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Martínez-Maestre MÁ, Castelo-Branco C, Calderón AM, Espigado I, Pérez-Simón JA, González-Cejudo C. Genital chronic graft-versus-host disease: an unmet need that requires trained gynecologists. Climacteric 2024; 27:275-281. [PMID: 38415712 DOI: 10.1080/13697137.2024.2314521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Menopause and chronic graft-versus-host disease (cGvHD) are the leading causes of morbidity after allogeneic hematopoietic stem cell transplantation (alloHSCT). Genitalia are one of the target organs of cGvHD causing sexual dysfunction and local symptoms, which may impair women's quality of life. The aim of this study is to describe the prevalence and clinical characteristics of genital cGvHD. METHODS A retrospective cross-sectional observational study was performed including 85 women with alloHSCT. All women were diagnosed and counseled by a trained gynecologist. Health-related quality of life was assessed by the Cervantes Short-Form Scale and sexual function was evaluated by the Female Sexual Function Index. RESULTS Seventeen women (20%) included in the study were diagnosed with genital cGvHD. The main complaints were vulvovaginal dryness (42.2%) and dyspareunia (29.4%), the presence of erythema/erythematous plaques (52.9%) being the most frequent sign. Median time from transplant to diagnosis of genital cGvHD was 17 months among those with mild involvement, 25 months for moderate and 42 months for severe forms. Mortality was 29.4% in patients who developed cGvHD with genital involvement versus 8.8% among those without (p = 0.012). CONCLUSION Early gynecological evaluation might allow to identify patients with mild forms of genital cGvHD, potentially enabling better management and improved outcomes.
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Affiliation(s)
| | - C Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A M Calderón
- Department of Gynecology, Virgen del Rocío University Hospital, Seville, Spain
| | - I Espigado
- Department of Haematology, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS), CSIC, University of Seville, Seville, Spain
| | - J A Pérez-Simón
- Department of Haematology, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS), CSIC, University of Seville, Seville, Spain
| | - C González-Cejudo
- Department of Gynecology, Virgen del Rocío University Hospital, Seville, Spain
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Chimenea A, Calderón AM, Antiñolo G, Moreno-Reina E, García-Díaz L. Assessing the impact of pregnancy planning on obstetric and perinatal outcomes in women with pregestational diabetes mellitus. Diabetes Res Clin Pract 2024; 209:111599. [PMID: 38423476 DOI: 10.1016/j.diabres.2024.111599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/17/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
AIMS We investigated the role of pregnancy planning in improving glycemic control and its potential impact on the overall pregnancy outcomes, obstetric outcomes, and perinatal well-being in women with pregestational diabetes mellitus (PGDM). METHODS A retrospective observational cohort study was conducted, including all pregnant women with PGDM treated in our center 2012 and 2018. RESULTS Among 425 participants, 26.6 % had planned pregnancies. The lowest rate of pregnancy planning was observed in women with type 2 diabetes mellitus (6.5 %). Women with planned pregnancies had lower BMI. Both pregestational HbA1c levels (6.66 % vs. 7.61 %, p < 0.001) and HbA1c levels at the first prenatal visit (6.39 % vs. 7.24 %, p < 0.001) were significantly lower in the planned pregnancy group. These differences persisted until the end of pregnancy (6.09 % vs. 6.47 %, p = 0.006). Although better glycemic control was associated with a non-significant decrease in fetuses with birth weight over 4000 g (18.1 % vs. 22.1 %) and 4500 g (3.0 % vs. 4.2 %), we did not find significant effects on other morbidity events, maternal outcomes, or the cesarean section rate. CONCLUSIONS Pregnancy planning in PGDM women improved glycemic control and HbA1c levels. Limited impact on obstetric and perinatal outcomes suggests scope for other focused interventions to optimize maternal and fetal health.
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Affiliation(s)
- Angel Chimenea
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain; Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain
| | - Ana María Calderón
- Department of Gynecology, Hospital Universitario Virgen del Rocio, Seville, Spain.
| | - Guillermo Antiñolo
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain; Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain; Department of Surgery, University of Seville, Seville, Spain; Centre for Biomedical Network Research on Rare Diseases (CIBERER), Seville, Spain
| | - Eduardo Moreno-Reina
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Lutgardo García-Díaz
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain; Department of Surgery, University of Seville, Seville, Spain
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Chimenea A, García-Díaz L, Calderón AM, Antiñolo G. Prenatal diagnosis of VACTERL association after early-first trimester SARS-COV-2 infection. Congenit Anom (Kyoto) 2023; 63:44-46. [PMID: 36517451 PMCID: PMC9877562 DOI: 10.1111/cga.12503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/15/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
Organogenesis is a period of fetal development with a special vulnerability to biological and environmental agents. There are some viral infections whose transmission in the first trimester carries a significant risk for the development of congenital anomalies. Although the possibility of vertical transmission of SARS-CoV-2 during pregnancy has been demonstrated, there are no studies evaluating the impact of SARS-CoV-2 infection in the first trimester and its possible association with congenital anomalies. In this communication, we present the case of a pregnant woman with early SARS-CoV-2 infection, prenatally diagnosed with fetal VACTERL association by mid-trimester ultrasound. Further studies are needed to determine the causal association.
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Affiliation(s)
- Angel Chimenea
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain.,Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain
| | - Lutgardo García-Díaz
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain.,Department of Surgery, University of Seville, Seville, Spain
| | - Ana María Calderón
- Department of Gynecology, Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Guillermo Antiñolo
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain.,Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain.,Department of Surgery, University of Seville, Seville, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Seville, Spain
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González-Cejudo C, Calderón AM, García-Arreza A, Vieites B, Martínez MÁ. Conservative surgical approach of a synchronous malignant ovarian struma and papillary thyroid carcinoma in a postmenopausal woman. J OBSTET GYNAECOL 2019; 41:160-161. [DOI: 10.1080/01443615.2019.1677582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Ana María Calderón
- Department of Gynaecology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Aída García-Arreza
- Department of Gynaecology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Begoña Vieites
- Department of Pathology, Hospital Universitario Virgen del Rocio, Seville, Spain
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Chimenea A, García-Díaz L, Calderón AM, Heras MMDL, Antiñolo G. Resolution of maternal Mirror syndrome after succesful fetal intrauterine therapy: a case series. BMC Pregnancy Childbirth 2018; 18:85. [PMID: 29625560 PMCID: PMC5889608 DOI: 10.1186/s12884-018-1718-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/26/2018] [Indexed: 11/26/2022] Open
Abstract
Background Mirror syndrome (MS) is a rare obstetric condition usually defined as the development of maternal edema in association with fetal hydrops. The pathogenesis of MS remains unclear and may be misdiagnosed as pre-eclampsia. Case presentation We report a case series of MS in which fetal therapy (intrauterine blood transfusion and pleuroamniotic shunt) resulted in fetal as well as maternal favourable course with complete resolution of the condition in both mother and fetus. Conclusions Our case series add new evidence to support that early diagnosis of MS followed by fetal therapy and clinical maternal support are critical for a good outcome.
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Affiliation(s)
- Angel Chimenea
- Department of Genetics, Reproduction, and Fetal Medicine, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Lutgardo García-Díaz
- Department of Genetics, Reproduction, and Fetal Medicine, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Ana María Calderón
- Department of Genetics, Reproduction, and Fetal Medicine, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - María Moreno-De Las Heras
- Department of Genetics, Reproduction, and Fetal Medicine, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Guillermo Antiñolo
- Department of Genetics, Reproduction, and Fetal Medicine, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain. .,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Seville, Spain.
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Calderón AM, Chimenea A, González C, Martínez MA. Total hysterectomy as hematocolpos treatment following bone marrow transplant. A rare complication of chronic graft-versus-host disease. Eur J Obstet Gynecol Reprod Biol 2018; 221:204-205. [PMID: 29329824 DOI: 10.1016/j.ejogrb.2017.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Affiliation(s)
- A M Calderón
- Department of Gynaecology, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot S/N, ES-41013, Seville, Spain.
| | - A Chimenea
- Department of Gynaecology, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot S/N, ES-41013, Seville, Spain
| | - C González
- Department of Gynaecology, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot S/N, ES-41013, Seville, Spain
| | - M A Martínez
- Department of Gynaecology, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot S/N, ES-41013, Seville, Spain
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