University Clinical Center of Serbia, Belgrade
Gestational diabetes mellitus (GDM) is a pregnancy complication, in which women without previously diagnosed diabetes develop chronic hyperglycemia during gestation.
Diet and lifestyle of mother during pregnancy as well as lactation have long-term effect on child’s health and development. Detection of early risk markers of adult age chronic diseases which begin during prenatal life and appliance of complex nutritional interventions at the right time may reduce the risk of these diseases
Miljana Z. Jovandaric was born in Serbia. She graduated at the Faculty of Medicine, University of Belgrade. Pediatric specialization ended in 1999 in the University Children's Hospital, Belgrade. She completed her specialization in neonatology in 2003. Master's thesis `` Analysis of lipid infants in women suffering from gestational diabetes mellitus (GDM)``, she defended in 2006 and doctoral dissertation `` Effect of hypoxia on electrolyte and lipid levels in term newborns``, 2018, in the School of Medicine, University of Belgrade, Serbia. Research associate since 2020 at the School of Medicine, University of Belgrade, Serbia. Author and co-author of 84 scientific papers presented at national, international conferences and journals. Head of the Department of Sick Newborns at the Clinic for Gynecology and Obstetrics, Department of Neonatology, University Clinical Center of Serbia, Belgrade.
University Clinic of Ob/Gyn, Macedonia
Introduction: Perimenopause as a clinical entity is characterized by a series of symptoms that occur due to estrogen deficiency of multiple organs and systems. Obesity is a risk factor that favors all these changes, especially hyperplasia.Glycose homeostasis is often impaired in these patients, insulin levels are increased, HOMAIR is increased.
Goals: to detect hyperplasia in obese perimenopausal patients with abnormal uterine bleeding to determine insulin levels, HOMA IR, to determine association between hyperplasia and HOMA IR.
Material and methods: This was a prospective cohort study, performed at the Ob/Gyn Clinic, over a period of 1 year. 100 patients with abnormal uterine bleeding during the perimenopause were involved, aged 45–50, divided in two groups based on BMI. The control group consisted of 40 asymptomatic patients
1-patients with BMI above 30, 2-patients with BMI under 30,
Results:The average value of glycaemia in the first group was higher and is 5.7 mmol/l, cut off valuewas 5,5. The average value of the HOMA-IR insulin resistance index in the first group was highest - 2.8(cut off value was 1.8).Endometrial hyperplasia was registered in the first group at 40.9%.
The first group registered a significant association between HOMA IR and hyperplasia, risk of endometrial hyperplasia occurring was eight times higher.The first group registered a significant association between glycemia and endometrial hyperplasia. High levels of glycemiaincreases the risk of endometrial hyperplasia occurring by three times.
Conclusion: In menopausal transition patients with abnormal uterine bleeding there is increased incidence of endometrial hyperplasia, hyperglycaemia, increased HOMA IR. There is a strong association between these changes and the risk of cardiovascular disease increases. Menopause as a period in a woman's life that requires a multidisciplinary approach in diagnostics and treatment.
Dr. Aneta Sima obtained her medical degree in 1998 from the University of Skopje, Macedonia and she is a specialist in Obstetrics and Gynecology from 2009. She received her PhD degree in 2019. Her research interests cover various themes of gynecology with specific interest in the field of gynecologic endocrinology, surgical management, minimally invasive procedures and prevention, diagnosis and treatment of female infertility. She works as consultant of Obstetrics and Gynecology at University Clinic of Ob/Gyn, a tertiary teaching hospital in Macedonia. She is author of many articles published in international peer-review journals and usually serves as referee and as editor for indexed peer-review journals.
Spedali Civili of Brescia, Italy
The enhanced recovery after surgery (ERAS) concept is based on a multimodal approach to improve the functional rehabilitation after surgery.
This study aimed to validate an ERAS protocol in gynecologic surgery and to measure the adherence to the protocol items
We conducted a prospective randomized trial enrolling consecutive patients from a single institution affected by benign of malignant gynecological diseases (endometrial cancer and advanced ovarian cancer, excluding cervical cancer). We randomly assigned patients to undergo standard perioperative care or ERAS Main outcome. The primary outcome is a shorter length of stay in favor of ERAS. Secondary outcomes include measurement of adherence to the protocol items: comparison of postoperative pain, vomiting, and nausea; anesthesiologic and surgical complications up to 30 days after surgery; rate of readmissions; the time to event in hours for bowel movements, flatus, drinking, hunger, eating, and walking; and the quality of recovery using a validated questionnaire (QoR-15). Finally, we explored the length of stay (LOS) in the prespecified subgroups at randomization, based on the type of surgical access and gynecologic disease.
A total of 168 women were available for analysis: 85 women (50.6%) were assigned to the standard group, and 83 women (49.4%) were assigned to ERAS, and the groups were similar for baseline characteristics. Seventy-two patients (42.9%) underwent surgery for benign disease, 48 (28.6%) for endometrial cancer, and 48 (28.6%) for ovarian cancer. Women enrolled in ERAS had a shorter LOS (median: 2 [interquartile range, 2-3] vs 4 [interquartile range, 4-7] days; P<.001). A decreased rate of postoperative complications was noted for ERAS, as well as an earlier time to occur for all the events. Mean adherence to protocol items was 84.8% (95% confidence interval, 79.7-89.8), and we registered a better satisfaction in ERAS group. The shortening of the LOS was confirmed also in the prespecified subgroup analysis.
Conclusion: Application of ERAS in gynecologic surgery translated to a shorter LOS regardless of surgical access and type of gynecologic disease. Adherence to protocol items in the setting of a randomized trial was high.
Dr. Federico Ferrari attained his Medical degree in 2009 from the University of Brescia (Italy) and he is a specialist in Obstetrics and Gynecology from 2015. He moved to England at the University of Oxford for a Clinical Fellowship in Gynecologic Oncology and back to Italy he received his PhD degree in Biomedical sciences and translational medicine from the University of Brescia. His research interests cover various themes of gynecologic oncology with specific interest in the field of surgical management, minimally invasive procedures and clinical-translational setting in the prevention, diagnosis and treatment of female cancers. Actually, he works as consultant of Obstetrics and Gynecology and at the Department of Obstetrics and Gynecology at Spedali Civili of Brescia, a tertiary northeastern teaching hospital in Italy. He is author of articles published in international peer-review journals, he usually serves as referee and as editor for indexed peer-review journals.
Vivantes Auguste Viktoria Klinikum, Germany
Robot-assistedtechniquesand computer-assistedtechniques, are part ofmodern medicine. Innovative diagnostic and therapeuticstrategies involve them.Health care workers are confronted with an increasingwork volume and shortage of qualified staff which can be handled way betterifdigitaltools are usedassupportingstrategies. Thisinvolvesholisticdigitalapproachesthataddresshealth care work in allcasesthat do notnecessarilyhave to beendone by human beings. Resourcesthatcannot be replaced by human beings include interpersonalrelationshipssuchas human communication and touch or bedding.
Faculty of medicine of Tunis-Tunisia
The literature have described the desire of women suffering of Vaginismus to become pregnant as the primary reason to seek medical care. However; Only 19% of women with sexual disorders would consult their gynecologist for this reason. Vaginismus is a rare condition, which may affect up to 1% of the female population and which is characterized by involuntary contraction of perineal muscles resulting in an impossibility of penetration during sexual intercourse. Objective In this work, we are going to study the socia-demographic profile of these women/ patients. The sexual life of the woman before conception, the desire of pregnancy (spontaneous or induced), circumstances of its incidence as well as delivery and its complications.
Methods - Patient(s) It is a prospective study about 20 pregnant patients diagnosed with vaginism carried out in the emergency department at the Neonatology and Maternity centre of Tunis (CMNT) from october 2016 to March 2017. Main Outcome Measure(s) Vaginismus may result in infertility and may affect a woman’s perception about her femininity and her potential of motherhood. Despite their condition, women with vaginismus show an increasing desire for having children and despite the difficulties they have to encounter due to their condition, they aim to become pregnant (by assisted or spontaneous methode). Many authors have described the syringe method (carotid insemination). However, medical assistance from reproduction secondary to female subfertility was the method of having a pregnancy of a high number of women having a vaginismus. Result(s) The average age was 25.6 years. Vaginism was classified as primary in 75% of cases.. All the women studied (100%) reported the notion of pain during the first sexual intercourse. Sexual intercourse is incomplete in 90% of cases. The repercussion on the couple was represented essentially by: a perturbation of the couple's relational life. 65% of the patients had a spontaneous pregnancy due to incomplete sex, ejaculation at the entrance of the vagina without penetration. Vaginismus was an indication to caesarean section in 15 cases (75%). Conclusions Vaginismus, a sexual dysfunction preventing any vaginal penetration, a priori, a symptom incompatible with a pregnancy. However, there are virgin vaginal women and pregnant, in great physical and mental suffering.
ACHOUR Radhouane is associate professor at faculty of medicine of Tunis-Tunisia; He has published many basic and clinical articles, his research interests include gynecology obstetrics pathology and sexology behavior. He has published more than 40 scientific articles including the most recent: * Vaginismus and pregnancy: epidemiological profile and management difficulties. Psychology Research and Behavior Management 2019. He also served as member of the editorial team for for indexed peer-review journals and Reviewer in renowned international journals such as: * BMC Pregnancy and Childbirth * Journal of Sexual Medicine
King Abdulaziz Medical City, Saudi Arabia
Objectives:The objective of this study was to evaluate the trends in the incidence of women affected by OASI over a 10 year period comparing spontaneous vaginal delivery (SVD) and operative vaginal delivery(OVD) stratified by parity and mode of delivery. Furthermore this study aims to evaluate the temporal effect of education in the detection and management of obstetric anal injuries (OASIS), as evidence in practice became available over time.
Methodology:All women who underwent a vaginal delivery over a 10 year period (2009- 2018) at the Rotunda Hospital were reviewed retrospectively. The overall incidence of OASIwas calculated and compared to incidence ratesstratified by parity and type of vaginal birth to determine trends over time.
Main results: Vaginal delivery occurred in 59,187 women.24,580 (42%) were primiparous and 34607 (58%) were multiparous. The overall incidence of OASI was 2.9%. The incidence in OVD was 5.5% and the incidence in SVD 2%.There was a significant reduction over the 10 years in primips who had an OVD but no reduction in the other groups.
Conclusion: This study found that the overall incidence of OASI was 2.9%. Further education is required to assist with reduction in OASI particularly in the SVD group.
Yera Care for Women, USA
Dr. Yera is Cuban born but did his training in the United States. While a partner at Kaiser Permanente, he was instrumental in developing the minimally invasive gynecological surgery program there and has performed over 3000 laparoscopic procedures. Dr. Yera is one of the leading surgeons in his field who has trained over 350 surgeons around the country in laparoscopic hysterectomy. He has presented in National Meetings and frequently gives Grand Rounds at different teaching institutions. Dr. Yera currently travels around the country proctoring Laparoscopic Hysterectomy, Laparoscopic Sacrocolpopexy as well as advanced laparoscopic procedures. Areas of Expertise: - Laparoscopic Sacrocolpopexy - Laparoscopic Hesterectomy - Laparoscopic Myomectomy and Cystectomy - Endometriosis Surgery
Anfa Fertility Center, Morocco
The cornerstone of a successful ART (artificial reproductive technique) programme is the multi-follicular development. In the current era, with an ever-increasing incidence of dwindling ovarian reserve in patients, it is a common challenge encountered by the treating specialists.
A poor response is defined as failure to develop a sufficient number of mature follicles to proceed to oocyte retrieval or yielding only a few oocytes following ovarian stimulation.
The diagnostic criteria of the poor ovarian responders have been changing over the years in 2011 being the Bologna Criteria and the latest being the new POSEIDON (Patient-Oriented Strategies Encompassing Individualized Oocyte Number) classification. The patients were divided into four categories based on quantitative and qualitative parameters − age, the antral follicle count and/or AMH and the ovarian response − if any previous stimulation performed.
Various therapeutic modalities have been proposed for the management of diminished ovarian reserve, with varying efficacies. In this writing, we provide you with a comprehensive overview of the modalities, their therapeutic response.
In the review presented by Cochrane, in the year 2010, it was very clearly stated that there was no specific therapeutic agent that offered an outright benefit in management of poor ovarian responders.
In the current era, there is an ever increasing incidence of poor ovarian response. Many strategies have been studied and hypothesized for the management.
Androgens have been widely used and studies in the management of Poor ovarian response. The two prime androgens used in poor ovarian response are Dehydroepiandrosterone [DHEA], Androstenadione and testosterone.
Use of Growth hormone, recombinant luteinizing Hormone and vasoactive substances have been analyzed based on the current evidence.
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