Ten Years of Experience in Contraception Options for Teenagers in a Family Planning Center in Thrace and Review of the Literature.

Abstract: Introduction: The goal of our study was to investigate and evaluate the contraceptive behavior in teenagers from our family planning centre that services two different religious and socioeconomic populations living in the Thrace area. Methods: During the last 10 years 115 Christian Orthodox (group A) and 53 Muslim teenagers (group B) were enrolled in our retrospective study. Contraceptive practice attitudes were assessed by a questionnaire. Religion, demographics, socio-economic characteristics were key factors used to discuss contraception and avoid unplanned pregnancy in each group and to compare with the contraceptive method used. Results: The most used contraceptive method-about two times more frequently-among Christian Orthodox participants was the oral contraceptive pill (p = 0.015; OR = 1.81, 95% CI = 1.13-2.90), while in the other group the use of condoms and IUDs was seven and three times more frequent, respectively. Our family planning centre was the main source of information for contraception. Conclusions: During adolescence, the existence of a family planning centre and participation in family planning programs plays a crucial role to help the teenagers to improve their knowledge and choose an effective contraception method.

Predictive value of fetal scalp pH and base excess for fetal acidosis and poor neonatal outcome.

OBJECTIVE: The objective of this study is to assess retrospectively the predictive value of fetal scalp pH and base excess (BE) for fetal acidosis and poor neonatal outcome in term, low-risk, spontaneous deliveries with suspicious or pathological intrapartum cardiotocography (CTG) tracings. METHODS: Umbilical artery pH and BE values obtained immediately after delivery and Apgar score were the outcomes under consideration. Statistics included receiver-operating characteristic curve (ROC) and multiple logistic regression analysis. RESULTS: Four hundred and six deliveries were included in the study. Scalp pH < 7.20 predicted umbilical pH ≤7.1 with 64.3% sensitivity and 92.9% specificity (p < .001). The corresponding positive-predictive value (PPV) was 24.3% and the negative-predictive value (NPV) was 98.6%. Scalp BE ≤ -7 mmol/l (a cut-off value provided by ROC curve analysis) predicted Apgar score ≤ 7 at 5 min with 61.9% sensitivity and 91.7% specificity (p < .001). The corresponding PPV and NPV were 29.5 and 97.7%, respectively. Neither scalp pH nor BE was significantly associated with umbilical BE values. Infants with intrapartum BE ≤ -7 mmol/l were 30 times on an average more likely to get a low Apgar score, independently of intrapartum pH values. CONCLUSION: Our study supports the consideration of both scalp pH and BE values, when fetal blood sampling (FBS) is used.

Ovarian reserve after fibroid embolization in premenopausal women.

OBJECTIVE: To investigate the effect of uterine artery embolization (UAE) for fibroids on ovarian pool of premenopausal women. STUDY DESIGN: Prospective case control study. MATERIAL AND METHODS: One-hundred and twenty premenopausal women, aged between 40 and 50 years, who underwent UAE for symptomatic uterine fibroids and the same number of women, aged between 40 and 50 years, with symptomatic uterine fibroids, who were not offered treatment were recruited for this study. Hormonal status and ovarian reserve were evaluated by means of anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH) pre-procedural, three months, six months and 12 months after UAE. RESULTS: No statistically significant decrease was noted in AMH values 12 months post procedure and no statistical significant alterations in AMH values between the two groups. CONCLUSIONS: Even though the study results may not be able to confirm the preservation of ovarian reserve and normal menstruation after UAE in premenopausal women, it should be considered as a friendly to normal menstruation treatment option of symptomatic fibroids.

Preoperative assessment in endometrial cancer. Is triage for lymphadenectomy possible?

PURPOSE: We sought to examine whether a preoperative assessment with usual means, available in most hospitals (preoperative histology, pelvic MRI, serum CA-125) can confidently exclude from a full staging surgical procedure low-risk endometrial carcinoma (EC) patients according to ESMO-ESTRO-ESGO criteria (stage I endometrioid EC, grade 1 or 2, myometrial invasion <50% and negative lymphovascular space invasion). METHODS: We retrospectively identified all EC patients that underwent total hysterectomy with bilateral salpingo-oophorectomy (TH-BSO) plus lymph node dissection (LND) as primary treatment for endometrioid tumors from January, 2000 to December, 2010. Extensive review was made through patients' medical records. Having set the final pathology report as the "gold standard", we applied the ESMO-ESGO-ESTRO criteria to classify patients into risk categories (low-risk and non-low risk). We also evaluated preoperative risk status using combined data from preoperative biopsy, pelvic MRI and serum CA-125. We classified patients according to the following criteria: grade 1 or 2 on preoperative histology, myometrial invasion on MRI <50% and serum CA-125 <35 IU/ml, in low risk group. Receiver operating characteristic (ROC) curves were plotted. The area under the ROC curve (AUC), quantifying the overall ability of the combined preoperative assessment to discriminate between patients at low and non-low risk, was the primary outcome of our study. False negative rate was the secondary outcome. RESULTS: Preoperative data on histology, MRI and CA-125 levels were available for 292 patients. The sensitivity and specificity of combined preoperative assessment to discriminate between low- and non-low risk EC patients according to ESMO-ESTRO-ESGO criteria were 96.1% and 73.6% respectively. AUC of the corresponding ROC curve was 0.849. False negative rate was 3.8% (9/235). Among the 9 patients falsely classified as low-risk, one patient had nodal metastasis (1/9, 11.1%) after full staging. CONCLUSION: A selective LND strategy for EC patients based on preoperative assessment is possible and would probably be cost-effective, while not jeopardizing patients' survival or patient quality of life (QoL).

Paraaortic lymphadenectomy in intermediate to high risk uterine endometrioid cancer : a retrospective evaluation.

PURPOSE: To investigate the impact on survival of paraaortic lymph node dissection (PALND) added to pelvic lymph node dissection (PLND) in patients with intermediate to high-risk endometrioid endometrial cancer (EC ). Surgical parameters and perioperative morbidity have been explored as well. METHODS: We retrospectively identified all eligible patients that received LND as part of their primary treatment at a single institution from January 2000 to December 2010. Survival curves for overall (OS), disease-specific (DSS) and disease-free (DFS) survival were plotted by the Kaplan-Meier method and compared by the log-rank test. Cox proportional hazards regression was used for multivariable analysis for OS and DSS. RESULTS: 93 patients underwent PLND plus PALND in their initial operation (PALND group) and 177 patients underwent PLND only (no-PALND group). Patients in the non-PALND group were older, more obese and had higher rates of comorbidities. The median number of PLN and PALN retrieved were 26 and 13 respectively. Isolated PALN metastasis was seen in 2 (2.1%) patients. PALND was associated with longer operative time, higher transfusion rate and longer hospital stay. PALND group had a benefit in OS (p=0.033), which did not persist in DSS or DFS. Furthermore, the type of LND did not significantly improve either OS or DSS according to the multivariate analysis results. CONCLUSION: PALND had no therapeutic value per se in women with intermediate to high risk endometrioid tumors and the improvement seen in OS should rather be attributed to the better medical status of women who received PALND.

Contraceptive behaviour of Christian and Muslim teenagers at the time of abortion and post-abortion in Thrace, Greece.

OBJECTIVES: The aims of the study were to compare the contraceptive behaviour of Christian and Muslim adolescents who had an abortion in Thrace, Greece, and to examine whether extensive contraceptive counselling at the time of abortion modified their subsequent contraceptive practices. METHODS: Adolescents, aged 14-19 years, who had undergone an elective abortion in our department, were included in a prospective 12-year study. Extensive contraceptive counselling was offered before discharge from the hospital. Attitudes to contraception were assessed by means of a simple questionnaire at the time of abortion and at 1-year follow-up. RESULTS: The study population comprised of 95 Christian Orthodox adolescents (Group A) and 79 Muslim adolescents (Group B). At the time of abortion, contraceptive behaviour differed significantly between the two groups (p = .004). Contraceptive methods used in Group A in comparison with Group B were as follows: oral contraceptives (27.4% vs. 12.7%), condoms (22.1% vs. 38.0%), interrupted coitus (18.9% vs. 20.3%), periodic abstinence (16.8% vs. 25.3%) and emergency contraception (14.7% vs. 3.8%). The commonest source of information on contraception in Group A was the gynaecologist (17.9%) and family planning clinic (15.8%), whereas in Group B it was the individual's partner (25.3%) and parents (16.4%). Contraceptive behaviour was significantly modified in both groups at post-abortion follow-up (both p < .001). The original difference between the groups, however, persisted (p = .006). In Group A, oral contraceptives were the dominant method (48.4%), followed by condoms (30.5%), whereas in Group B, the order was still the reverse (24.1% and 46.8%, respectively). CONCLUSION: Cultural differences significantly affect the contraceptive behaviour. Nevertheless, interventions that promote contraception can still be successful in different populations.

Cervical cancer: screening, diagnosis and staging.

Purpose: Despite the widespread screening programs, cervical cancer remains the third most common cancer in developing countries. Based on the implementation of cervical screening programs with the referred adoption of improved screening methods in cervical cytology with the knowledge of the important role of the human papilloma virus (HPV) it's incidence is decreased in the developed world. Even if cervical HPV infection is incredibly common, cervical cancer is relatively rare. Depending on the rarity of invasive disease and the improvement of detection of pre-cancerous lesions due to the participation in screening programs, the goal of screening is to detect the cervical lesions early in order to be treated before cancer is developed. In populations with many preventive screening programs, a decrease in cervical cancer mortality of 50-75% is mentioned over the past 50 years. The preventive examination of vagina and cervix smear, Pap test, and the HPV DNA test are remarkable diagnostic tools according to the American Cancer Association guidelines, in the investigation of asymptomatic women and in the follow up of women after the treatment of pre-invasive cervical cancer. The treatment of cervical cancer is based on the FIGO 2009 cervical cancer staging.

Inherited thrombophilia and reproductive disorders.

Apart from its established role in the pathogenesis of venous thromboembolism (VTE), inherited thrombophilia has been proposed as a possible cause of pregnancy loss and vascular gestational complications. There is a lot of controversy in the literature on the relationship between inherited prothrombotic defects and these obstetric complications. This is a review of the literature on inherited thrombophilia and reproductive disorders. Factor V Leiden, prothrombin G20210A mutation, and protein S deficiency seem to be associated with late and recurrent early pregnancy loss, while their impact on other pregnancy complications is conflicting. No definite association has been established between protein C and antithrombin deficiency and adverse pregnancy outcome, primarily due to their low prevalence. Screening is suggested only for women with early recurrent loss or late pregnancy loss. Anticoagulant treatment during pregnancy should be considered for women with complications who were tested positive for thrombophilia.

Evaluation of the effect of natural and emotional stress of labor on lactation and breast-feeding.

BACKGROUND: The amount of stress experienced by both the mother and fetus during labor and delivery varies considerably and is likely to be different in primiparous and multiparous women as well as in those who receive analgesia during labor and those who do not receive. OBJECTIVE: In this study, we explored relations between stress during birth experience and lactogenesis of 100 women, who experienced vaginal delivery in Department of Obstetrics and Gynecology of University Hospital of Alexandroupolis. METHOD: Stress hormones (cortisol and glucose) were measured in serum (cord and maternal blood) immediately after delivery. Moreover, breast-feeding frequency on day 4, the time when the subjects first felt fullness in the breasts, milk volume on day 4 postpartum and duration of labor were recorded. Also, we recorded maternal exhaustion score during labor and positive and negative affects, posttraumatic stress score and mother-infant bonding rate, with the use of questionnaires. RESULTS: There were significant intercorrelations among the outcome variables. Mothers who experienced pain, exhaustion and negative feelings in a stressful and long labor had delayed onset of lactation. CONCLUSIONS: These results indicate that primiparity, long labor, stress to the mother and fetus during labor and delivery, negative affects and high score of posttraumatic stress are risk factors for delayed lactogenesis.

The effect of the use of a new type of partogram on the cesarean section rates.

OBJECTIVE: To assess the contribution of a new type of partogram, used in labor monitoring, in caesarean section rates. MATERIAL AND METHODS: The study included term singleton uncomplicated pregnancies divided into two groups. Two types of partogram were used in labor monitoring. In the first group, the classical WHO partogram (A) was used. In the second group, a new type of partogram, in which cervical dilatation and the position of descending head (B) (one line) were estimated and reported, was used. The labor duration and caesarean section rates were calculated and compared in the two groups. RESULTS: A statistically significant decrease in labor duration (from the initiation of the active phase of labor to the delivery time) (dt1+dt2+dt3) (p<0.001, A: median: 318.4±10.4 min, B: 246.56±8.28 min) and in caesarean section rates was noted (p<0.001, A: 89 vs B: 49). CONCLUSION: The new type of partogram seems to have potential benefits such as reducing the incidence of prolonged labor and decreasing the caesarean section rates.