh Postnatal Depression Scale (EPDS) has been employed for the screening of PD over time as well as other standardized measures for neuroticism, resilience, coping strategies, and quality of life.
Results
Of 1,664,
n
= 1,541 were tested at T1, and 131 scored ≥ 12 at EPDS (14.6 ± 2.95), showing a higher risk for PD. They were followed over time at 1, 6, and 12 months after childbirth (T2–T4), and 15 of them scored ≥ 12 (EPDS) at T4. Women with a higher risk of PD also reported higher levels of neuroticism, lower levels of personal resilience, more anxiety and avoidance in close relationships, higher employment of dysfunctional coping strategies (e.g., denial, self-blame, etc.), and lower quality of life (0.0008 <
all p
< 0.0001).
Conclusion
This study confirmed the benefit of screening programs for the early detection of PD among pregnant women. We may suggest a set of risk factors to be considered in the clinical assessment of PD risk as well as the promotion of similar programs to improve depressive outcomes and pathways to care for PD on the basis of a more accurate assessment and referral.
Ovarian tissue inadvertently excised along with endometriomas was associated with the presence of pericystic fibrosis and serum levels of CA-125, representing the only clinical parameter for ...predicting follicle loss before surgery. A consecutive series of 91 ovarian endometriotic cysts were studied, and an inverse relationship between serum CA-125 and the thickness of the fibrotic tissue of the endometrioma capsule was demonstrated.
To evaluate the benefits of adopting 3 simple "diagnostic criteria" in the differential diagnosis between septate and bicornuate uteri, and the relative treatment by hysteroscopy in an office ...setting.
Prospective clinical study (Canadian Task Force classification III).
University-affiliated hospital.
Two hundred-sixty patients with a hysteroscopic diagnosis of a double uterine cavity were enrolled.
Office hysteroscopic metroplasty was performed without analgesia or anesthesia using 5F scissors.
The presence of vascularized tissue, sensitive innervation, and the appearance of the tissue at the incision of a supposed septum during an office hysteroscopic procedure were the criteria used to differentiate a septate from a bicornuate uterus. In 93.1% of the cases, office hysteroscopic metroplasty was successfully performed during the same diagnostic procedure. In 15 of 18 patients scheduled for laparoscopic control of the uterine anatomy, the suspicion of a bicornuate uterus was confirmed. Hysteroscopic follow-up at 3 months showed a regular uterine cavity with a fundal notch less than 1 cm.
The study demonstrates the possibility of obtaining complete, safe removal of uterine septae in most cases by office hysteroscopy confirmation, using mechanical instruments, in an office setting. This was achieved by relating the diagnosis and treatment to simple anatomic and physiologic diagnostic criteria.
Ewing sarcoma-primitive neuroectodermal tumors (ES/PNETs) constitute a family of neoplasms characterized by a continuum of neuroectodermal differentiations. ES/PNET of the uterus is rare. There are ...48 cases of ES/PNET of the uterus published in the literature as far as we know. We describe a case of Ewing sarcoma of the uterus occurring in a 17-year-old woman presenting with a two-month history of pelvic pain. After surgical excision and microscopic, immunohistochemical, and electron microscopy examination, the diagnosis of Ewing sarcoma of the uterus was suggested. This report will discuss the diagnosis and surgical and clinical management of Ewing uterine sarcoma in young women, according to the available literature. In spite of the rarity of ES/PNETs, they should be taken into account in the differential diagnosis of uterine neoplasms in young women.
Herlyn-Werner-Wunderlich syndrome (HWWs) is a rare congenital malformation of the female urogenital track characterized by a triad consisting of didelphys uterus, obstructed hemivagina, and ...ipsilateral renal agenesis. We report 5 consecutive cases of patients diagnosed with HWWs treated in our center. Imaging studies with 2-dimensional/3-dimensional ultrasound and abdominopelvic magnetic resonance imaging were obtained to confirm the diagnosis. The treatment consisted of a 1-step surgical in-office hysteroscopic incision of the vaginal septum using 5 Fr hysteroscopic bipolar electrodes. At the follow-up visit, between 1 and 2 months after the initial procedure, the patients underwent a diagnostic vaginoscopy with excision of exceeding vaginal tissue if needed, performed with a vaginal hysteroscopic approach. In-office hysteroscopic treatment of patients diagnosed with HWWs is a safe and effective, minimally invasive treatment modality that provides symptomatic relief and preserves fertility, avoiding the cost and risks of the use of general anesthesia in an operating room setting. We recommend shifting the management of this challenging condition to the office setting.
To assess the accuracy and characterize two-dimensional ultrasonographic formulas for the estimation of birth weight according to the type of fetal biometric parameters these formulas rely on to make ...fetal weight predictions.
A prospective recruitment of 589 pregnant women was carried out for this cross-sectional study. Different biometric parameters were taken ultrasonographically to estimate birth weight using 35 different formulas. Only those patients who delivered within 48 hours were considered for the analysis (n=441). Differences between the estimated and actual birth weight were assessed by percentage error, accuracy in predictions within +/-10% and +/-15% of error, and use of the Bland-Altman method. All formulas were assessed individually and clustered on the basis of the type of fetal biometric information that they incorporate.
Twenty-nine formulas provided an overall mean absolute percentage error less than or equal to 10%, with overall predictions within +/-10% and +/-15% of the actual birth weight (69.2% and 86.5%, respectively). Twenty formulas showed a good accuracy (bias 0.50 or less) and low variability (mean standard deviation 1.2). Among the categorized algorithms, formulas based on head-abdomen-femur measurements showed the lowest mean absolute percentage error. Upon stratification for birth weight, the group of formulas that rely on abdomen and femur measurements performed best for fetuses weighing more than 3,500 g (P<.01).
Our findings show that most formulas are relatively accurate at predicting birth weight up to 3,500 g, and all algorithms tend to underestimate large fetuses.
III.
To preoperatively predict follicular loss after laparoscopic cystectomy of ovarian endometriomas.
Case-control study. (Canadian Task Force classification II-2).
University hospital.
Seventy-six women ...with ovarian endometrioma and 41 patients with nonendometriotic ovarian cysts who underwent laparoscopy.
Sonographic findings and serum levels of CA 125 and CA 19.9 were recorded.
Considered parameters were compared with a histologic score, on the basis of the presence and morphologic features of follicles on the normal ovarian tissue adjacent to the cyst wall surgically removed. Serum levels of CA 125 and CA 19.9 were increased in patients with ovarian endometrioma (p <.001 and p <.01, respectively). Capsule wall thickness, presence of fibrosis, and follicles in the tissue surrounding the capsule were significantly increased in the study group (p <.01). CA 125 serum level was directly correlated to the histologic score (r = 0.46, p <.05) and to cyst diameter (r = 0.12, p = .01), whereas no correlation was found between CA 19.9 or cyst diameter and follicular score.
Our data suggest that the ovarian tissue inadvertently removed along with the endometrioma wall by laparoscopic stripping is due to pericystic fibrosis. Serum levels of CA 125 represent a useful parameter to predict follicular loss before surgery.
Objective: To assess the diagnostic inadequacy of dilatation and curettage (D&C) by comparing histologic findings with this technique with those obtained after hysterectomy.
Design: Retrospective ...clinical study.
Setting: University-affiliated hospital.
Patient(s): Three hundred ninety-seven patients with abnormal uterine bleeding who underwent D&C and, within 2 months, hysterectomy because of histologic findings or persistence of symptoms.
Main Outcome Measure(s): Comparison of histologic findings on D&C with those obtained after hysterectomy.
Result(s): In 248 of 397 patients (62.5%), D&C failed to detect intrauterine disorders subsequently found at hysterectomy; the sensitivity was 46%, the specificity was 100.0%, the positive predictive value was 100.0%, and the negative predictive value was 7.1%.
Conclusion(s): Dilatation and curettage is an inadequate diagnostic and therapeutic tool for all uterine disorders; this technique missed 62.5% of major intrauterine disorders, and all endometrial disorders were still present in the removed uterus.
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