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Addressing optimal maternal weight and exercise during the preconception period and pregnancy
C.P. Moutos, V. Lozovyy, S.M. Clark
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (5): 622-628.   DOI: 10.31083/j.ceog.2020.05.9041
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Pregnancy is an opportunity for women to access the healthcare system and address their health needs. Before and during pregnancy, providers should emphasize assisting women in interventions aimed at establishing a healthy weight and exercise regimen and should tailor their guidance based on a woman's baseline level of fitness. Doing so will improve a woman's likelihood of pregnancy and improve outcomes if she does become pregnant. Our goal is to propose actions providers should take to improve a woman's understanding of and ability to manage her weight and exercise goals during the preconception and pregnancy periods.
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A giant placental chorioangioma with a resultant live birth; a discussion of management options
Saša Raičević, Duško Kljakić, Filip Vukmirović, Miloš Z. Milosavljević
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (2): 426-430.   DOI: 10.31083/j.ceog.2021.02.2260
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Introduction: Chorioangiomas are benign, nontrophoblastic tumors of the placenta. Giant chorioangiomas (larger 5 cm) are infrequent and have unfavorable outcomes due to their strong association with maternal and fetal complications. We describe a case of a giant chorioangioma that had a good outcome without complications. Case report: A 27-year-old woman, primipara, with a regularly monitored pregnancy was admitted to the hospital at 37 + 5 weeks of gestation due to pain in the lower half of the abdomen, rupture of the amniotic sac and accumulation of thick, green, amniotic fluid. Ultrasonography performed at 33 weeks of gestation indicated the presence of a tumor mass 12.5 × 7.7 cm in diameter that was localized near the chorionic surface. Cardiotocography indicated variable decelerations, which necessitated an emergency cesarean section. A live, healthy, male child was born without complications via Dorfler's cesarean section. The encapsulated tumor mass was manually removed from the uterus, and angiomatous chorioangioma of the placenta was diagnosed by pathohistological examination. Conclusion: Ultrasonographic monitoring is the choice method for the accurate diagnosis and intervention of chorioangioma, but only pathohistological examination can confirm the diagnosis. This case report demonstrates that giant placental chorioangioma may have a favorable outcome without any medical intervention.
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Caesarean section between doctrine to heresis. Medicoethical and deontological view of caesarology: an opinion
Dubravko Habek, Matija Prka, Anto Čartolovni, Anis Cerovac, Domagoj Dokozić
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 1-4.   DOI: 10.31083/j.ceog.2021.01.2305
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Increasing the incidence of caesarean section is not in line with professional and deontological guidelines. Elective cesarean section prevents primordial prevention of chronic cardiovascular, gastrointestinal, imunological, endocrinological morbidity by peripartal programming. Elective non-medical indicated caesarean section is not a procedure that respects deontological, clinical etics, scientific and professional principles. It is like an unacceptable surgery outside the scope of medical ethics. Clientelism in high-risk clinical obstetric medicine is not a professional and deontologically correct category: a physician should not be a provider on request of healthy pregnant women with the potential to have a medically incorrect procedure and complications associated with it and to put a healthy pregnant/maternity and child status in the patient's status. The financial, social, political and cultural components must not outweigh good clinical practice and the moral principles of medicine.
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PCR positivity and D-dimer levels in pregnant women with COVID-19
K. Uzel, I. Lakhno
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (5): 638-644.   DOI: 10.31083/j.ceog.2020.05.2229
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Background: Every day brings us new data on COVID-19, which has come to affect all the dynamics of the society, and increasingly more scientific literature becomes available on the topic. However, research information about its effects on particular groups, e.g., pregnant women, is still very limited. Aims: This study was aimed to investigate D-dimer levels in pregnant women admitted to the hospital with suspected COVID-19. Study Design: This descriptive cross-sectional study was carried out among pregnant women admitted to our hospital between 1 April 2020 and 31 May 2020 with suspected COVID-19. The data about patients was obtained from patient records and the hospital automation system. Methods: The primary outcome variable of the study was the D-dimer levels. Secondary outcome variables were the presence/absence of cough, shortness of breath, headache, fever, weakness, proteinuria, diarrhoea, haematuria, loss of taste, hypertension, and gestational diabetes mellitus. Results: Data for 64 pregnant women were analyzed. Thirty-three (51.5%) of them had a positive polymerase chain reaction (PCR) results, and thirty-one (48.5%) had negative ones. The mean age of the participants was 26.33 ± 5.15 years. Of the pregnant women, 51.6% (n = 33) were PCR (+) for COVID-19, and 48.5% (n = 31) were PCR (-). The mean age of the participants was 26.33 ± 5.15 years. Headache occurred significantly more often in PCR (+) pregnant women than in PCR (-) ones (χ2 = 4.201, p = 0.040). A statistically significant difference was found when the groups were compared in regard to the presence of the fever symptom (χ2 = 5.036, p = 0.025). When PCR (+) and PCR (-) pregnant women were compared, a statistically significant difference was found in the D-dimer levels (Z = 2.896, p = 0.004). A logistic regression model with PCR positivity as the dependent variables and headache, fever, and D-dimer levels as independent ones revealed a Nagelkerke R2 of 26.8%, and relatively high sensitivity (87.9%) and specificity (59.1%) values in predicting PCR positivity. Conclusion: This research is the first study to have suggested a model for predicting PCR positivity in women suspected of having the COVID-19 disease, which can speed up decision-making in regard to pregnant women with COVID-19.
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A systematic review and meta-analysis of the reported symptoms of Covid 19 in pregnancy
H.S.O. Abduljabbar, H. Abduljabar
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (5): 632-637.   DOI: 10.31083/j.ceog.2020.05.2223
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Introduction: The percentage of Symptomatic pregnant and non-pregnant women infected with Covid 19 is the same. The common symptoms in pregnant women are cough, fever, sore throat and myalgia. The objective of this is systematic review and meta-analysis of the commonly reported symptoms of COVID 19 in pregnancy and to compare it to non-pregnant. Methods: Study Design; Systematic review and meta-analysis of published retrospective studies. Searches conducted from December 2019 - April 2020 on PubMed. Medline, EMBASE, ISI Web of Science Electronic database used to collect data, corresponding to the (PRISMA) Preferred Reporting Items for Systematic Meta-Analysis, using the following search terms: keywords "coronavirus, COVID-19, pregnancy". Results: Figure 1 presents the study flow diagram. We identify 114 records through database searching, sixteen further studies recognized through other sources, and 98 papers isolated after duplicates, leaving 32 reports. After screening for titles and abstracts, we found only 27 reports to be potentially suitable and rescued these reports in full text. We excluded seven studies; 20 did not report symptoms of groups of interest. In the process of Screening, 16 were screened. Ten of full-text articles assessed for appropriateness, six full-text articles omitted with reasons, and only Four studies [12-15] were included in the review. Conclusion: The only symptoms that are more common in pregnant than non-pregnant are the sore throat. That concluded that when pregnant women start to have sore throat care should be taken to exclude COVID-19 infection.

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Uterine torsion in a 25-week pregnant female with congenital uterine didelphys and intraoperative complication of uterine atony: a report of a rare clinical case
Khac Tu Chau, Minh Tam Le, Doan Tu Tran, Vu Quoc Huy Nguyen
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 185-188.   DOI: 10.31083/j.ceog.2021.01.2230
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Uterine torsion is an extremely rare pregnancy-related complication. Its diagnosis is often difficult due to unspecific clinical symptoms, which can be mistaken for other conditions such as placental abruption. A 23-year-old pregnant woman with gestational age of 25 weeks presented with acute abdominal pain and hypertonic uterus. Vaginal examination revealed a septated vagina, double cervix, and double uterus. Bedside sonography revealed absence of fetal cardiac activity and signs of placental abruption. The patient was emergently operated with a preliminary diagnosis of severe placental abruption in the uterus didelphys. During surgery, we noted a double uterus and the fetus had implanted in the right uterus, which was twisted 180 degrees to the left. After detorsion, a low transverse hysterotomy was performed to extract the dead fetus. However, subsequently, the patient developed uterine atony. Subtotal hysterectomy and right adnexectomy were inevitable due to failure of conservative treatment with B-lynch suture. The patient's postoperative condition was stable, and she was discharged after 5 days.
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What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South India
Momina Zulfeen, Rekha Upadhyay, Sapna V. Amin, Muralidhar V. Pai, Leslie Lewis
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 144-150.   DOI: 10.31083/j.ceog.2021.01.5466
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Objective: In India, despite a reduction in perinatal mortality rate from 2014 to 2019, still birth rate is still the same at the national average of 4/1000 live births. As yet there is no nation-wide audit in India except for facility based audits. Hence the need for a simplified yet effective audit process exists. The aim of this study was to perform a qualitative perinatal audit and devise methods for future audits. Methods: We conducted a one year audit for all perinatal deaths using WHO ICD PM and 3-delay classification. Gestational age(GA) specific mortality was calculated for significant underlying factors using fetuses-at risk approach. Results: We recorded a perinatal mortality rate of 6.1/1000 births among booked cases and 21.32/1000 births among referred cases. Fetal growth restriction was the most common antenatal condition, accounting to 33.3% of antepartum deaths. Prematurity accounted to 52% of neonatal deaths. Phase 2 delay with delayed referrals in severe pre-eclampsia and Phase 1 delay with late visit (> 24h) to hospital after experiencing absent fetal movements were the most common identifiable delays. Hypertension stood out to be the single most common risk-factor. GA specific mortalities, calculated using fetuses-at risk approach, show a peak mortality rate at 30 weeks, 37 weeks and 38 weeks in pregnancies with early-onset preeclampsia, severe fetal growth restriction and medically treated gestational diabetes respectively. Conclusion: The audit identified significant contributing factors to the mortality. ICD-PM and 3-delay classification was simpler and easier to apply with wide areas of opportunities for secondary analysis.
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To operate or to wait? Doppler indices as predictors for medical termination for first trimester missed abortion
Wassan Nori, Muna Abdulghani, Ali B Roomi, Wisam Akram
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 168-174.   DOI: 10.31083/j.ceog.2021.01.2215
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Purpose: Missed abortion is a common obstetrical problem with a high incidence. Evidence supports a change in approach from the traditional dilatation and curettage to medical; however, few studies have investigated the prediction success of the medical approach. This study investigates whether first trimester missed abortion can be successfully terminated using Doppler indices, such as resistance index (RI) and pulsatility index (PI), as predictors. Material and Method: In this prospective study, the sample is made up of 78 patients, with a first trimester missed abortion range of 6-13 weeks of pregnancy and who meets the maternal parameters as well as transvaginal Doppler indices, RI and PI. The participants were subdivided into 3 groups based on their response to sublingual misoprostol and weeks needed to terminate as Groups I (43/78), II (26/78), and III (9/78) aborted in the first, second, and third weeks, respectively. Results: Age, BMI, and gestational age of dead fetus were not significant for Groups I, II, and III with P = 0.13, P = 0.13, and P = 0.35, respectively. Parity and delivery mode showed significant differences (P < 0.0001) between group means of PI and RI. PI for Group I plus II and Group III are 1.53 (0.75-2.70) and 1.58 (1.10-2.10), respectively. RI for Group I plus II and Group III are 0.71 (0.50-1.00) and 0.80 (0.69-0.92), respectively. The coefficient of correlation proves that RI is the primary predictor of successful termination of a first trimester missed abortion with a cut-off value of 0.74 and associated sensitivity and specificity of 68.7% and 56.7%, respectively. Conclusions: Increased parity and a history of vaginal delivery, in addition to measured RI, were predictors of successful termination of a first trimester missed abortion. These results may be used in counseling patients who are deciding on the safest and most suitable option to terminate a first trimester missed abortion, depending on their demographic criteria and ultrasound scores.
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Comparison of electrocautery and scalpel for blood loss and postoperative pain in Pfannenstiel incisions in recurrent cesarean sections: a randomized controlled trial
Eser Ağar, Gökhan Karakoç
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (3): 534-539.   DOI: 10.31083/j.ceog.2021.03.2341
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Background: Limited data is available on the use of cold-scalpel and electrocautery blades in Cesarean delivery (CD) operations. This randomized controlled trial aimed to compare their use for subcutaneous incisions in terms of blood loss and postoperative pain in women undergoing repeat CD. Methods: A total of 149 women scheduled for elective CD underwent spinal anesthesia, Pfannenstiel transverse skin incision with a cold-scalpel blade, and subsequent subcutaneous incisions until the peritoneum with a cold-scalpel or electrocautery blade. Perioperative blood loss and postoperative pain were evaluated. Results: The groups were similar in terms of maternal age, physical characteristics, and gestational age. The electrocautery group recorded significantly less blood loss and pain at the postoperative 6th and 12th hours. No significant correlation was found between blood loss or pain and women's physical characteristics or gestational age. Discussion: Perioperative and postoperative pain associated with CD is one of the predominant causes of anxiety in mothers. This study demonstrated that the use of electrocautery for subcutaneous incisions was associated with lower blood loss and lower postoperative pain compared to the cold-scalpel incisions in pregnant women undergoing repeat C-sections with Pfannenstiel incision. The study supports the recently shifting trend regarding the use of electrocautery instead of the scalpel.
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Multiple chemical sensitivity (MCS): women’s health issue
L. Roncati, M. Vadalà, C. Laurino, B. Palmieri
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (5): 629-631.   DOI: 10.31083/j.ceog.2020.05.5127
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Multiple chemical sensitivity (MCS) is a controversial, complex, and recurring chronic disturbance resulting from olfactory exposure at low levels to foreign chemicals usually tolerated in the rest of the healthy population, without functional tests capable to explain signs and symptoms of the disorder. Recently, some authors have supported that organic abnormalities in the olfactory sensors and a hyperactive limbic system, combined with peculiar personality traits, can best explain MCS. Epidemiological observations suggest that MCS has a 2-3% prevalence in the general population and that women are more significantly at risk to develop the disturbance; about 80% of affected patients are in fact women between the ages of 30 and 50. On closer inspection, many women present with hyperosmia during two other common female conditions, i.e. pregnancy and menstrual migraine, both accompanied by well known neurovegetative limbic symptoms; therefore, it appears reasonable to include a hormonal imbalance in the pathogenesis of MCS.
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The significance of amniotic fluid immunological analysis for the prediction of intrauterine infection
G. Balciuniene, L. Jakubauskiene, G.S. Drasutiene, A. Meskauskiene, D. Ramasauskaite
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (6): 810-813.   DOI: 10.31083/j.ceog.2020.06.5497
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Intrauterine infection, a dangerous condition for a pregnant woman and her fetus, increases the risk of neonatal death and the incidence of severe diseases like cerebral palsy, chronic lung illnesses and psychomotor disorders. Better prediction of intrauterine infection would support the choice of an appropriate treatment plan during pregnancy and suitable healthcare for the mother and newborn after birth. Herein, we review the immunological analysis of amniotic fluid for prediction of intrauterine infection and survey advances in the field that are bringing us closer to clinical implementation.
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Comparison of the aesthetic and functional efficacy of subcuticular running closure (3/0 rapid absorbable 910 polyglactin) with N-BUTYL cyanoacrylate in episiotomy repair
E.E. Atesli, S. Guven, G.N. Cimilli Senocak, E.S. Guvendag Guven
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (5): 660-663.   DOI: 10.31083/j.ceog.2020.05.2060
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The aim of this study was to compare the aesthetic and functional efficacies of n-butyl cyanoacrylate and 3/0 rapid absorbable polyglactin 910 sutures in cutaneous repair during episiotomy. This study involved 52 cases of patients who had spontaneous vaginal delivery and episiotomy. The cases were randomized among to the type of cutaneous repair during their episiotomy. The perineal skin was repaired by taping with n-butyl cyanoacrylate (group 1) or by suturing with subcuticular 3/0 rapid absorbable polyglactin 910 suture (group 2). These two groups of patients were compared in terms of duration of repair, postpartum pain, healing and cosmetic outcomes, and dyspareunia at 48 hours and 6 weeks postpartum. The incidence of episiotomy skin dehiscence was lower in group 2 than group 1 but it was not statistically significant (p > 0.05). The average visual analog score of group 1 was statistically significantly lower at 48 hours postpartum (1.40 ± 0.50 vs. 3.44 ± 0.93, p < 0.01) and at 6 weeks (1.12 ± 0.72 vs. 2.07 ± 0.82, p < 0.01) compared with that of group 2. Also, the count of paracetamol pills used in the first 48 hours was significantly lower in the tissue glue group (1.97 ± 0.93 vs. 2.67 ± 1.21, p < 0.05). Dyspareunia incidences in the first coitus following vaginal delivery showed no statistically significant differences between the two groups. Similarly, the mean Vancouver scar score showed no statistically significant differences between the two groups. The duration of operation was shorter for group 1 than for group 2 (0.81 ± 0.62 vs. 2.12 ± 0.33, p < 0.001). The efficacy of using n-butyl cyanoacrylate tissue adhesives versus 3/0 rapid absorbable polyglactin 910 sutures for cutaneous episiotomy repair was similar. However, taping with tissue adhesive has the advantages of fast application and a painless postpartum period.

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Thyroid stimulating hormone (TSH) level variations in early pregnancy and feto-maternal outcome; retrospective study
N. Al-Husban, A. Hababeh, M. Al-Kasasbeh, R. Odeh, M. Shaheen, D. Moughrabi, D. Zabalawi
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (5): 675-680.   DOI: 10.31083/j.ceog.2020.05.5431
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Introduction: Thyroid disease is the second most common endocrine disorder affecting women of reproductive age. The debate continues which TSH levels need to be considered as a reflection of subclinical hypothyroidism in pregnancy. Our aim was to find out if variations in the level of thyroid stimulating hormone (TSH) in early pregnancy of women not known to have thyroid disease or anti-thyroid antibodies were linked to different fetomaternal outcomes. Materials and Methods: Retrospective comparative study that compared group 1 (TSH level 0.1-1.99 mIU/L) and group 2 (TSH level 2.0-4 mIU/L). Each group was further subdivided into primigravidae and multipara with a total of 1527 pregnant women included in the study. Results: The body mass index (BMI), was statistically higher in primiparous women in group 2 (P2) than primiparous in group 1 (P1), (mean BMI 28.0 vs. 26.9, respectively, P value 0.014). The odds ratio of miscarriage in the primigravidae in group 2 was 1.24. This was not statistically significant (95% confidence interval; 0.42-3.63). The miscarriage rate was not also statistically different between multipara (odds ratio 1.04, 95% CI 0.6-1.7). For the primigravid groups, the odds of developing gestational diabetes mellitus was significantly higher in group 2 than in group 1 (Odds Ratio = 2.6, 95% CI 1.2-5.4). This was not seen in multiparous women. This difference could be explained by the higher BMI in group 2. There was a significant difference in the mean arterial blood pressure in multipara between the 2 groups. Although the values of the mean blood pressure (85 and 84 mmHg) were close, the P-value of the t-test performed was 0.007 possibly due to the difference in variance and sample size of each group. There were no statistical difference in the mean gestational age at delivery, preterm birth, mode of delivery and birth weight of term and preterm deliveries. Conclusions: In singleton pregnancies of women without thyroid dysfunction and with negative anti-thyroid antibodies, variations of the TSH level in early pregnancy up to 4.0 mIU/L were not associated with a significant difference in most of the fetomaternal outcomes. TSH values between 2.0-4.0 mIU/L were found to be associated with gestational diabetes in primigravid women and higher mean arterial blood pressure in multiparous women.
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Adenomyosis – Is a new treatment solution available?
Wu Shun Felix Wong, Xiao-Gang Zhu, Min Xue
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 5-8.   DOI: 10.31083/j.ceog.2021.01.2144
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Adenomyosis is increasingly common up to 20% to 30% of reproductive-aged women who present with menorrhagia, dysmenorrhoea, infertility, and related pregnancy complications. It is often diagnosed by the clinical symptoms and ultrasound examinations. MRI, if available, will give a more detailed confirmation of adenomyosis. There are many medical treatments available for adenomyosis, e.g., oral contraceptives, LNG-IUS, GnRH-a, and progestin, while surgery is often either conservative adenomyomectomy or hysterectomy. All these treatments either impact on the fertility of these patients or not readily accepted by them because of the invasiveness of the surgery and side effects of medication. High Intensity Focused Ultrasound (HIFU) ablation treatment discussed in the paper offers an alternative non-invasive treatment for adenomyosis. The early results of HIFU ablation are satisfactory and well accepted by patients. However, long term follows up, with a combination of medical treatments after HIFU ablation, may offer a new treatment solution for adenomyosis.
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Evaluation of sexual functions and quality of life in female patients after hysterectomy for benign symptomatic diseases
Ö. Koşar Can, Ö.T. Güler, Ü. Çabuş, D. Kılıç, C. Kabukçu
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (5): 693-700.   DOI: 10.31083/j.ceog.2020.05.5389
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Objective: To evaluate selected quality of life parameters among sexually active patients who underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) for benign symptomatic disease. Materials and Methods: Fifty-six TAH-BSO patients (20 menopausal + 36 premenopausalhysterectomized women) were evaluated between September 2017 and May 2018 using the FSFI, ASEX and SF-36 scores with individual interviews before and six months after TAH + BSO surgery. Results: The preoperative and postoperative period scores from three different validated questionnaires were found to be significantly different for all patients. Scores in the postoperative periods were better in all patients. Also, scores in the preoperative and postoperative periods were higher among premenopausal patients than menopausal patients. Conclusion: Our results showed that sexual function and quality of life improved in all patients who underwent TAH-BSO for benign symptomatic disease. Also, menopausal status is very important.

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Ovarian teratoma with anti-N-methyl-D-aspartate receptor encephalitis, a type of limbic encephalitis: a review of the literature and a case report in korea
S.H. Park, J. Lim, K.T. Lim, K.H. Choi, S.M. Yoon, H.J. Chung
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (5): 774-780.   DOI: 10.31083/j.ceog.2020.05.2094
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Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a type of limbic encephalitis that is resulted by an autoimmune processes; it is a rare autoimmune encephalitis caused by the NMDA receptor antibody secreted by all kinds of tumors. This paraneoplastic syndrome is frequently associated with ovarian teratomas; however, neural cells expressing anti-NMDAR may also be involved in the disease. We report a patient with a case of anti-NMDAR encephalitis associated with an ovarian teratoma, and present a literature review of 16 cases of anti-NMDAR encephalitis in Korean women.
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Coagulation challenges in pregnancy: from thrombophilia involvement and management to the utility of thrombin generation monitoring
R. Mihăilă
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (6): 814-820.   DOI: 10.31083/j.ceog.2020.06.5499
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Despite numerous studies, there is no general agreement on an ideal biomarker for estimating thrombotic risk in pregnant women. However, it is accepted that the analysis of thrombin generation assesses the coagulation state more accurately compared to the classical tests used to investigate it. Increasing evidence has found that thrombin generation is correlated with overall plasma hypercoagulability, which is involved in the occurrence of major obstetrical syndromes, including preeclampsia, intrauterine growth restriction or recurrent abortions. It is difficult to investigate the thrombophilic mutations which, once discovered, are not able to quantify the thrombotic risk. The standardization of thrombin generation assay could allow a quantification of the individual thrombotic risk, which has a high variability, and would facilitate multicenter studies to establish the utility of thrombin generation monitoring for the prophylactic anticoagulant treatment in order to reduce pregnancy-related complications.
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Effect of seven oriental herbs mixture (Jogyeongbohyeoldan) on the restoration of ovarian aging in aged mice
Jong-Kil Joo, Chae-Hak Lim, Min Jung Park, Hyeon Jeong Kim, Chang-Woon Kim, Chul-Hee Yoon, Jeong-Eun Yoo, Bo Sun Joo
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 37-46.   DOI: 10.31083/j.ceog.2021.01.2201
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Purpose of Investigation: Ovarian aging remains a difficult problem in infertility treatment. The traditional oriental herbs have been widely used for female infertility treatment. This study investigated the effect of seven oriental herbs mixture (Jogyeongbohyeoldan, JBD) on ovarian aging and oocyte quality in aged and premature ovarian failure female mice. Materials and Methods: C57BL/6female mice aged 12 months (natural ovarian aging, NOA) were administered once daily with JBD of 15 mg/kg (n = 7) and 30 mg/kg (n = 7) of body weight for 4 weeks using syringe with oral zoned needle. The control group (n = 7) was treated with normal saline. After final treatment of JBD, follicle counts were evaluated by hematoxylin and eosin (H&E) staining, and ovarian mRNA expressions of genes related to PI3K/mTOR (4E-BP1, S6K1, RPS6) and Hippo (MST1, LATS1) signaling pathway, and angiogenesis (VEGF, visfatin, and SDF-1α) were examined by quantitative real-time PCR. In the second experiment, NOA and premature ovarian failure mice (POF) were treated with JBD (n = 7 each), and were superovulated with PMSG and hCG, followed by mated with male. Numbers of zygotes ovulated and embryo development rate were examined. In the third experiment, a total of 18 NOA female mice and 24 POF mice were administered with JBD and mated with males for 2 weeks, and then the pregnancy outcome was monitored up to 20 days. Results: JBD significantly increased numbers of primordial, primary, secondary, and antral/mature follicles, and ovarian mRNA expression of 4EBP1, S6K1, RPS6, MST1, LATS, VEGF, and SDF-1α. Also JBD significantly increased numbers of zygotes retrieved and embryo development rate to blastocyst in NOA and POF mice compared to controls (P < 0.05). JBD treatment significantly increased pregnancy outcome including number of live birthed pups in both NOA and POF mice. Conclusions: These results suggest that JBD can restore ovarian aging and improve ovarian function, ovarian response and oocyte quality in aged mice. It is suggested that this beneficial effect may be related to an increase in ovarian expression of genes associated with PI3K/mTOR and Hippo signaling pathways and angiogenesis.
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Case report of successful live birth in an infertile couple with male idiopathic hypogonadotropic hypogonadism/azoospermia and atypical polypoid adenomyoma of the uterus
K. Okuno, K. Kitaya, N. Kim, K. Yamaguchi, H. Matsubayashi, T. Ishikawa
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (6): 972-973.   DOI: 10.31083/j.ceog.2020.06.5496
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The authors report a unique case of a successful live birth in an infertile couple both with male factor (idiopathic hypogonadotropic hypogonadism, IHH/azoospermia) and female factor [atypical polypoid adenomyoma (APA) of the uterus]. According to the history of ejaculation disorder and low values of serum follicle stimulating hormone, luteinizing hormone, and testosterone concentration, an infertile man was diagnosed with IHH. Gonadotropin therapy failed to produce ejaculated spermatozoa, but microdissection testicular sperm extraction was successful for retrieval and cryopreservation of motile testicular spermatozoa. Meanwhile, in the course of infertility workup for his female partner, fluid hysteroscopy detected multiple endometrial polypoid lesions in her uterine cavity. Hysteroscopic resection and histopathologic examinations revealed that the lesions were APA. Repeated hysteroscopic and histopathologic examinations did not find any evidence of the recurrence. She underwent controlled ovarian stimulation, oocyte pickup, and intracytoplasmic sperm injection using thawed testicular spermatozoa. She had a pregnancy in the first frozen-thawed blastocyst transfer cycle and gave birth to a healthy baby.
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Autosexual behavior as a topic for inclusion in gynecological practice
Ewa Jakubek, Grażyna Jarząbek-Bielecka, Jacek Boroch, Małgorzata Mizgier, Katarzyna Plagens-Rotman, Witold Kędzia
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (2): 212-215.   DOI: 10.31083/j.ceog.2021.02.2127
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It is advisable that the medical history of the gynecologist be extended to include the functioning of patients in the sexual sphere, including partner relationships, which affects health, including women's sexual health. For many patients, sexology issues are taboo and autosexual behavior (masturbation) is a special taboo. Masturbation refers to sexual stimulation, especially of one's own genitals and often to the point of orgasm, which is performed manually, by other types of bodily contact (except for sexual intercourse), by use of objects or tools, or by some combination of these methods. Autosexual behavior as a topic for inclusion in general gynecology and developmental gynecology indicates the need for a very individual approach to this issue in the context of a given patient. Similar medical issues seem to refer to a general truth about medicine that it is neither merely art nor science, in the modern sense of these terms. It is a separate, indirect field, tertium quid, i.e., the third, intermediate possibility between art and science, but different from both. In the Aristotelian sense, medicine is a habit of practical understanding, perfected by experience in patient care, and the issue of autosexual behavior in general gynecological requires special experience and an individual approach to a patient.
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Disability vs the sexual life of women - selected issues
Katarzyna Plagens-Rotman, Grażyna Jarząbek-Bielecka, Piotr Merks, Małgorzata Mizgier, Witold Kędzia, Maciej Wilczak
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 19-23.   DOI: 10.31083/j.ceog.2021.01.2200
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Sex refers to a set of somatic and mental characteristics. The former are determined according to three criteria: gender, external and internal genital organs, and tertiary sex characteristics (breast, specific hair, specific fat distribution, body proportions), the latter distinguish women from men. Every single person experiences problems related to sex - in childhood, adolescence, maturity, old age. In women, these issues are particularly complex at each stage of development. Additionally, during pregnancy, gynaecologists should discuss sexual health with their patients. The sexual health of women with disabilities is a special issue in this respect. Disabilities are a serious social and health problem in both urban and rural agglomerations. Sexual health problems, in the light of these aspects, should also be the task of rural medicine.
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Tenofovir disoproxil fumarate for preventing mother-to-child transmission of hepatitis B: a literature review
Iulia Baciu, Dalila-Ana Domuncu, Tiberiu Domuncu, Anca Marina Ciobanu, Theodor Voiosu, Gheorghe Peltecu, Anca Maria Panaitescu
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 9-18.   DOI: 10.31083/j.ceog.2021.01.2240
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Infection with the hepatitis B virus (HBV) is one of the leading global public health issues. Over 250 million people worldwide have chronic HBV infection, out of which roughly 65 million are women in their reproductive age. The most common route of passing the infection in areas of high endemicity is by mother-to-child transmission (MTCT). In children the infection may still occur despite adequate immunoprophylaxis, however, antiviral medication, such as Tenofovir disoproxil fumarate (TDF), may be helpful in reducing the risk of MTCT. A literature review was conducted concerning TDF's role in preventing MTCT and its safety in pregnancy. Studies were identified by researching various databases up to 2020 for variations of the following sentence: "Tenofovir disoproxil fumarate and Lamivudine and Telbivudine and Entecavir and pregnancy and transmission and safety and HBV". Prenatal and perinatal adequate management of maternal HBV infection is of utmost importance, with focus on prevention of MTCT as the key strategy to reduce the global HBV infection burden. This review discusses the most up-to-date evidence from a multidisciplinary perspective of using TDF to reduce MTCT of HBV infection as well as its safety profile for pregnant women.
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International Symposium on Reproductive Health: overcoming barriers for research in reproduction
ISRH2021 Scientific and Organizing Committee
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (3): 733-777.   DOI: 10.31083/j.ceog.2021.03.0511
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Accumulating evidence suggests that parental health, even before conception, may affect offspring development. Stressful environments during critical periods of growth and development that include preconception, pregnancy, and early childhood could cause long-term effects that may impact offspring's health. These environmental factors may include maternal and paternal metabolic and endocrine health, exposure to endocrine disruptors, pollutants, environmental stressors and chemicals, and also the use of assisted reproductive techniques (ARTs), among others.
Periconceptional and prenatal care are crucial to improving infants' development and health and preventing adult diseases, such as diabetes, neurocognitive, and other multifactorial and complex disorders.
Although increasing attention has been given to prenatal care management in the last years, there are still disparities among nations in terms of access to healthcare and also controversial results in many aspects, and unresolved issues. In this regard, the COVID-19 pandemic has raised new questions regarding reproduction, pregnancy and childhood development care.
In particular, in Latin America, socioeconomic inequalities in primary health system access make these societies vulnerable in terms of gestational care. Moreover, although antenatal care is more accessible in developed countries, there is still a need to comprehend the impact of different environmental cues on human health and development and improve the possible medical interventions and public policy management.
To address the above-mentioned topics, the International Symposium on Reproductive Health 2021 (ISRH2021) was proposed by a group of early-career scientists from Argentina, as a free one-day symposium with different roundtable sessions, including:
-Maternal-fetal interface
-Maternal effects on pregnancy and offspring health
-ARTs effects on embryo and offspring development
-Paternal effects on fertility and offspring health
The virtual format provided a networking space between Early-Career and experienced researchers from home, anywhere in the world. This not only allowed to join experts from Latin-American and developed countries but also allowed a wider global audience to attend, including those who may not be able to travel for a face-to-face meeting. The economic barrier is a common problem in Latin America and developing countries as the low incomes affect the possibility of attending international meetings. Moreover, as ECRs are the academic members with lower salaries, they are usually the most affected. The spirit of this symposium was to create possibilities for worldwide participation at all career stages.
During the ISRH2021, each session consisted of two Senior talks of invited international researchers and two short talks of early-career researchers (ECRs), which were selected based on their abstract quality. Also, a poster session was held.
To generate different opportunities for interaction between Senior and ECRs, several short talks were also held, followed by a debate. Among the topics discussed were "Women in Science and Gender Discrepancy", "From basic research to public policies", "ECRs Resources" and "Career Paths".
Listed below we present the abstract of the works presented at the ISRH 2021 meeting.
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Less is more—a minimal approach technique for Cesarean Section
Dragan Belci, Gian Carlo Di Renzo, Davor Zoričić, Andrea Tinelli, Antonio Malvasi, Michael Stark
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (3): 478-482.   DOI: 10.31083/j.ceog.2021.03.2422
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Background: The various techniques for performing a Cesarean Section (CS) have a long history. There are numerous surgical variations based on personal or local tradition, but these are not based on evidence and often have different outcomes on maternal and newborn health. Many modifications of the CS technique have been utilized in order to improve outcome with variable results both positive and negative. Several CS laparotomic methods have been developed but no consensus has been reached on the most optimal approach as related to safety and morbidity. Methods: The minimalistic approach of the Stark Cesarean Section (SCS) is compared to other methods thorugh an evaluation of the studies published in the last 20 years comparing this technique with others, the systematic reviews and the personal experience of the authors. Results and Discussion: The abdominal incision done at the Stark Cesarean Section differs from the Pfannenstiel incision by its location being above the arcuate line eliminating the need to separate the fascia from the recti muscles. The muscle separations being away from the pubic bone and the iliohypogastric and ilioinguinal nerves eliminates the risk of damage. This unique surgical approach is a logical, fast and simple one that eliminates unnecessary operative steps saving time and reducing complications. After fifteen years of experience and thousands of SCS performed at our departments, we may conclude that this method has several advantages over other surgical methods as related to short and long-term outcomes, including chronic/neuropathic pain and quality of life.
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Obesity, neural tube defects and folic acid—A complex relationship
Gideon Koren, Yusuf C Kaplan
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (2): 223-227.   DOI: 10.31083/j.ceog.2021.02.2304
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Obesity is associated with twofold increased risk of neural tube defects (NTD). Research has repeatedly shown that about 70% of NTD are folic-acid dependent. Yet, there is controversy whether folic acid status is the main determinant of the increased risk of obesity-induced NTD. The rational for this review is to update and discuss the evidence on the link between obesity, folic acid and NTD, in an attempt to shed light on the question whether optimal folic acid dose schedule can mitigate this risk. During pregnancy maternal folate requirements increase by 5–10-fold, as folate is diverted towards the placenta and fetus, as well as supporting different maternal organs. Correspondingly, low maternal folate status has been associated with birth defects in fetal anatomical regions particularly sensitive to reduced folate intake including oral cleft, cardiovascular defects and NTD. A recent study has documented decreased placental folate transporter expression and activity in the first and second trimesters among obese mothers. This may explain the higher incidence on NTD in infants of obese women, as less folate may find its way to the developing fetus during the sensitive periods for creating NTD. Recent pharmacokinetic results indicate that steady state levels of folate are almost perfectly defined by the dose per lean body weight (LBW). The mean dose per kg LBW that would be expected to result in steady state serum folate level of > 15.9 nmol/L was identified as 0.0073 mg/kg LBW. A large study found no differences in dietary supplementations of folic acid, yet obese women exhibited lower median serum folate as well as lower mean serum B12 levels, but no differences in mean RBC folate levels. There was a negative correlation between increasing BMI and both serum folate and plasma B12. Future research will be needed to incorporate more fully, in addition to evidence of NTD, obesity and folic acid intake, also direct measurements of serum and RBC folate, as well as other confounders, in order to create a model that will shed light on these complex interactions.
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Acknowledgement to Reviewers of Clinical and Experimental Obstetrics & Gynecology (CEOG) in 2020
CEOG Editorial Office
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (2): 206-211.   DOI: 10.31083/j.ceog.2021.02.2591
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No abstract present.
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Fertility options in Mayer-Rokitansky-Küster-Hauser syndrome
Francesco Fedele, Alessandro Bulfoni, Stefano Salvatore, Massimo Candiani
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (3): 453-460.   DOI: 10.31083/j.ceog.2021.03.2442
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Background: The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the most common cause of uterine aplasia, with a worldwide frequency of 1 in 4500 females. Although abundant literature is present regarding the different available methods for creating a neovagina in MRKH syndrome, the attention dedicated to these women's reproductive potential remains insufficient. Methods: Online searches were carried out in PubMed database during November and December 2020. The search included a combination of the various terms (e.g., MRKH, vaginoplasty, uterus transplantation, infertility treatment, gestational surrogacy, etc.). The following inclusion criteria were used: (1) The articles should be written in English or French language. (2) The article should have been published by an official scientific organization. Results: Until few years ago, the only option for women with MRKH syndrome was legal adoption, now gestational surrogacy (GS) and uterine transplantation (UTx) have become new fertility options available to these patients. Discussion: GS is officially recognized in several countries and widely practiced. On the other hand, UTx, although the great recent technical improvements, is far from being an option for all women with MRKH syndrome secondary to its complexity and the necessary immunologic therapies.
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Effects of intrauterine autologous platelet-rich plasma infusions on outcomes in women with repetitive in vitro fertilization failures: a prospective randomized study
Mahvash Zargar, Razieh Pazhouhanfar, Mahin Najafian, Parastoo Moradi Choghakabodi
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 179-184.   DOI: 10.31083/j.ceog.2021.01.2131
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Purpose: Evaluation of the effect of platelet-rich plasma (PRP) containing platelet-derived growth factor on in vitro fertilization (IVF) failure patients. Methods: In this clinical trial, 80 eligible patients (infertile women with at least two IVF failures) were randomly assigned into two groups, including patients who received an intrauterine infusion of PRP (n: 40) and controls (n: 40). Before PRP therapy, standard hormone replacement therapy was performed for all patients to endometrial thickness preparation. After sonographic assessment of endometrium, PRP was injected into all patients' endometrium whether they had an appropriate endometrial thickness or not. Then, the embryo transferring was done through IVF. Eventually, the consequences of fertility, embryo implantation, and pregnancy were evaluated. Data analysis was performed using SPSS version 22. Results: The rate of successful IVF [6 (15%)], pregnancy rate [5 (12.5%)], and live birth [5 (12.5%)] were relatively higher in patients undergoing PRP therapy compared with controls [2 (5%), 1 (2.5%) and 0, respectively]. However, their statistical difference was not significant between the two groups (P > 0.05). Conclusion: Our findings suggest that endometrial injection of platelet-rich plasma for IVF failure patients did not significantly improve the IVF process, pregnancy, and live birth rates.
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Retrospective analysis of pregnancy terminations and indications in a tertiary center
Sureyya Saridas Demir, Erkan Cağliyan, Sabahattin Altunyurt
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 85-90.   DOI: 10.31083/j.ceog.2021.01.5524
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Purpose: The aim of this study was to evaluate the indications of pregnancies terminated which were for maternal and fetal causes in our clinic and to discuss legal and ethical issues differing by countries. Methods: This study was performed retrospectively by evaluating 318 pregnancies terminated due to maternal or fetal indications over 10 weeks Results: TOP was performed due to fetal congenital, chromosomal and obstetrical reasons in 96.8% of 318 terminated cases and due to maternal reasons in 3.2% of them. Thirty-two (10%) late termination cases with gestational week > 23 + 0 were termed after feticide procedure. Conclusion: Gestational limit for termination of pregnancy varies from country to country, which brings ethical problems with it. We presented indications of pregnancy terminations in our clinic, which is a tertiary and reference center within the legal framework.
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Deep infiltrating endometriosis as a cause of severe urogynecological complications despite invasive treatment - report of two cases from the center of endometriosis surgery
D. Filipecka-Tyczka, A. Kajdy, B.P. Siekierski, M. Stańczyk, A. Rogowski, M. Rabijewski, R.B. Maksym
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (6): 955-960.   DOI: 10.31083/j.ceog.2020.06.2092
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Endometriosis involvement of the urological tract may lead to significant disabilities. The involvement of the urological tract gives rise to severe complications that burden patient health and quality of life. Two cases of patients with severe urogynecological complications after surgery of deep infiltrating endometriosis were analyzed. Last resort radical surgical treatment did not stop the progression of the disease and failed to prevent further deterioration despite concomitant hormone therapy. Careful clinical consideration is recommended to plan an effective therapeutic strategy and the extent of the surgery for this multidisciplinary and complex disease. The treatment should start and be proceed by a dedicated and experienced team. Radical surgery including a total hysterectomy with a salpingo-oophorectomy could be necessary. Although a radical dissection increases the chances of recovery and long-term remission, it is also associated with an increased risk of serious short-term and long-term postoperative complications. In presented cases, the infiltration of the ureter by endometriosis caused non-symptomatic kidney function loss. The radical surgical treatment of deep infiltrating endometriosis did not stop the progression of a disease and was associated with severe urogynecological complications. Screening for pyelocaliectasis in patients with deep endometriosis could be considered as an important part of preoperative examination and postoperative follow-up.

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Retracted: Bulking agents — an analysis of 500 cases and review of the literature
Y. Zhao, X. Guo, K. Lobodasch, B. Liu, S. Wang, Q. Lin, Y. Yu, F. Su
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (6): 997-997.   DOI: 10.31083/j.ceog.2020.06.2136
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The Clinical and Experimental Obstetrics & Gynecology Editorial Office has been made aware that the published paper [1] has a plagiarism issue with published paper [2]. The Editor-in-Chief and Editorial Office of the Clinical and Experimental Obstetrics & Gynecology have checked the case, and the Editor-in-Chief has approved the retraction. The Clinical and Experimental Obstetrics & Gynecology Editorial Office apologize to the readers of Clinical and Experimental Obstetrics & Gynecology and to the authors of the previous work.
To ensure the addition of only high quality scientific works to the field of scholarly publication, the published paper [1] is retracted and shall be marked accordingly. IMR Press has been following the regulations of the Committee on Publication Ethics (COPE) and takes very seriously the responsibility to enforce strict ethical policies and standards.

Retraction of Clinical and Experimental Obstetrics & Gynecology, 2016, 43(5): 666-672
https://ceog.imrpress.com/EN/10.12891/ceog2136.2016

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Comparison of bilateral lymphedema and unilateral lymphedema in lower extremities after gynecologic cancer surgery
S.H. Ryu, B.S. Jang, J.H. Lee, H.J. Jeong, G.C. Kim, Y.J. Sim
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (6): 829-834.   DOI: 10.31083/j.ceog.2020.06.5531
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Purpose of investigation: To identify factors associated with bilateral lymphedema in lower extremities that occur after gynecological cancer surgery. Materials and methods: Retrospective chart review was performed on 110 patients who were hospitalized for lymphedema after gynecological cancer surgery from 2006 to 2018. Statistical significance was verified using Pearson's Chi-square test, Fisher's exact test, and exact logistic regression analysis. Results: The types of cancer, cancer stage, genital swelling, and extensive lymph node dissection were significantly different between the two groups. Exact logistic regression analysis showed that cancer stage and genital swelling were associated with bilateral lymphedema. Significant differences were observed for radiation therapy and lymphangitis. Exact logistic regression analysis revealed that radiation therapy and lymphangitis were factors associated with unilateral to bilateral progression. Conclusion: Cancer stage, genital swelling, and extensive lymph node dissection were identified as factors related to bilateral lower limb lymphedema. Radiation therapy and infection history were identified as factors related to lymphedema progressing from unilateral to bilateral. Content: The associated factors for bilateral lymphedema in lower extremities after gynecological cancer surgery.
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COVID-19 in pregnancy
Luca Roncati, Greta Gianotti, Elisa Ambrogi, Giovanna Attolini
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (4): 778-780.   DOI: 10.31083/j.ceog4804124
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Coronavirus Disease 2019 (COVID-19) is the most dramatic pandemic of the new millennium with repercussions also in the obstetric-gynecological field. More recently, new research has disclosed that COVID-19 pregnant women are at higher risk for severe infections, intensive care unit admission, preeclampsia/eclampsia, maternal mortality, preterm birth, medically indicated preterm birth, severe neonatal morbidity index, and severe perinatal morbidity and mortality index. Here, we deal with the biomolecular bases behind these findings with particular reference to changes in the immune arrangement of pregnant women and to the angiotensin-converting system of blood pressure control. Pregnant women and clinicians should be therefore alerted to implement strictly all the recommended COVID-19 preventive measures, such as respiratory hygiene by filtering facepiece masks, physical distancing at least 1 meter, avoid interacting with sick people and spending time in crowded places, cleaning hands with sanitizer or soap and water.
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At-Home IVF Kit: application during the COVID-19 pandemic
Z. Merhi, J. Zhang
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (5): 653-659.   DOI: 10.31083/j.ceog.2020.05.2157
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The guidelines, at the time of writing this manuscript, recommend withholding fertility treatments due to fear of the COVID-19. However, many fertility doctors and many patients, especially those with diminished ovarian reserve (DOR), strongly suggest that their fertility treatment including oocyte and/or embryo freezing is a time-sensitive matter due to fear of losing all their ovarian reserve. This report presents a novel approach for ovarian stimulation at home in women with DOR for oocyte/embryo cryopreservation using At-HOME IVF kit mailed to the patients’ home, and without the need for blood hormones and transvaginal ultrasounds monitoring. In this study, women (n = 22) diagnosed with DOR who underwent either oocyte (n = 6) or embryo freezing (n = 16) were included. Each patient took the medications included in the kit without the frequent visits to the office for monitoring and presented only once to the fertility clinic on the day of the oocyte retrieval. Upon presentation on the day of oocyte retrieval, none of the patients had ovulated. All patients underwent oocyte retrieval with 21 out of 22 patients having had at least one or more oocytes collected, with the number of mature oocytes retrieved ranging from 1 to 7. Eight out of 16 patients (50%) who underwent IVF, had embryos cryopreserved at either the cleavage-stage or blastocyst stage. This report suggests that, during the COVID-19 pandemic, At-HOME IVF kit presents a novel solution for women with DOR, or in situations where time is of essence, limiting office visits and thus minimizing the risk of coronavirus infection.
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Impact of clinical pharmacist intervention on blood glucose control and perinatal outcomes in gestational diabetes mellitus through a diabetes management system
C. Ji, L.J. Sun, L.T. Li, J. Ma, W.H. Ge, X. Zhao
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (5): 645-652.   DOI: 10.31083/j.ceog.2020.05.2212
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Background: Very few studies have assessed the role of a clinical pharmacist in women with gestational diabetes mellitus (GDM). To improve pharmaceutical care, we explored a method to improve the control of blood glucose and perinatal outcomes in females with GDM through the application of a diabetes management system. Methods: A randomized controlled trial was conducted from October 2017 to October 2018 for 200 outpatients with GDM. In the study, a diabetes management system with pharmaceutical care was used for the intervention group. The clinical outcomes of all patients were recorded at the end of delivery. Results: From one sample of 200 patients, 169 finished the research. Compared with the control group, patients in the intervention group manifested greater reductions in fasting plasma glucose (5.22 ± 0.37 vs. 6.05 ± 1.06 mmol/L; P = 0.018), 2 h postprandial plasma glucose (6.66 ± 0.57 vs. 9.69 ± 1.58 mmol/L; P = 0.00), and glycated hemoglobin A1c corrected values (1.02 ± 0.12 vs. 1.16 ± 0.22; P = 0.023). Moreover, the rate of polyhydramnios was significantly lower in the intervention group than in the control group (0% vs. 10.59%; P = 0.003) as well as significantly fewer macrosomia in the intervention group (7.14% vs. 18.82%; P = 0.038). Conclusions: Using a diabetes management system, clinical pharmacists can improve the control of blood glucose and perinatal results in GDM females. With a diabetes management system, the comprehensive management of GDM is a new model for pharmaceutical care in the future.

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Comparison of laparoscopic surgical skills acquired on a virtual reality simulator and a box trainer: an analysis for obstetrics-gynecology residents
M. Varras, C. Loukas, N. Nikiteas, V.K. Varra, F.N. Varra, E. Georgiou
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (5): 755-763.   DOI: 10.31083/j.ceog.2020.05.4988
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Background/Aims: It is well known that laparoscopic surgery requires the demonstration of a different set of technical skills when compared to open surgery. Laparoscopic training using simulators has been shown to accelerate learning in an efficient and standardized manner. Significant research has been conducted for skills acquisition in abdominal surgery, but in the field of gynecologic laparoscopy the relevant studies are limited. The aim of this study was to compare the training efficacy of virtual reality (VR) simulators and box-trainers (BTs) for skills acquisition in gynecologic surgery, and also to study the transferability of these skills in the performance of more advanced gynecologic operations. Methods: Twenty residents in obstetrics-gynecology with minimal laparoscopic experience were randomized into two equal groups to be trained on either a VR simulator (Group-A) or a BT (Group-B). Group-A was trained on basic tasks (clipping, peg transfer, and cutting), whereas Group-B was trained on ovarian cystectomy and salpingotomy using custom training models. After training, the two groups were assessed on the performance of two laparoscopic gynecologic procedures on a VR simulator (salpingotomy and salpingectomy). Performance metrics included time, instrument pathlength, and various task-specific errors. Results: Both groups demonstrated significant performance improvement in all training tasks, for all but one of the metrics (p < 0.05). After training, both groups had improved performance in the laparoscopic operations using the VR simulator, but this trend was not statistically significant in any metric considered (p > 0.05). Similarly, the post-training performance between the two groups was not statistically different (p > 0.05). Conclusions: Basic skills training on either a VR simulator or BT results in equivalent but not statistically significant performance improvement with more advanced gynecologic laparoscopic tasks on a VR simulator.

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Efficacy of kinesio tape on neck pain and functional disability in pregnant women: a randomized controlled trial
Eman A. Elhosary, Mahmoud M. Ewidea, Marwa A. Mohamed
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (1): 175-178.   DOI: 10.31083/j.ceog.2021.01.2145
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Neck pain during pregnancy has negative effects on the quality of a woman's life. The goal of this study was to determine the efficacy of kinesio-tape application on neck pain and functional activity during pregnancy. Thirty primigravid women who suffered from mechanical neck pain during the second and third trimester of pregnancy were recruited. They were randomly assigned to two groups: one received general antenatal advice about good posture in addition to kinesio taping for 4 weeks; the other received only general antenatal advice about good posture. Pain was assessed with the Visual Analogue Scale (VAS) and Neck Disability Index scale (NDI) at the start of the study and after 4 weeks of treatment. After 4 weeks, both groups showed improvement, but the group that received advice and kinesiology taping showed significantly less pain (VAS) than did the control group, but no differences in NDI scores. Kinesiology taping and antenatal advice are more effective for trea tment of neck pain during pregnancy than is antenatal advice alone.
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Elective embryo or fetal reduction for caesarean scar pregnancy combined with intrauterine pregnancy
J.R. Huang, X. Li, Q.Z. Peng, J.J. Zhang, X.X. Lin, L.Q. Xie, X.H. Wu, W.S. Zhang
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (6): 867-874.   DOI: 10.31083/j.ceog.2020.06.5516
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Objective: The purpose of this study is to report and discuss the use of elective embryo reduction to treat a cesarean scar pregnancy (CSP) combined with intrauterine pregnancy after assisted reproduction, and its clinical outcomes. Material and Methods: Clinical data from six patients who were diagnosed with CSP combined with intrauterine pregnancy were retrospectively collected and analyzed. Four patients underwent elective embryo or fetal reduction following local injection of potassium chloride (reduction group), while the other two patients chose to continue their multiple pregnancies (observation group). Results: All patients were pregnant with multiple chorionic and amniotic fetuses after assisted reproduction. Mild placenta accreta was observed in one patient in the reduction group. In this group, hemorrhage volume during delivery was from 400 to 900 mL, and the average birth weight was 2,776 g. Placenta accreta spectrum occurred in both patients in the observation group, and they gave birth prematurely between 32 and 34 weeks. Conclusion: CSP combined with intrauterine pregnancy was treated using elective embryo or fetal reduction, which may improve maternal and fetal safety. Content: Outcomes of cesarean scar pregnancy with intrauterine pregnancy with or without elective embryo reduction.
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Successful cryopreservation of mouse and human blastocysts using vitrification solution without sucrose and Ficoll
C.W. Kim, D.H. Lee, B.S. Joo, K.S. Lee
Clinical and Experimental Obstetrics & Gynecology    2020, 47 (6): 847-855.   DOI: 10.31083/j.ceog.2020.06.5508
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Purpose of Investigation: This study investigated whether cryopreservation of mouse and human blastocysts using vitrification solutions formulated with or without sucrose and Ficoll affects survival rate and pregnancy outcome. Materials and Methods: Two-cell mouse embryos were retrieved from C57BL/CBA females aged 5 weeks and cultured to the blastocyst stage. Artificial shrinkage of blastocysts was performed by blastocoel fluid aspiration before vitrification and then exposed to and vitrified-warmed in one of four different vitrification solutions: 1) 25% glycerol, 25% ethylene glycol, 20% SSS and PBS without sucrose and Ficoll (G25E25), 2) G25E25 with 0.5 M sucrose (G25E25S0.5), 3) G25E25 with 10 mg/mL Ficoll (G25E25F10), and 4) G25E25 with 0.5 M sucrose and 10mg/mL Ficoll (G25E25S0.5F10). Second, in 435 infertile women undergoing in vitro fertilization and embryo transfer (IVF-ET), artificially shrunken blastocysts were vitrified-warmed either in G25E25 (n = 206) and G25E25S0.5F10 (n = 229). Results: In the mouse series, in vitro survival rates of post-warm blastocysts were 93, 91, 90, and 90% in G25E25, G25E25S0.5, G25E25F10, and G25E25S0.5F10, respectively. No significant differences among four groups were found. In the human series, in vitro survival rates and clinical pregnancy rate of blastocysts vitrified-warmed in G25E25 were 96 and 53.3%, respectively, which were similar to those in G25E25S0.5F10 (92 and 51.9%, respectively). Conclusions: Sucrose- and Ficoll-free vitrification solutions can be successfully cryopreserved mouse and human blastocysts without compromising survival rate and pregnancy outcome.
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Pregnancy and neonatal outcomes of hyperglycemia caused by atosiban administration during pregnancy
Hyun Jin Ko, Seong Yeon Hong, Jin Young Bae
Clinical and Experimental Obstetrics & Gynecology    2021, 48 (2): 257-262.   DOI: 10.31083/j.ceog.2021.02.2364
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It is known that atosiban has fewer side effects than conventional tocolytics. In clinical practice, however, hyperglycemia can be commonly observed in mothers who have been administered atosiban. Therefore, we investigated whether intravenous atosiban injection actually causes hyperglycemia and how these changes affect newborns. From December 2015 to July 2018, a retrospective study was conducted on 96 mothers who were diagnosed with preterm labor and were administered atosiban at our institution. Maternal blood glucose was measured and compared before and during the administration of atosiban. The paired t-test, independent samples t-test, Chi-square test and Fisher's exact test were performed using SPSS version 21.0. A statistically significant increase in fasting blood glucose levels was observed during the administration of atosiban, compared with random blood glucose levels before administration (110.7 mg/dL vs. 86.3 mg/dL). The mean postprandial blood glucose level during administration was 170.75 mg/dL. Gestational diabetes, twin pregnancy, preeclampsia, and polyhydramnios did not significantly affect the degree of blood glucose increase. Statistically significant hypoglycemia was observed after performing a neonatal blood test immediately after birth from mothers who used atosiban. The neonates from the group with elevated maternal blood glucose levels exceeding 20 mg/dL showed lower blood glucose levels. No serious side effects other than hypoglycemia were observed. Atosiban administration in pregnant women results in significantly elevated maternal blood glucose, which results in hypoglycemia in neonates after birth. Therefore, neonates from mothers who received atosiban require a blood glucose test and close monitoring after birth.
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