Category: Obstetrics & Gynaecology

Categories : Obstetrics & Gynaecology Surgeries & ProceduresTags :

Removing Fallopian Tubes during Other Abdominal Surgeries may Lower Ovarian Cancer Risk

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Mathematical modelling study suggests this approach could also reduce total healthcare costs in Germany

Female reproductive system. Credit: Scientific Animations CC4.0 BY-SA

A mathematical modelling study conducted in Germany suggests that ovarian cancer incidence could be reduced and healthcare savings boosted if women who have already completed their families were offered fallopian tube removal during any other suitable abdominal surgeries. Angela Kather and Ingo Runnebaum of Jena University Hospital, Germany, and colleagues present these findings on January 30th in the open-access journal PLOS Medicine.

Some of the most widespread and serious forms of ovarian cancer begin in the fallopian tubes, and removing them may reduce ovarian cancer risk. While women at average risk of ovarian cancer are not recommended to have surgery solely to remove their fallopian tubes, many surgeons offer “opportunistic” tube removal during other gynaecologic surgeries such as hysterectomy or tubal sterilisation. Opportunistic removal may also be feasible during other abdominal surgeries, such as gallbladder removal.

However, the overall potential benefits of opportunistic fallopian tube removal have been unclear. To help clarify, Kather and colleagues developed a mathematical model that incorporates real-world patient statistics to predict population-level risks of ovarian cancer after opportunistic fallopian tube removal, as well as the potential healthcare cost savings.

By applying the model to statistics from Germany, the researchers predicted that opportunistic fallopian tube removal during every hysterectomy and tubal sterilisation could reduce ovarian cancer cases by 5% across the female population of Germany. Removal during every suitable abdominal surgery for women who are done having children could reduce nationwide cancer cases by 15%, the analysis suggests, and it could save more than €10 million in healthcare costs annually.

Ovarian cancer is the third most common gynaecologic cancer in the world and has a mortality rate of 66%. Overall, these findings suggest that opportunistic fallopian tube removal during appropriate abdominal surgeries could not only lower population-level ovarian cancer risks and prevent ovarian cancer deaths, but also provide economic benefits. This study could help inform health policy and insurance costs for the procedure.

The authors add, “We developed a mathematical model to estimate the likelihood of women undergoing surgeries that offer an opportunity for fallopian tube removal and the potential for reducing their ovarian cancer risk. Applying this model to the entire female population of Germany revealed that 15% of ovarian cancer cases could be prevented if fallopian tubes were removed during every suitable abdominal surgery in women who have completed their families. This approach has the potential to extend healthy years of life and significantly save healthcare costs.”

Provided by PLOS

Categories : Mental Health Obstetrics & GynaecologyTags :

PTSD and Anxiety may Affect Reproductive Health in Female Firefighters

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Source: CC0

A new study led by University of Arizona researchers in collaboration with fire service partners and other researchers around the country through the Fire Fighter Cancer Cohort Study showed that post-traumatic stress disorder and anxiety are associated with lower levels of anti-Müllerian hormone, a marker of ovarian reserve, among women firefighters.

The ovarian reserve, a measure of fertility, is the number of healthy eggs in a woman’s ovaries that could potentially be fertilised.

“These findings highlight the negative effect that mental health conditions can have on health – specifically, reproductive health,” said first author Michelle Valenti, MPH, a doctoral student in epidemiology at the Zuckerman College of Public Health and program coordinator of the Fire Fighter Cancer Cohort Study’s Women Firefighter Studies.

The paper was published in the Journal of Women’s Health.

Firefighters are exposed to high stress and traumatic situations in addition to chemical exposures and have a higher prevalence of PTSD compared with the general population. Previous research showed that women firefighters have lower levels of anti-Müllerian hormone compared with women who are not firefighters; however, the reason why was unknown.

The research team, which included personnel at the Zuckerman College of Public Health’s Center for Firefighter Health Collaborative Research, led this analysis to determine whether anxiety, depression or PTSD were associated with anti-Müllerian hormone levels. They found that clinical diagnoses of PTSD and anxiety among women firefighters were associated with reductions in anti-Müllerian hormone levels of 66% and 33%, respectively.

These findings highlight a potential mechanism through which adverse mental health conditions could lead to adverse reproductive outcomes. Further research is needed to identify potential areas for intervention.

“The work of this AMH study within the broader context of the FFCCS is imperative to taking care of all of our firefighters,” said Captain Caitlin St. Clair of the Puget Sound Regional Fire Authority. “These findings provide scientific leverage to fire departments to implement programs to reduce stress and improve the lives of our firefighter women.”

The Women Firefighter Study, a subgroup of the Fire Fighter Cancer Cohort Study, aims to identify causes of stress, cancer and adverse reproductive health effects in women firefighters that would inform effective interventions to mitigate these conditions.

“This study demonstrates the power of the Fire Fighter Cancer Cohort Study’s Women Firefighter Study to evaluate exposures that lead to adverse gynaecologic conditions,” Valenti said. “The Women Firefighter Study would not be possible without our amazing fire service partners who have championed women firefighter research.”

Source: University of Arizona Health Sciences

Categories : Diseases, Syndromes and Conditions Obstetrics & GynaecologyTags :

Human Papillomavirus Infection Kinetics Revealed in New Longitudinal Study

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Improved understanding of why some infections persist could improve treatment, screening, and vaccination strategies for HPV infection

Non-persistent human papillomavirus (HPV) infections are characterized by a sharp increase in viral load followed by a long plateau, according to a study published January 21st in the open-access journal PLOS Biology by Samuel Alizon of the National Centre for Scientific Research (CNRS), France, and colleagues.

Chronic HPV infection is responsible for more than 600 000 new cancers each year, including nearly all cervical cancers. Infection among young women is common, impacting nearly 20% of women 25 years of age. Fortunately, the vast majority of these infections clear within two years without symptoms. Still, a better understanding of why some infections clear while others persist could improve treatment, screening, and vaccination strategies for HPV-associated diseases.

To monitor the dynamics of HPV infection, the PAPCLEAR cohort study in France followed 189 women aged 18 to 25 years for up to 24 months. Researchers followed participants every two months, collecting information on viral kinetics and immune markers.

By frequently monitoring participants, the researchers achieved unprecedented temporal resolution on viral and immune kinetics. They found that non-persistent infections are characterised by a plateau in HPV viral load that starts around 2 months after infection and lasts for 13 to 20 months before rapidly declining. Additionally, they found a strong correlation between a population of immune cells in between innate and adaptive immunity, namely TCRγδ cells, and the total amount of viruses produced.

The study is limited by the fact that many of the infection follow-ups were truncated, meaning that the participants were already infected when enrolled or were lost to follow-up before infection clearance. Furthermore, only 4 out of 76 infected participants were followed for 18 months or more. Therefore, differences between chronic and acute infections will have to wait for longer studies.

The authors add, “Asymptomatic genital infections by human papillomaviruses (HPVs) display striking dynamics at the frontier between acute and chronic infections. HPV infections appear to be associated with specific patterns of the innate and adaptative local immune response.”

Provided by PLOS

Categories : Lab Tests and Imaging Obstetrics & GynaecologyTags :

Point-of-care Ultrasound Enhances Early Pregnancy Care, Cuts Emergency Visits by 81%

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Photo by Mart Production on Pexels

Published in Annals of Family Medicine, a University of Minnesota Medical School research team found that implementing point-of-care ultrasounds (POCUS) to assess the viability and gestational age of pregnancies in the first trimester enhanced care for pregnant patients and cut emergency visits by 81% for non-miscarrying patients.

Previously, early pregnancy care was provided through separate appointments for ultrasound, risk assessment and patient education. This new integrated approach allows patients who are under 14 weeks pregnant to receive comprehensive care during a single visit. This includes ultrasound-based pregnancy dating, immediate assessment of pregnancy viability, risk evaluation and on-site counselling – all based on real-time ultrasound results.

“Our study demonstrates that the use of point-of-care ultrasound provides meaningful benefit to the patients we serve by addressing early pregnancy problems at the time they are identified,” said Allison Newman, MD, an assistant professor at the U of M Medical School and family medicine physician at M Health Fairview Clinic. “POCUS in early pregnancy helps clinicians more efficiently and accurately diagnose problems without compromising the quality of needed first trimester assessments – saving time, money and stress for patients.”

The research team introduced this integrated approach at M Health Fairview Clinic – Bethesda in autumn 2022, allowing the clinic to quickly identify high-risk cases and offer timely intervention for issues such as miscarriage or abnormal pregnancies. They found:

  • The clinic saw an 81% reduction in emergency visits, urgent clinic appointments and first-trimester phone inquiries for non-miscarrying patients. 
  • Clinic implementation led to more timely diagnosis of abnormal pregnancies and improved education and support for all patients, including those who experience miscarriage. 
  • For miscarriage cases, the time from initial concern to diagnosis decreased from an average of 5.8 days to 1.7 days.

Suggested next steps include rolling out the process more widely within other family medicine practices and performing a wider study across multiple sites.

Source: University of Michigan

Categories : Gastrointestinal Obstetrics & GynaecologyTags :

The Massive Changes to Mothers’ Intestines in Pregnancy and Breastfeeding

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Source: Pixabay CC0

When women are pregnant and nurse their babies, their bodies change and various organs, such as the breasts or the immune system, are adapted to ensure the health of both mother and child. This happens throughout evolution in all mammals. An international research team led by Josef Penninger and Masahiro Onji, Medical University of Vienna, now reports the surprising finding that the intestine also changes completely in pregnant and nursing females, resulting in a doubling of the intestinal surface area and a striking structural reorganisation.

Reporting their findings in Nature, the researchers also provide the first genetic and mechanistic evidence of how this intestinal epithelial expansion occurs in mothers, with direct implications for the transgenerational health of the babies.

A multinational team led by Josef Penninger observed that the intestinal villi reorganise during pregnancy and breastfeeding and significantly enlarge, doubling their surface area. The studies were carried out in genetically modified mice and intestinal organoids from mice and humans – self-organised three-dimensional tissues derived from stem cells in the intestine. Mechanistically, the researchers identified the RANK receptor/RANK ligand (RANK/RANKL) system as the key to the villous enlargement of the small intestine during reproduction, which is regulated by sex and lactation hormones. When mice were engineered to lack the RANK/RANKL system in the intestine, the villous expansion during pregnancy and breastfeeding was significantly impaired.

For decades, researchers have studied the RANK/RANKL system as a key facilitator of essential, evolutionarily conserved processes. The Penninger group has already identified key functions of the RANK/RANKL system in bone turnover, in the biology of the mammary gland, in breast cancer, and in immune tolerance in pregnancy, contributing to the development of drugs against bone loss used by millions of people and clinical trials for breast cancer prevention and cancer immunotherapies are underway. The researchers now discovered that these intestinal changes, which appear to be completely reversible when nursing is stopped, are important for proper feeding and nourishment of the babies.

“Our study shows that the impairment of this intestinal expansion by the lack of the RANK/RANKL system during pregnancy changes the milk of the nursing mothers. This results in lower weights of the babies and transgenerational long-term metabolic consequences,” states lead author Masahiro Onji. “Mothers need to eat for themselves and their babies. These new studies provide for the first time a molecular and structural explanation of how and why the intestine changes to adapt to enhanced nutrient demand of mothers, which is probably the case in all pregnant and nursing mammals,” adds study leader Josef Penninger.

How mothers adapt to the demands of pregnancy and breastfeeding remains a central question of evolution and human health. During this phase, female hormones influence multiple organs to control and change their structure and functions, which is crucial for the health of the mother and the development of the offspring. It was known that pregnant women have enhanced nutrient demands. However, this fundamental aspect has not been well studied until now:

“By identifying the RANK/RANKL system as the driving force behind intestinal adaptation during pregnancy and lactation, our study contributes to a deeper understanding of biological processes that are of fundamental importance for evolution and human health”, says Josef Penninger, summarising the impact of the findings.

This massive expansion is controlled by sex and pregnancy hormones, which change the stem cells in the gut via the RANK/RANKL system and then give the intestinal cell a survival signal to grow much larger. This growth then leads to a near doubling of the intestinal surface area, which also increases the molecular machinery for the uptake of sugar, protein, and fat, and even leads to a profound architectural change in the intestinal villi, which probably slows down the flow of food, again maximising the uptake of nutrients.

Josef Penninger said: “Our team has discovered an amazing new way how mother’s bodies change to keep babies healthy. Hardly anybody knew about this, apart from a few old studies that have largely been forgotten. We have also found that this system, via stem cells, can directly affect tumours in the intestine; maybe we can learn from pregnant and nursing mothers to reversibly rewire this system to develop new treatments and a better understanding of intestinal cancer or gut regeneration.”

Source: Medical University of Vienna

Categories : Immune System Obstetrics & GynaecologyTags :

Pregnancy Enhances Natural Immunity to Block Severe Flu

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Photo by Anna Hecker on Unsplash

McGill University scientists have discovered that pregnancy may trigger a natural immunity to boost protection against severe flu infection. Contrary to the common belief that pregnancy increases vulnerability to infections, researchers found that it strengthened an immune defence in mice, blocking the Influenza A virus from spreading to the lungs, where it can cause severe infection.

“Our results are surprising because of the current dogma, but it makes sense from an evolutionary perspective,” said co-lead author Dr Maziar Divangahi, Professor in McGill’s Faculty of Medicine and Health Sciences and Senior Scientist at the Research Institute of the McGill University Health Centre (The Institute).

“A mother needs to stay healthy to protect her developing baby, so the immune system adapts to provide stronger defenses. This fascinating response in the nasal cavity is the body’s way of adding an extra layer of protection, which turns on during pregnancy.”

Exploring benefits for pregnancy and beyond

The researchers used a mouse model to observe how a certain type of immune cell activates in the nasal cavity of mice during pregnancy, producing a powerful molecule that boosts the body’s antiviral defenses, especially in the nose and upper airways.

“Influenza A virus remains among the deadliest threats to humanity,” said first author Julia Chronopoulos, who carried out the research while completing her PhD at McGill. “This natural immunity in pregnancy could change the way we think about flu protection for expectant mothers.”

The Public Health Agency of Canada recommends pregnant women and pregnant individuals get the flu vaccine, as they are at high risk of severe illness and complications like preterm birth. The new insights offer promise for more targeted vaccines for influenza, which is among the top 10 leading causes of death in Canada.

“The broader population could also benefit, as our findings suggest the immune response we observed could be replicated beyond pregnancy,” said co-lead author Dr James Martin, Professor in McGill’s Faculty of Medicine and Health Sciences and Senior Scientist at the RI-MUHC. This could mean new nasal vaccines or treatments that increase protective molecules, known as Interleukin-17.

The team’s next focus is on finding ways to reduce lung damage during viral infections like the flu or COVID. Rather than targeting the virus, as previous research has done, they aim to prevent dysregulated immune systems from overreacting, an approach that could lower the risk of serious complications associated with flu infection.

Source: McGill University

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

The Risks of Various Menopausal Hormone Treatments Vary

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Photo by cottonbro studio:

Researchers have analysed the effects of seven different hormone treatments for menopausal symptoms, and the risk of blood clots, stroke and heart attack. The risks differ depending on the active substance and how the medicine is taken, according to the study findings which appear in the BMJ. In this world’s largest and most comprehensive study of currently prescribed hormonal substances, researchers analysed the risks for one million women aged 50–58.

“There is concern among women that menopausal hormone therapy increases the risk of cardiovascular disease. This concern is based on older studies conducted more than 20 years ago that only looked at one type of treatment. Since then, many new preparations have been introduced and our study shows that the previous conclusions do not apply to all types of treatments,” says Therese Johansson, postdoctoral researcher and lead author of the study, which was part of her thesis at Uppsala University.

To counteract the health effects of menopause, such as hot flashes and osteoporosis, women may be prescribed hormone replacement therapy which consists of hormones or hormone-like substances.

Treatment available since the 1970s

In Sweden alone, hundreds of thousands of women currently use hormone replacement therapy and this type of treatment has been available since the 1970s. At that time, there was only one type of hormone replacement therapy and when a major study in the 1990s showed that it increased the risk of cardiovascular disease, its use rapidly declined. Since then, new preparations have entered the market, and following this, the use of hormone replacement therapy in connection with menopause has increased significantly in recent years.

In the new study, the researchers looked at seven different types of currently used hormone replacement treatments, administered via tablets, hormone patches or hormone-releasing IUDs. The study is based on all prescriptions for hormone replacement therapy in Sweden from 2007 to 2020 and covers nearly one million women aged 50 to 58. The women were monitored for two years after starting hormone replacement therapy. The risk of blood clots and cardiovascular disease was compared between women who had and had not collected a prescription medicine for hormone replacement therapy.

Different therapies, different risks

The results show clearly that the risks of hormone replacement therapy vary depending on the type of treatment.

For example, the synthetic hormone tibolone, which mimics the effects of the body’s natural hormones, was linked to an increased risk of both heart attack and stroke, but not to an increased risk of blood clots. The risk of heart attack or stroke due to tibolone is estimated at one in a thousand women.

Combined preparations containing both oestrogen and progesterone instead increase the risk of blood clots, including deep vein thrombosis and pulmonary embolism. The researchers estimate that the risk of deep vein thrombosis resulting from this combined preparation is about 7000 women per year.

“It is important that both doctors and women are aware of the risks of menopausal hormone therapy and, in particular, that the existing drugs carry different risks of blood clots and cardiovascular disease. Tibolone in particular was associated with an increased risk of stroke and heart attack. Tibolone is used in Europe but is not approved in countries such as the United States. We hope that our study will lead to the drug being withdrawn from use here as well,” says Åsa Johansson, research group leader at Uppsala University and SciLifeLab, and the study’s senior author.

During the period of the study, 2007–2020, a roughly 50% increase hormone patch use was observed, and these preparations were not linked to the same higher risk. The increased use of safer alternatives, such as patches, is an important step forward in reducing the risk of cardiovascular disease among menopausal women.

Identify individual increased risk

“The next step in our research will be to develop strategies to identify which women are at increased risk of certain diseases in connection with using hormonal drugs. In this way, we can guide patients to the most appropriate medicine for each individual and drastically reduce the number of side effects,” Åsa Johansson says.

Source: Uppsala University

Categories : Obstetrics & GynaecologyTags :

Pregnancy Complications make Women Less Inclined to Have More Children

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Photo by Jonathan Borba on Unsplash

Women who suffer severe complications during their first pregnancy or delivery are less inclined to have more babies, according to a study published in JAMA by researchers at Karolinska Institutet. For Sweden, given its recent steady decline in birth rate, the researchers propose monitoring in antenatal care to address the problem.

“The clinical monitoring of these women is essential, and they need individualised advice on possible future pregnancies,” says the study’s first author Eleni Tsamantioti, doctoral student at the Department of Medicine in Solna, Karolinska Institutet.

Reduced fertility

Birth rates and fertility have both been in steady decline in Sweden over the past years. In this new population-based study, the researchers have studied the association between severe maternal morbidity in first-time mothers and the likelihood of their having a second baby. The study comprised over a million women in Sweden who had their first baby between 1999 and 2021.

“We found that the likelihood of having more children was much lower in women who had experienced severe complications during their first pregnancy, delivery or postnatal period,” says the study’s last author Neda Razaz, associate professor at the same department. “Such events can often have a physical and mental impact on women for a long time to come.”

All in all, 3.5% of the first-time mothers in the study suffered serious complications and were 12% less likely to have a second baby. Most impacted were women who had experienced cardiac complications, a ruptured uterus or severe mental health problems, who were 50% less likely to have another birth than women who had not experienced such complications.

Monitoring in antenatal care

Women who needed respiratory care or who suffered a cerebrovascular accident like stroke or intracranial haemorrhage were 40% less likely to have a second baby. Acute kidney failure, severe preeclampsia and blood clotting were also associated with a lower probability of a second pregnancy. The researchers also compared the women with any sisters they had to control for familial factors. 

“The reasons are hard to speculate on and may result from multiple factors, such as decreased desire for more children, trauma, infertility related to psychiatric medications, or lack of health counselling,” says Tsamantioti. “Proper support and monitoring by antenatal care staff is therefore essential for women who have suffered serious health problems during pregnancy or delivery.”

Source: Karolinska Institutet

Categories : Medical Industry Obstetrics & GynaecologyTags :

Bayer Issues Recall on YAZ Plus Contraceptive Pills

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Photos supplied by Bayer showing the affected blister (left) and the normal blister (right).

On November 21, Bayer (Pty) Ltd issued a medicine recall for a specific batch (WEW96J) of YAZ PLUS tablets. In a press release, they explain the reason for the recall: it has been discovered that the active and inactive tablets in this batch are swapped. This mix-up has resulted in some packs containing only four hormone tablets instead of the required 24, and 24 hormone-free tablets instead of four, compromising the product’s contraceptive efficacy.

The company advises that healthcare professionals, wholesalers, hospitals, retail pharmacy outlets, doctors, nurses, pharmacists, authorised prescribers, dispensers, and individual customers or patients in possession of the affected batch can return product to their healthcare facility from which it was dispensed, for credit.

Bayer urges that if you are in possession of YAZ PLUS tablets from the affected batch, to do the following:

  1. Stop Use Immediately: If you have been taking the tablets from a batch that is affected with the mix-
    up, stop taking them immediately and contact your healthcare professional. While only a limited number of packs from the respective batch is affected, as a precautionary measure, no tablets from these packs shall be used until you have consulted your Healthcare Practitioner, as they may potentially not provide the contraceptive protection you expect.
  2. Return the Product: Please return any affected packs to the pharmacy or retailer where you
    purchased them for a replacement or refund.
  3. Check Your Packs: If you have multiple packs of YAZ PLUS, please check each one of them, to
    ensure they are not from the affected batch.
  4. Consult Healthcare Provider: If you have consumed tablets from the affected batch, or if you have
    concerns about your contraceptive coverage, please consult your healthcare provider as soon as
    possible for advice.

In the press release, Bayer says that it “takes the safety and efficacy of its products seriously and is committed to ensuring that all YAZ PLUS tablets in the market meet the highest quality standards.” It further advises that the root cause for the mix-up of tablets in the packaging has been identified and corrective measures taken. Only this one batch – and no others – was affected.

“The company is working diligently with SAHPRA and healthcare providers to facilitate the recall process and minimise any inconvenience to our customers. We are dedicated to addressing this issue promptly and ensuring the continued health and safety of all our customers.”

Further Information and Support:
For more information about this recall, or if you have any questions or concerns, please contact Bayer +27
(0) 11 921 5000. Our team is available to provide the support and information you need.
Report a side effect: Patient Safety Reporting – Introduction
Report a product quality complaint for Pharmaceutical Products: afptc@bayer.com

Categories : Obstetrics & GynaecologyTags :

Short-term Menopausal Hormone Therapy has no Long-term Cognitive Impact

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Photo by Teona Swift on Unsplash

Women in early postmenopause taking short-term MHT had no cognitive effects a decade later

Short-term menopausal hormone therapy (MHT) did not have long-term cognitive effects when given to women in early postmenopause, according to a study published November 21st in the open-access journal PLOS Medicine by Carey Gleason from the University of Wisconsin-Madison, USA, and colleagues.

While MHT can offer relief from the challenging symptoms of menopause, many women and doctors are hesitant to start MHT due to safety concerns. Previous research has linked one form of hormone therapy to mild cognitive impairment and dementia in women older than 65 years of age, prompting research on the importance of age and timing of therapy on cognitive impairment. Other studies have suggested that transdermal oestrogen may have long-term cognitive benefits.

In the Kronos Early Estrogen Prevention Study (KEEPS), women in early postmenopause with good cardiovascular health were randomised to receive one of two types of MHT (oral or transdermal oestrogen) or placebo. At the end of four years, no cognitive benefit or harm was seen in those who received MHT compared to the placebo group. However, long-term cognitive effects of MHT are still understudied.

In this new follow-up study – the KEEPS Continuation Study – researchers revisited participants nearly ten years later to repeat a series of cognitive tests. Among 275 women, although MTH failed to protect against cognitive decline, short-term MHT also had no long-term negative cognitive impact.

These findings may offer reassurance to women considering MHT while adding to the growing body of research supporting the importance of timing for MHT. More research is needed to investigate whether these results are generalisable to women with higher cardiovascular risk.

The authors add, “For women in menopause and the health care providers caring for them, getting direct, clear and evidence-based information about menopausal hormone therapy is challenging. And they need data to guide their decisions.”

Provided by PLOS