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Matalliotakis M, Matalliotaki C, Tsakiridis I, Dagklis T, Michos G, Romanos A, Krithinakis K, Kalogiannidis IA. Co-existence of Ovarian Teratomas With Other Gynecological Tumors. Cureus 2024; 16:e58068. [PMID: 38737998 PMCID: PMC11088460 DOI: 10.7759/cureus.58068] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION This study aims to investigate the co-existence of ovarian teratomas with other benign or malignant gynecological tumors in women who underwent gynecological surgery. METHODS We retrospectively reviewed all women who underwent gynecological surgery over a 15-year period. Pre-operative, surgical, and histological records were obtained from women who presented with gynecological pathology, aiming to discover a possible link between ovarian teratomas and other gynecological tumors. RESULTS Of the total patient sample, 288 (8.2%) had a mature teratoma, and 9 (0.3%) had an immature teratoma. The mean age was 38.0±13.3 years and 30.9±11.1 years, respectively. Women with mature teratoma showed a positive correlation with struma ovarii (SO, p=0.001). Moreover, we reported a positive linear relationship between struma ovarri and thecoma. Of the 288 women with a mature teratoma, 1 (0.3%) had co-existent endometrioid ovarian cancer, and 1 (0.3%) had borderline cancer. There were 14 women (4.9%) with a co-existent serous cystadenoma, 7 (2.4%) with a mucin cystadenoma, 1 (0.3%) with a thecoma, 4 (1.4%) with struma ovarii, 3 (1.0%) had Brenner cyst, 3 (1.0%) had ovarian fibroma, 2 had endometriosis (0.7%), and 8 (2.8%) had endometriomas. Of a total of nine women with immature teratomas, one (11.1%) had a serous cystadenoma. CONCLUSIONS Ovarian teratomas may co-exist with other gynecological diseases. Our study reports various cases of the co-existence of several gynecological tumors with teratomas.
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Affiliation(s)
| | | | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Georgios Michos
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Andreas Romanos
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | | | - Ioannis A Kalogiannidis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Mitta K, Tsakiridis I, Dagklis T, Kalogiannidis I, Mamopoulos A, Michos G, Virgiliou A, Athanasiadis A. Ultrasonographic Evaluation of the Second Stage of Labor according to the Mode of Delivery: A Prospective Study in Greece. J Clin Med 2024; 13:1068. [PMID: 38398380 PMCID: PMC10889379 DOI: 10.3390/jcm13041068] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Accurate diagnosis of labor progress is crucial for making well-informed decisions regarding timely and appropriate interventions to optimize outcomes for both the mother and the fetus. The aim of this study was to assess the progress of the second stage of labor using intrapartum ultrasound. MATERIAL AND METHODS This was a prospective study (December 2022-December 2023) conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece. Maternal-fetal and labor characteristics were recorded, and two ultrasound parameters were measured: the angle of progression (AoP) and the head-perineum distance (HPD). The correlation between the two ultrasonographic values and the maternal-fetal characteristics was investigated. Multinomial regression analysis was also conducted to investigate any potential predictors of the mode of delivery. RESULTS A total of 82 women at the second stage of labor were clinically and sonographically assessed. The mean duration of the second stage of labor differed between vaginal and cesarean deliveries (65.3 vs. 160 min; p-value < 0.001) and between cesarean and operative vaginal deliveries (160 vs. 88.6 min; p-value = 0.015). The occiput anterior position was associated with an increased likelihood of vaginal delivery (OR: 24.167; 95% CI: 3.8-152.5; p-value < 0.001). No significant differences were identified in the AoP among the three different modes of delivery (vaginal: 145.7° vs. operative vaginal: 139.9° vs. cesarean: 132.1°; p-value = 0.289). The mean HPD differed significantly between vaginal and cesarean deliveries (28.6 vs. 41.4 mm; p-value < 0.001) and between cesarean and operative vaginal deliveries (41.4 vs. 26.9 mm; p-value = 0.002); it was correlated significantly with maternal BMI (r = 0.268; p-value = 0.024) and the duration of the second stage of labor (r = 0.256; p-value = 0.031). Low parity (OR: 12.024; 95% CI: 6.320-22.876; p-value < 0.001) and high HPD (OR: 1.23; 95% CI: 1.05-1.43; p-value = 0.007) were found to be significant predictors of cesarean delivery. CONCLUSIONS The use of intrapartum ultrasound as an adjunctive technique to the standard clinical evaluation may enhance the diagnostic approach to an abnormal labor progress and predict the need for operative vaginal or cesarean delivery.
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Affiliation(s)
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (K.M.); (T.D.); (I.K.); (A.M.); (G.M.); (A.V.); (A.A.)
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Michos G, Dagklis T, Papanikolaou E, Tsakiridis I, Oikonomou K, Mamopoulos AM, Kalogiannidis IA, Athanasiadis A. Uterine Leiomyomas and Infertility: A Comparison of National and International Guidelines. Cureus 2023; 15:e50992. [PMID: 38259363 PMCID: PMC10802214 DOI: 10.7759/cureus.50992] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
Uterine leiomyomas are the most common benign tumors of the female genital track, causing various symptoms and problems, including a possible impact on fertility. The relationship between fibroids and infertility has long been a debate among gynecologists. Management of fibroids in women with otherwise unexplained infertility worldwide lacks standardized, evidence-based guidelines. Therefore, a review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Collège National des Gynécologues et Obstétriciens Français, and the American Society of Reproductive Medicine was conducted. There is agreement among all guidelines that the effect of fibroids on fertility is related to their position in the uterus and the alteration of the endometrial cavity. However, whether surgical intervention (laparotomy, laparoscopy, or hysteroscopy) is required varies among committees. More specifically, for submucous myomas, all guidelines agree that surgical intervention is needed. On the other hand, regarding intramural myomas, there is no consensus on what the approach may be. Novel treatments such as uterine artery embolization (UAE) and magnetic resonance-guided focused ultrasound surgery (MRgFUS) should only be used in clinical trial settings. Nevertheless, all guidelines agree that medical management of fibroids further delays efforts to conceive and has no role as a stand-alone treatment of fibroids; though, the use of GnRH analogues preoperatively can be useful to improve anemia and/or reduce fibroid volume. There is a need for updated international protocols to be introduced, in order to help clinicians dealing with fibroids and infertility to better suggest the optimal treatment.
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Affiliation(s)
- Georgios Michos
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Themistoklis Dagklis
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Evangelos Papanikolaou
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Kyriakos Oikonomou
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Apostolos M Mamopoulos
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioannis A Kalogiannidis
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Apostolos Athanasiadis
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Peitsidis N, Tsakiridis I, Najdecki R, Michos G, Chouliara F, Timotheou E, Chartomatsidou T, Athanasiadis A, Papanikolaou E. Diagnostic hysteroscopy with endometrial fundal incision may improve reproductive outcomes in oocyte recipients after implantation failure. JBRA Assist Reprod 2023. [PMID: 37962971 DOI: 10.5935/1518-0557.20230037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE This study aimed to investigate whether hysteroscopy plus endometrial fundal incision (EFI) with endoscopic scissors can improve reproductive outcomes in oocyte recipients who have failed in their first egg donation cycle. METHODS This was a prospective study (2014-2022) conducted in Assisting Nature Centre Reproduction and Genetics, Thessaloniki Greece, IVF Unit. The study population consisted of oocyte recipients with implantation failure in their first embryo transfer (ET) with donor eggs. All the recipients underwent routine evaluation during their early follicular phase, 1-3 months before the start of a new cycle with donor oocytes and were eligible to undergo EFI. RESULTS During the study period, 218 egg recipients underwent egg donation; 126 out of 218 oocyte recipients (57.8%) did not achieve a live birth at the 1st ET. 109 of them had surplus embryos cryopreserved and underwent a second ET; 50 women consented for EFI. Both groups were similar in terms of age, years of infertility, duration of estrogen replacement protocol and number of transferred blastocysts (p>0.05). In the EFI group, 60% had normal intrauterine cavity, while 40% had minor anomalies. The pregnancy test was positive in 46% (n=23/50) in the EFI group compared with 27.1% (n=16/59) in the control group (p=0.04). Moreover, live birth rates were higher in the EFI group compared to the control group (38.0% vs. 20.3%; p=0.04). CONCLUSIONS The findings of our study indicate that in oocyte recipients after implantation failure, diagnostic hysteroscopy plus EFI prior to subsequent ETmay increase pregnancy and live birth rates.
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Affiliation(s)
- Nikolaos Peitsidis
- Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Robert Najdecki
- Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece
| | - Georgios Michos
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Foteini Chouliara
- Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece
| | - Evi Timotheou
- Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece
| | | | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Evangelos Papanikolaou
- Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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Najdecki R, Peitsidis N, Tsakiridis I, Michos G, Timotheou E, Chartomatsidou T, Athanasiadis A, Papanikolaou E. Hysteroscopic Endometrial Fundal Incision in Oocyte Recipients before Embryo Transfer May Improve Reproductive Outcomes: A Prospective Study. Int J Fertil Steril 2023; 18:40-44. [PMID: 38041458 PMCID: PMC10692741 DOI: 10.22074/ijfs.2023.560746.1354] [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] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 06/18/2023] [Accepted: 08/06/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Induced endometrial injury is a technique described that have positive impact on implantation. The aim of this study was to investigate whether hysteroscopic endometrial fundal incision (EFI) in oocyte recipients before embryo transfer increases pregnancy and live birth rates or not. MATERIALS AND METHODS A prospective study was conducted between 2014 and 2019 at an in vitro fertilization (IVF) unit in Greece. As part of the protocol, hysteroscopy and EFI were offered to all the egg recipients and the outcomes compared with those from an older cohort from the same Unit not undergoing hysteroscopy. RESULTS In total, 332 egg recipients participated in the study; 114 of them underwent EFI prior to embryo transfer. Both groups were similar in terms of age, years of infertility, duration of hormone replacement treatment (HRT) and number of blastocysts transferred. In the EFI group, minor anomalies were detected and treated in 6.1% (n=7) of the participants. Moreover, pregnancy test was positive in 73.7% of the women in the hysteroscopy group compared to 57.8% in the nonhysteroscopy group (P=0.004). Live birth rate was also higher (56.1 vs. 42.2%, P=0.016) in the EFI group compared to the non-hysteroscopy one. CONCLUSION Apart from the obvious benefit of recognizing obscured anomalies, requiring surgical correction, it appears that in oocyte recipients prior to embryo transfer, EFI might improve uterine receptivity and reproductive outcomes.
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Affiliation(s)
- Robert Najdecki
- Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece
| | - Nikolaos Peitsidis
- Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece.
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Michos
- Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evi Timotheou
- Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece
| | | | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Papanikolaou
- Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, Greece
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Papanikolaou E, Peitsidis N, Tsakiridis I, Michos G, Skalias A, Patoulias D, Poutoglidis A, Mamopoulos A, Athanasiadis A, Grimpizis G, Najdecki R. Endometrial scratching during hysteroscopy in women undergoing in vitro fertilization: a systematic review and meta-analysis. Front Surg 2023; 10:1225111. [PMID: 37795147 PMCID: PMC10546045 DOI: 10.3389/fsurg.2023.1225111] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
Objective Endometrial scratching (ES) during hysteroscopy before embryotransfer (ET) remains doubtable on whether it benefits the reproductive outcomes. The optimal technique is not clear and repeated implantation failure as a challenging field in in vitro fertilization (IVF) seems to be the springboard for clinicians to test its effectiveness. Methods Medline, PMC, ScienceDirect, Scopus, CENTRAL, Google Scholar were searched from their inception up to April 2023 for studies to evaluate the effectiveness of adding endometrial scratching during hysteroscopy before ET. Results The initial search yielded 959 references, while 12 eligible studies were included in the analyses, involving 2,213 patients. We found that hysteroscopy and concurrent ES before ET resulted in a statistically significant improvement in clinical pregnancy rate (CPR) [RR = 1.50, (95% CI 1.30-1.74), p < 0.0001] and live birth rate (LBR) [RR = 1.67, (95% CI 1.30-2.15), p < 0.0001] with no statistically significant difference on miscarriage rate [RR = 0.80 (95% CI 0.52-1.22), p = 0.30]. Conclusion Our meta-analysis suggests that hysteroscopy with concurrent ES may be offered in IVF before ET as a potentially improving manipulation. Future randomized trials comparing different patient groups would also provide more precise data on that issue, to clarify specific criteria in the selection of patients. Systematic Review Registration PROSPERO (CRD42023414117).
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Affiliation(s)
| | - Nikolaos Peitsidis
- Assisting Nature IVF Centre and Genetics, Thessaloniki, Greece
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Michos
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Skalias
- 2nd Academic Otorhinolaryngology, Head and Neck Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Patoulias
- Department of Obstetrics and Gynaecology, Interbalkan Hospital, Thessaloniki, Greece
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology, Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- 3rd Department of Obstetrics and Gynaecology, General Hospital Hippocrateion, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigorios Grimpizis
- 1st Department of Obstetrics and Gynaecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert Najdecki
- Assisting Nature IVF Centre and Genetics, Thessaloniki, Greece
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Mitta K, Tsakiridis I, Dagklis T, Michos G, Zachomitros F, Mamopoulos A, Zavlanos A, Athanasiadis A. Selective feticide reverses intrahepatic cholestasis of pregnancy in twins discordant for growth: A case report. Case Rep Womens Health 2023; 39:e00529. [PMID: 37534193 PMCID: PMC10393552 DOI: 10.1016/j.crwh.2023.e00529] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023] Open
Abstract
Twin gestations are associated with an increased risk of intrahepatic cholestasis in pregnancy (ICP), probably attributed to the elevated pregnancy hormones. We report a case of a dichorionic diamniotic twin pregnancy, at the third trimester, complicated with ICP and severe, selective fetal growth restriction (sFGR). A 32-year-old primiparous woman with a dichorionic, diamniotic twin gestation conceived via in vitro fertilization (IVF) presented with pruritus at the maternity care unit at 26+4 weeks of pregnancy. Following a detailed assessment, she was diagnosed with severe sFGR and ICP. During her hospitalization, selective feticide of the FGR fetus was decided and a remarkable improvement in the symptoms and the laboratory findings of ICP was noticed. The incidence of ICP is reported to be higher in twin pregnancies, especially those conceived via IVF, compared with singletons. The optimal timing of delivery and management of twin pregnancies complicated with ICP remain unclear. In our case, selective reduction of the FGR fetus led to the resolution of ICP.
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Affiliation(s)
| | - Ioannis Tsakiridis
- Corresponding author at: Konstantinoupoleos 49, 54642 Thessaloniki, Greece.
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Michos G, Dagklis T, Papanikolaou E, Peitsidis NI, Kalogiannidis IA, Mamopoulos AM, Athanasiadis A. Laparoscopy in Pregnancy: A Comparative Review of National Guidelines. Cureus 2023; 15:e38904. [PMID: 37303332 PMCID: PMC10257531 DOI: 10.7759/cureus.38904] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Gynecological and general surgical conditions requiring surgical management during pregnancy constitute a medical challenge, which often entails the collaboration of numerous medical specialties. In recent years, laparoscopy in pregnancy has been accepted as a safe alternative to open surgery. This has led gynecological societies to conduct studies and issue guidelines related to laparoscopy in pregnancy, with a view to assisting and guiding clinicians and surgeons. The aim of this study was to review and compare the recommendations from various published national guidelines on laparoscopy in pregnant women. To that end, a descriptive review of guidelines from the British Society for Gynaecological Endoscopy (BSGE), the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the Society of Obstetricians and Gynaecologists of Canada (SOCG), and the Collège National des Gynécologues et Obstétriciens Français (CNGOF) was conducted. Regarding diagnosis, the SAGES and SOCG societies recommend ultrasound as the preferred and safe imaging technique during pregnancy. In terms of the optimal timing for laparoscopic intervention, BSGE and SAGES do not restrict the laparoscopic approach based on safety, depending on the gestation week, whereas SOCG and CNGOF propose early second trimester and first and second quarter of pregnancy respectively. There is an overall consensus regarding patient positioning, initial port placement, insufflation pressure during the operation, venous thromboembolic (VTE) prophylaxis, fetal heart monitoring, and tocolysis among the reviewed guidelines. Moreover, only the BSGE mentions the need for corticosteroids, magnesium sulfate, and anti-D prophylactic administration.
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Affiliation(s)
- Georgios Michos
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Evangelos Papanikolaou
- Private IVF Unit, Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, GRC
| | - Nikolaos I Peitsidis
- Private IVF Unit, Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, GRC
| | - Ioannis A Kalogiannidis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Apostolos M Mamopoulos
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Peitsidis N, Tsakiridis I, Najdecki R, Michos G, Chouliara F, Zachomitros F, Kalogiannidis I, Athanasiadis A, Papanikolaou E. Hysteroscopic Identification of Intrauterine Pathology in Oocyte Donation Cycles: A Retrospective Study. Cureus 2023; 15:e37470. [PMID: 37187651 PMCID: PMC10176530 DOI: 10.7759/cureus.37470] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Hysteroscopy remains the gold standard for the diagnosis and treatment of intracavitary uterine anomalies. As for recipients where oocyte donation is mandatory, accurate evaluation of previously missed intrauterine pathology may be an important step to optimize implantation process. The aim of this study was to hysteroscopically assess the incidence of unidentified intrauterine pathology prior to embryo transfer in an oocyte recipient population. METHODS A retrospective descriptive study was conducted between 2013 and 2022 at Assisting Nature In Vitro Fertilization (IVF) Centre in Thessaloniki, Greece. The study population consisted of oocyte recipient women who underwent hysteroscopy one-three months before embryo transfer. Furthermore, oocyte recipients after repeated implantation failure were investigated as a subgroup. Any identified pathology was treated accordingly. RESULTS In total, 180 women underwent diagnostic hysteroscopy prior to embryo transfer with donor oocytes. The mean maternal age at the time of intervention was 38.9 (+5.2) years, while the mean duration of infertility was 6.03 (+1.23) years. Additionally, 21.7% (n=39) of the study population had abnormal hysteroscopic findings. In particular, congenital uterine anomalies (U1a: 1.1% {n=2}, U2a: 5.6% {n=10}, U2b: 2.2% {n=4}) and polyps (n=16) were the main findings in the sample population. Furthermore, 2.8% (n=5) had submucous fibroids and 1.1% (n=2) were diagnosed with intrauterine adhesions. Notably, in recipients after repeated implantation failure intrauterine pathology rates were even higher (39.5%). CONCLUSIONS Oocyte recipients and especially those with repeated implantation failures probably have high rates of previously undiagnosed intrauterine pathology so, hysteroscopy would be justified in these subfertile populations.
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Affiliation(s)
- Nikolaos Peitsidis
- Private In Vitro Fertilization (IVF) Unit, Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, GRC
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Robert Najdecki
- Private In Vitro Fertilization (IVF) Unit, Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, GRC
| | - Georgios Michos
- Private In Vitro Fertilization (IVF) Unit, Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, GRC
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Foteini Chouliara
- Private In Vitro Fertilization (IVF) Unit, Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, GRC
| | - Fotios Zachomitros
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Evangelos Papanikolaou
- Private In Vitro Fertilization (IVF) Unit, Assisting Nature Centre of Reproduction and Genetics, Thessaloniki, GRC
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Zachomitros F, Tsakiridis I, Peitsidis N, Michos G, Dagklis T, Kalogiannidis I. Hemoperitoneum due to spontaneous bleeding from a smooth muscle tumor of uncertain malignant potential: A rare case report. Int J Surg Case Rep 2023; 103:107910. [PMID: 36736227 PMCID: PMC9925965 DOI: 10.1016/j.ijscr.2023.107910] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/29/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Smooth muscle tumors of uncertain malignant potential (STUMPs) are uncommon tumors representing an extremely rare cause of hemoperitoneum. CASE PRESENTATION We report a case of a 48-year-old Caucasian, premenopausal woman that presented in the emergency department with acute abdominal pain. There was no remarkable past medical and surgical history except from a known uterine leiomyoma. The ultrasound and the computed tomography imaging showed an intraperitoneal fluid collection and a heterogenous uterine mass. The patient underwent emergent exploratory laparotomy; a subserosal uterine tumor was identified with an actively bleeding vessel on its surface. The uterine lesion was completely excised and the histopathology set the diagnosis of a STUMP. After consultation on the significance of this finding with the patient, an abdominal total hysterectomy and bilateral salpingo-oophorectomy were scheduled and performed and the subsequent histopathology detected no malignancy. CLINICAL DISCUSSION This case demonstrates that a STUMP may be a rare cause of acute intraperitoneal bleeding. Careful evaluation of clinical history, imaging findings and, if needed, surgical exploration are important for the diagnosis, while appropriate follow-up is also of major importance for the management of these rare tumors. CONCLUSION We presented an extremely rare case of hemoperitoneum due to spontaneous bleeding from a STUMP. From an oncological perspective, this case poses a diagnostic, management and follow-up challenge.
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Affiliation(s)
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece.
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Najdecki R, Michos G, Peitsidis N, Timotheou E, Chartomatsidou T, Kakanis S, Chouliara F, Mamopoulos A, Papanikolaou E. Agonist triggering in oocyte donation programs-Mini review. Front Endocrinol (Lausanne) 2022; 13:838236. [PMID: 36093096 PMCID: PMC9462512 DOI: 10.3389/fendo.2022.838236] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Oocyte donation programs involve young and healthy women undergoing heavy ovarian stimulation protocols in order to yield good-quality oocytes for their respective recipient couples. These stimulation cycles were for many years beset by a serious and potentially lethal complication known as ovarian hyperstimulation syndrome (OHSS). The use of the short antagonist protocol not only is patient-friendly but also has halved the need for hospitalization due to OHSS sequelae. Moreover, the replacement of beta-human chorionic gonadotropin (b-hCG) with gonadotropin-releasing hormone agonist (GnRH-a) triggering has reduced OHSS occurrence significantly, almost eliminating its moderate to severe presentations. Despite differences in the dosage and type of GnRH-a used across different studies, a comparable number of mature oocytes retrieved, fertilization, blastulation, and pregnancy rates in egg recipients are seen when compared to hCG-triggered cycles. Nowadays, GnRH-a tend to be the triggering agents of choice in oocyte donation cycles, as they are effective and safe and reduce OHSS incidence. However, as GnRH-a triggering does not eliminate OHSS altogether, caution should be practiced in order to avoid unnecessary lengthy and heavy ovarian stimulation that could potentially compromise both the donor's wellbeing and the treatment's efficacy.
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Affiliation(s)
- Robert Najdecki
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
- *Correspondence: Robert Najdecki,
| | - Georgios Michos
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
| | - Nikos Peitsidis
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
| | - Evangelia Timotheou
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
| | | | - Stelios Kakanis
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Foteini Chouliara
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Papanikolaou
- Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Michos G, Sotiriadis A, Paraskevaidis E, Georgiou I, Dagklis T, Mamopoulos A, Papanikolaou E, Athanasiadis A, Makrydimas G. Is nuchal translucency measurement feasible in early pregnancy? Hippokratia 2021; 25:151-155. [PMID: 36743865 PMCID: PMC9894305] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To investigate whether early nuchal translucency measurement at 7+0 to 9+0 weeks (NT7-9w) is feasible, obtain normal values for different crown-rump lengths (CRL) in the above weeks and create percentile tables. METHODS A prospective study was conducted in the Obstetrics and Gynecology Department of the University Hospital of Ioannina, including data from women with singleton pregnancies, examined in the early pregnancy unit between November 2010 and May 2015 at a CRL of 10-27 mm. The early pregnancy scan was performed vaginally, and the NT7-9w, CRL, fetal heart rate, and mean yolk sac diameter were measured. Demographic data, including body mass index and smoking, were recorded. RESULTS NT7-9w was measured successfully in 192 fetuses out of 210 (91.4 %), with a CRL ranging from 10-27 mm. The median maternal age was 31 (range 18-43) years, and the median CRL was 19.9 (range 10.0-27.0) mm. Considering the above measurements, we created normal values and percentiles tables of NT at 7+0 to 9+0 weeks in relation to the corresponding CRL measurement. CONCLUSION According to the literature, this is the first attempt to measure NT in such weeks of pregnancy. NT measurement as early as 7+0 to 9+0 is feasible and normal values can be created and correlated with CRL measurements. HIPPOKRATIA 2021, 25 (4):151-155.
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Affiliation(s)
- G Michos
- Third Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - E Paraskevaidis
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Ioannina, Greece
| | - I Georgiou
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Ioannina, Greece
| | - T Dagklis
- Third Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - A Mamopoulos
- Third Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - E Papanikolaou
- Third Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - A Athanasiadis
- Third Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - G Makrydimas
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital of Ioannina, Greece
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Tsakiridis I, Najdecki R, Tatsi P, Timotheou E, Kalinderi K, Michos G, Virgiliou A, Yarali H, Athanasiadis A, Papanikolaou EG. Evaluation of the safety and efficacy of corifollitropin alfa combined with GnRH agonist triggering in oocyte donation cycles. A prospective longitudinal study. JBRA Assist Reprod 2020; 24:436-441. [PMID: 32489086 PMCID: PMC7558885 DOI: 10.5935/1518-0557.20200033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: In order to help make the dream of parenthood come true for oocyte acceptors, it is essential that the procedure is not dangerous or unpleasant for oocyte donors. The aim of this study was to identify differences in safety, efficacy and patient acceptability between a traditional stimulation antagonist protocol with recombinant-FSH (rFSH) with hCG-triggering, compared with an innovative antagonist protocol with corifollitropin alfa (Elonva®) plus GnRH agonist triggering in oocyte donors. Methods: A prospective longitudinal study was conducted at an in vitro fertilization center in Greece. The same eighty donors underwent two consecutive antagonist stimulation schemes. Primary outcomes were patient satisfaction (scored by a questionnaire) and delivery rate per donor. Secondary outcomes were mean number of cumulus-oocyte-complexes, metaphase II (MII) oocytes and ovarian hyperstimulation syndrome (OHSS) rate. Results: Donors reported better adherence and less discomfort with the corifollitropin alpha + GnRH agonist-triggering protocol (p<0.001). No significant differences were identified in the clinical pregnancy rate per donor (p=0.13), the delivery rates, the number of oocytes (p=0.35), the number of MII oocytes (p=0.50) and the number of transferred embryos, between the two protocols. However, the luteal phase duration was significantly shorter (p<0.001) in the corifollitropin alpha + GnRH agonist-triggering protocol. Moreover, three cases of moderate OHSS (3.75%) were identified after hCG triggering, whereas no case of OHSS occurred after GnRH agonist ovulation induction (p=0.25). Conclusion: The use of corifollitropin alpha combined with a GnRH agonist for triggering is a safe, effective and acceptable protocol for oocyte donors.
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Affiliation(s)
- Ioannis Tsakiridis
- 3rd Department Ob-Gyn, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert Najdecki
- Assisting Nature, Center of Reproduction & Genetics, Thessaloniki, Greece
| | - Petroula Tatsi
- Assisting Nature, Center of Reproduction & Genetics, Thessaloniki, Greece
| | - Evi Timotheou
- Assisting Nature, Center of Reproduction & Genetics, Thessaloniki, Greece
| | - Kallirhoe Kalinderi
- 3rd Department Ob-Gyn, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Michos
- 3rd Department Ob-Gyn, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andriana Virgiliou
- 3rd Department Ob-Gyn, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Evangelos G Papanikolaou
- 3rd Department Ob-Gyn, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Assisting Nature, Center of Reproduction & Genetics, Thessaloniki, Greece
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Pinto RM, Michos G, Papageorgiou G, Halmos G, Moustafa M, Magos A. Incidence of unplanned oophorectomy at laparoscopic ovarian cystectomy for clinically benign cysts. J OBSTET GYNAECOL 2014; 34:718-20. [PMID: 24922340 DOI: 10.3109/01443615.2014.925432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Laparoscopic surgery is the preferred approach in women with ovarian cysts and a low risk of malignancy, and the aim in young women should be to preserve the ovary. We are not aware of any data on the success of conservative surgery in preserving the affected ovary and this is the reason why we decided to investigate the incidence of unplanned oophorectomy, when a woman is originally scheduled for laparoscopic ovarian cystectomy for clinically benign cysts. We reviewed the medical notes of the 123 women who underwent surgery for clinically benign ovarian cysts between November 2004 and May 2012. The operative procedures performed were ovarian cystectomies (n = 119), salpingo-oophorectomy (n = 2) and fenestration (n = 2). In total, 61 women underwent a concomitant procedure. In our study, we found that planned laparoscopic cystectomy was mostly successful, with only 1.6% of patients in our series requiring unplanned oophorectomy.
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Affiliation(s)
- R M Pinto
- University Department of Obstetrics and Gynaecology, Royal Free Hospital , London , UK
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Georgiou GK, Gizas I, Papadopoulos C, Goussia AC, Michos G, Stefos T, Glantzounis GK. Subphrenic abscess after appendiceal rupture in full-term pregnancy. Surg Infect (Larchmt) 2014; 16:204-5. [PMID: 24871376 DOI: 10.1089/sur.2013.234] [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] [Indexed: 11/13/2022] Open
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