57 research outputs found
Office hysteroscopy: a scientific overview
No full textMinihisteroskopia (histeroskopia ambulatoryjna) wykonywana bez użycia wzierników (waginoskopia) i kulociągóworaz bez konieczności analgezji jest metodą diagnostyczno-leczniczą o bardzo niskim ryzyku powikłańi może być wykonana z minimalnym dyskomfortem dla pacjentki. Rzadko wymaga znieczulenia ogólnego pacjentki.Metoda ta wykazuje niski odsetek niepowodzeń przy zachowanej wysokiej efektywności. Zakres wskazańdo minihisteroskopii obejmuje nie tylko procedury diagnostyczne, w tym również stany przednowotworowei nowotwory, ale również procedury operacyjne w zakresie zbliżonym do tradycyjnej histeroskopii wykonywanejprzy użyciu „tradycyjnego” resektoskopu. W relacji do innych metod diagnostycznych (USG, SIS, badania radiologiczne,NMR) umożliwia nie tylko precyzyjną wizualizację zmian, lecz także celowane pobranie tkanek dobadań mikroskopowych. Te cechy minihisteroskopii sprawiają, że zarówno w wymiarze ekonomicznym (krótkiczas trwania procedury, brak konieczności znieczulenia), jak i psychologicznym (szybka diagnoza i niezwłoczneleczenie) jest metodą z wyboru w diagnostyce i leczeniu patologii jamy macicy i kanału szyjki. Pomimo swoichzalet, w porównaniu z USG, nie jest polecana, mimo sugestii pewnej grupy klinicystów, do rutynowego skrininguu pacjentek niemających objawów
Office hysteroscopy: A scientific overview
No full textOffice hysteroscopy, when defined as the vaginoscopic procedure, is a method which can be performed with very little discomfort for the patient and at an extremely low risk for serious complications. It has a low failure rate and high efficacy. It can be used for routine diagnostics but also for small operational interven tions and diagnosis of malignancy and pre-malignancy. It has proved to be superior to other diagnostic tools in the unique possibility of visualization and simultaneous visually-controlled biopsy. Primarily and foremost however, it represents an enormously beneficial gain in both time and psychological impact for the patients undergoing the procedure, who often obtain immediate diagnosis and treatment. There is a further advantage in minimizing the diameter of the hysteroscope, the so-called mini-hysteroscope of 3.3 mm sheath diameter being significantly better tolerated than the wider 4 mm hysteroscope. The use of mini-hysteroscopes may also obviate the need to restrict the patient population to those having undergone vaginal delivery or the need for a very experienced surgeon. At present, however, there seems to be no clear advantage in using a flexible scope, as the gain of greater patient comfort is outweighed by the fact of greater visibility, shorter procedure time and thus lower cost of rigid hysteroscopy. Given that this procedure is still more expensive, more time-consuming and somewhat less comfortable for patients than routine ultrasound it may at this time be premature to recommend, as suggested by some authors [29, 14], it as a screening tool for asymptomatic patients. Most asymptomatic patients will after all present to the clinic without uterine abnormality or cause for intervention. © 2011 Termedia Sp. z o.o. All rights reserved
Characterizing retained placenta : epidemiology and pathophysiology of a critical obstetric disorder
No full textBackground: Retained placenta is associated with severe postpartum hemorrhage but its etiology and pathophysiology are largely unknown. Certain studies have suggested that retained placenta is associated to defective placentation disorders- pregnancy disorders with an initial defective placentation resulting in increased oxidative stress. The aim of this thesis was to investigate risk factors for and consequences of retained placenta, determine whether retained placenta and defective placentation disorders are epidemiologically associated and to assess if this association is supported at the molecular and histological level.Methods and Main Results: Study I was a case-control study comparing pregnancy and deliveryrelated variables in women with retained placenta and controls (n=408 in each group) after singleton vaginal birth. The study found that retained placenta was associated with severe postpartum hemorrhage and that a history of abortion or recurrent miscarriage, pre-eclampsia, preterm delivery and prolonged oxytocin use in the current pregnancy were independent risk factors for retained placenta. Study II was a population based cohort study investigating the association between retained placenta and defective placentation disorders (pre-eclampsia, preterm birth, small-for-gestational-age birth and stillbirth) in primiparous women giving vaginal birth at 32-41 gestational weeks between 1997 and 2009 in Sweden (n=386 607). The study found that retained placenta was associated to pre-eclampsia, spontaneous preterm birth, small-for-gestational-age birth and stillbirth. The risk was further increased for women with these disorders among preterm deliveries. Study III was a cross-sectional pilot study investigating the antioxidative enzyme Glutathione Peroxidase 1 (GPX1) and the transcription factor Nuclear Factor Kappa-light-chain-enhancer of activated β-cells (NFκB), as markers of antioxidative defence capacity and inflammation, in 29 retained and 31 non-retained placentas. The study found that retained placentas showed a tendency of lower median concentrations GPX1 and were significantly more likely to have a low level of GPX1 protein concentration. There were no differences in expression ofNFκB. Study IV was a case-control study comparing histological signs of maternal underperfusion and inflammation in retained (n=49) and non-retained (n=47) placentas. The study found that retained placentas had a significantly smaller surface area, were more oblong in shape and showed overall more signs of maternal placental underperfusion compared to non-retained placentas.Conclusions: Retained placenta is epidemiologically associated to defective placentation disorders, a finding which is supported in part by signs of decreased antioxidative capacity in the placenta and increased histological signs of maternal placental underperfusion. Prolonged oxytocin use may exacerbate the risk of retained placenta. Risk awareness of retained placenta should guide preparedness during the third stage of labor given the high risk of severe postpartum hemorrhage that the disorder entails.List of scientific papersI. Endler M, Grünewald C, Saltvedt S. Epidemiology of retained placenta: oxytocin an independent risk factor. Obstet Gynecol. 2012 Apr;119(4):801-9. https://doi.org/10.1097/AOG.0b013e31824acb3b II. Endler M, Saltvedt S, Cnattingius S, Stephansson O, Wikström AK. Retained placenta is associated with pre-eclampsia, stillbirth, giving birth to a smallfor-gestational-age infant, and spontaneous preterm birth: a national registerbased study. BJOG. 2014 Nov;121(12):1462-70 https://doi.org/10.1111/1471-0528.12752 III. Endler M, Saltvedt S, Eweida M, Åkerud H. Oxidative stress and inflammation in retained placenta: a pilot study of protein and gene expression of GPX1 and NFκB. [Submitted]IV. Endler M, Saltvedt S, Papadogiannakis N. Macroscopic and histological characteristics of retained placenta: a prospectively collected case-control study. [Submitted]</p
Oxidative stress and inflammation in retained placenta : a pilot study of protein and gene expression of GPX1 and NF kappa B
No full textBackground: Retained placenta is associated with severe postpartum hemorrhage. Its etiology is unknown and its biochemistry has not been studied. We aimed to assess whether levels of the antioxidative enzyme Glutathione Peroxidase 1 (GPX1) and the transcription factor Nuclear Factor kappa beta (NF kappa beta), as markers of oxidative stress and inflammation, were affected in retained placentas compared to spontaneously released placentas from otherwise normal full term pregnancies. Methods: In a pilot study we assessed concentrations of GPX1 by ELISA and gene (mRNA) expression of GPX1, NF kappa beta and its inhibitor I kappa beta alpha, by quantitative real-time-PCR in periumbilical and peripheral samples from retained (n = 29) and non-retained (n = 31) placental tissue. Results: Median periumbilical GPX1 concentrations were 13.32 ng/ml in retained placentas and 17.96 ng/ml in nonretained placentas (p = 0.22), peripheral concentrations were 13.27 ng/ml and 19.09 ng/ml (p = 0.08). Retained placental tissue was more likely to have a low GPX1 protein concentration (OR 3.82, p = 0.02 for periumbilical and OR 3.95, p = 0. 02 for peripheral samples). Median periumbilical GPX1 gene expressions were 1.13 for retained placentas and 0.88 for non-retained placentas (p = 0.08), peripheral expression was 1.32 and 1.18 (p = 0.46). Gene expressions of NF kappa beta and I kappa beta alpha were not significantly different between retained and non-retained placental tissue. Conclusions: Women with retained placenta were more likely to have a low level of GPX1 protein concentration in placental tissue compared to women without retained placenta and retained placental tissue showed a tendency of lower median concentrations of GPX1 protein expression. This may indicate decreased antioxidative capacity as a component in this disorder but requires a larger sample to corroborate results
Editorial: Women facing crises
No full textPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/191313/1/ijgo15163.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/191313/2/ijgo15163_am.pd
SENSE OF SELF-EFFICACY AND STYLES OF COPING STRESS OF YOUNG SPECIAL NEEDS TEACHERS
No full textThe author presented the results of research on the sense of self- efficacy and styles of coping with stress young special needs teachers, who take cooperation with people with disabilities, and who are obliged to cope with adversity and to help in the fight against distress their dependents. Research conducted in quantitative strategies, using the normalized and standardized tests: GSES - Generalized Self - Efficacy Scale by Schwarcer and Jerusalem in Polish adaptation by Schwarcer, Jerusalem and Juczyński, and CISS - Coping Inventory for Stressful Situation by Endler and Parker, in Polish adaptation by Strelau, Jaworowski, Wrześniewski and Szczepaniak from 2009
How task-sharing in abortion care became the norm in Sweden: a case study of historic and current determinants and events
No full textWe performed a country case study using thematic analysis of interviews and existing grey and published literature to identify facilitators and barriers to the implementation of midwife-provided abortion care in Sweden. Identified facilitating factors were: (1) the historical role and high status of Swedish midwives; (2) Swedish research and development of medical abortion that enabled an enlarged clinical role for midwives; (3) collaborations between individual clinicians and researchers within the professional associations, and the autonomy of clinical units to implement changes in clinical practice; (4) a historic precedent of changes in abortion policy occurring without prior official or legal sanction; (5) a context of liberal abortion laws, secularity, gender equality, public support for abortion, trust in public institutions; and (6) an increasing global interest in task-shifting to increase access and reduce costs. Identified barriers/risks were: (1) the lack of systems for monitoring and evaluation; and (2) a loss of physician competence in abortion care
Placental location and pregnancy outcomes in nulliparous women: A population‐based cohort study
No full textWhy women choose abortion through telemedicine outside the formal health sector in Germany: a mixed-methods study
No full textInternational audienceIntroduction: Women on Web (WoW) is a global medical abortion telemedicine service operating outside the formal health sector. In April 2019 they opened their helpdesk to Germany. Our aim was to understand the motivations, and perceived barriers to access, for women who choose telemedicine abortion outside the formal health sector in Germany. Methods: We conducted a parallel convergent mixed-methods study among 1090 women consulting WoW from Germany between 1 January and 31 December 2019. We performed a cross-sectional study of data contained in online consultations and a content analysis of 108 email texts. Analysis was done until saturation; results were merged and triangulation used to validate results. Results: The quantitative analysis found that the need for secrecy (n=502, 48%) and the wish for privacy (n=500, 48%) were frequent reasons for choosing telemedicine abortion. Adolescents were more likely to report secrecy, cost, stigma and legal restrictions as reasons for using telemedicine abortion compared with older women. The content analysis developed two main themes and seven subsidiary categories, (1) internal motivations for seeking telemedicine abortion encompassing (i) autonomy, (ii) perception of external threat and (iii) shame and stigma, and (2) external barriers to formal abortion care encompassing (iv) financial stress, (v) logistic barriers to access, (vi) provider attitudes and (vii) vulnerability of foreigners. Conclusions: Women in Germany who choose telemedicine abortion outside the formal health sector do so both from a place of empowerment and a place of disempowerment. Numerous barriers to abortion access exist in the formal sector which are of special relevance to vulnerable groups such as adolescents and undocumented immigrants
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