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  1. Article ; Online: Augmentation index and pulse wave velocity in normotensive versus preeclamptic pregnancies: a prospective case-control study using a new oscillometric method.

    Anthoulakis, Christos / Mamopoulos, Apostolos

    Annals of medicine

    2021  Volume 54, Issue 1, Page(s) 1–10

    Abstract: Objectives: The objective of this study was to investigate whether oscillometric AS measurements are different in pregnant women with and without preeclampsia (PE).: Study design: This was a prospective case-control study in singleton pregnancies ... ...

    Abstract Objectives: The objective of this study was to investigate whether oscillometric AS measurements are different in pregnant women with and without preeclampsia (PE).
    Study design: This was a prospective case-control study in singleton pregnancies that had been diagnosed with PE (
    Main outcome measures: Pulse wave velocity (PWV), augmentation index (Alx), and Alx at a heart rate of 75 beats per minute (Alx-75) were measured using a brachial cuff-based automatic oscillometric device (Mobil-O-Graph 24 h PWA).
    Results: In pregnancies complicated by PE, in comparison with normotensive pregnancies, there were significant differences in PWV (
    Conclusions: PWV and Alx-75 are higher in pregnancies complicated by PE, in comparison with normotensive pregnancies, as well as in early-onset PE, in comparison with late-onset PE.Key messagesPulse wave velocity is higher in pregnancies complicated by preeclampsia.Augmentation index at a heart rate of 75 beats per minute is higher in pregnancies complicated by preeclampsia.Arterial stiffness assessment is a promising risk-stratification tool for future cardiovascular complications but further studies are required.
    MeSH term(s) Blood Pressure ; Case-Control Studies ; Female ; Humans ; Pre-Eclampsia/diagnosis ; Pregnancy ; Pulse Wave Analysis ; Vascular Stiffness
    Language English
    Publishing date 2021-12-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 1004226-x
    ISSN 1365-2060 ; 1651-2219 ; 0785-3890 ; 1743-1387
    ISSN (online) 1365-2060 ; 1651-2219
    ISSN 0785-3890 ; 1743-1387
    DOI 10.1080/07853890.2021.2014553
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  2. Article ; Online: Risks of miscarriage or preterm delivery in trichorionic and dichorionic triplet pregnancies with embryo reduction versus expectant management: a systematic review and meta-analysis.

    Anthoulakis, C / Dagklis, T / Mamopoulos, A / Athanasiadis, A

    Human reproduction (Oxford, England)

    2017  Volume 32, Issue 6, Page(s) 1351–1359

    Abstract: Study question: Is pregnancy outcome in triplet pregnancies improved with embryo reduction (ER) to twins compared to expectant management?: Summary answer: In trichorionic triplet pregnancies, ER to twins reduces the risk of preterm birth (<34 weeks) ...

    Abstract Study question: Is pregnancy outcome in triplet pregnancies improved with embryo reduction (ER) to twins compared to expectant management?
    Summary answer: In trichorionic triplet pregnancies, ER to twins reduces the risk of preterm birth (<34 weeks) without significantly increasing the risk of miscarriage (<24 weeks), whereas in dichorionic triplet pregnancies, the results are inconclusive.
    What is known already: Triplet pregnancies are associated with a high risk of miscarriage and preterm birth. ER can ameliorate these conditions in higher order multiple gestations but is still controversial in triplets.
    Study design, size, duration: This study aimed to conduct a systematic review, following the PRISMA guidelines, and critically appraise ER at 8-14 weeks of gestation in both trichorionic triamniotic (TCTA) and dichorionic triamniotic (DCTA) pregnancies. Selective ER to twins was compared with expectant management, focusing on the risks of miscarriage and preterm birth. The computerized database search was performed on 8 January 2017. Overall, from 25 citations of relevance, eight studies with a total of 249 DCTA and 1167 TCTA pregnancies fulfilled the inclusion criteria.
    Participants/materials, setting, methods: A comprehensive computerized systematic literature search of all English language studies between 2000 and 2016 was performed in PubMed, EMBASE, Scopus, Evidence Based Medicine Reviews (Cochrane Database and Cochrane Central Register of Controlled Trials) and Google Scholar. Relevant article reference lists were hand searched. The management options were compared for rates of miscarriage <24 weeks and preterm birth <34 weeks. Only studies with both expectant management and ER to twins were included in the analysis. The quality of each individual article was critically appraised and appropriate statistical methods were used to extract results.
    Main results and the role of chance: In TCTA pregnancies managed expectantly (n = 501), the rates of miscarriage and preterm birth were 7.4 and 50.2%, respectively. Meta-analysis demonstrated that ER to twins in TCTA pregnancies (n = 666) was associated with a lower risk (17.3 versus 50.2%) of preterm birth (RR = 0.36, 95% CI: 0.28-0.48), whereas the risk of miscarriage (8.1% versus 7.4%) did not significantly increase (RR = 1.08, 95% CI: 0.58-1.98). In DCTA triplets managed expectantly (n = 200), the rates of miscarriage and preterm birth were 8.5 and 51.9%, respectively. Although the meta-analysis was inconclusive, it suggested that ER to twins in DCTA triplets, either of the foetus with a separate placenta (n = 15) or one of the monochorionic pair (n = 34), was neither significantly associated with an increased risk of miscarriage (8.5 versus 13.3%, P = 0.628 and RR = 1.22, 95% CI: 0.38-3.95, respectively) nor with a lower risk of preterm birth (51.9 versus 46.2%, P = 0.778 and RR = 0.5, 95% CI: 0.04-5.7, respectively).
    Limitations, reasons for caution: No randomized controlled trials of ER versus expectant management in TCTA or DCTA pregnancies were identified from our literature search. We were able to include only a handful of papers with small sample sizes and suffering from bias, and non-English publications were missed. Irrespective of the strict inclusion and exclusion criteria, publication bias was evident.
    Wider implications of the findings: The greatest strength of our systematic review is that, contrary to the existing literature, it only included studies with both the intervention and expectant arm. Our results are in agreement with current literature. In TCTA pregnancies, ER to twins is associated with a lower risk of preterm birth but is not associated with a higher risk of miscarriage. In the absence of a randomized trial, the data from systematic reviews appear to be the best existing evidence for counselling in the first trimester on the different options available. Finally, in DCTA pregnancies, indications exist that ER (of one of the MC pair) to twins could possibly reduce the risk of preterm birth without increasing the risk of miscarriage.
    Study funding/competing interest(s): None to declare.
    Registration number: N/A.
    Language English
    Publishing date 2017-06-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 632776-x
    ISSN 1460-2350 ; 0268-1161 ; 1477-741X
    ISSN (online) 1460-2350
    ISSN 0268-1161 ; 1477-741X
    DOI 10.1093/humrep/dex084
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  3. Article ; Online: Pelvic MRI as the "gold standard" in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: a systematic review.

    Anthoulakis, C / Nikoloudis, N

    Gynecologic oncology

    2014  Volume 132, Issue 3, Page(s) 661–668

    Abstract: Objective: Incidentally discovered adnexal masses are common, posing a challenging diagnostic problem because imaging features of benign and malignant overlap. Thus, once an adnexal lesion has been detected, the primary goal of further imaging is ... ...

    Abstract Objective: Incidentally discovered adnexal masses are common, posing a challenging diagnostic problem because imaging features of benign and malignant overlap. Thus, once an adnexal lesion has been detected, the primary goal of further imaging is accurate tissue characterization resulting in surgery only for lesions that are indeterminate or frankly malignant. This study aims to conduct a systematic review, following the PRISMA guidelines, and critically appraise pelvic MR Imaging as the preferred advanced second imaging test, as regards detection of ovarian cancer and assessment of indeterminate adnexal masses, with respect to pre-operatively improving the assignment of these patients to the appropriate level of care.
    Methods: A comprehensive computerized systematic literature search of English language studies was performed (from 2002 to 2012) of PubMed, EMBASE, Scopus, Evidence Based Medicine Reviews (Cochrane Database and Cochrane Central Register of Controlled Trials), and Google Scholar. Relevant article reference lists were hand searched.
    Results: Computerized database search revealed 37 citations of relevance, 10 of which fulfilled the inclusion/exclusion criteria. From the aforementioned, 8 articles were acquired (2 authors were contacted but did not respond) as well as assessed with AHRQ, QUADAS, and STARD evaluation tools. Finally, 6 papers (5 prospective and 1 retrospective) were included in the systematic review.
    Conclusions: MRI with intravenous (IV) contrast administration provides the highest post-test probability of ovarian cancer detection. However, the preponderant contribution of MRI in adnexal mass evaluation is its specificity because it provides confident diagnosis of many benign adnexal lesions.
    MeSH term(s) Adnexal Diseases/diagnosis ; Adnexal Diseases/diagnostic imaging ; Fallopian Tube Neoplasms/diagnosis ; Fallopian Tube Neoplasms/diagnostic imaging ; Female ; Guideline Adherence ; Humans ; Magnetic Resonance Imaging/methods ; Magnetic Resonance Imaging/standards ; Ovarian Neoplasms/diagnosis ; Ovarian Neoplasms/diagnostic imaging ; Ultrasonography
    Language English
    Publishing date 2014-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 801461-9
    ISSN 1095-6859 ; 0090-8258
    ISSN (online) 1095-6859
    ISSN 0090-8258
    DOI 10.1016/j.ygyno.2013.10.022
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  4. Article ; Online: Autonomic dysreflexia triggered by breastfeeding in a non-plegic patient with syringomyelia: A case report.

    Anthoulakis, Christos / Iordanidou, Eirini / Theodoridis, Theodoros

    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

    2020  Volume 151, Issue 1, Page(s) 157–158

    Language English
    Publishing date 2020-07-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80149-5
    ISSN 1879-3479 ; 0020-7292
    ISSN (online) 1879-3479
    ISSN 0020-7292
    DOI 10.1002/ijgo.13284
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  5. Article ; Online: Functional and Reproductive Outcomes Following Surgical Management of Congenital Anomalies of the Cervix: A Systematic Review.

    Mikos, Themistoklis / Lantzanaki, Maria / Anthoulakis, Christos / Grimbizis, Grigoris F

    Journal of minimally invasive gynecology

    2021  Volume 28, Issue 8, Page(s) 1452–1461.e16

    Abstract: Objective: The purpose of this systematic review was to evaluate surgical treatment for malformations of the cervix in terms of short- and long-term postoperative function and relevant reproductive outcomes.: Data sources: International Prospective ... ...

    Abstract Objective: The purpose of this systematic review was to evaluate surgical treatment for malformations of the cervix in terms of short- and long-term postoperative function and relevant reproductive outcomes.
    Data sources: International Prospective Register of Systematic Reviews (ID No CRD42019128899). Electronic databases were searched for eligible studies up to October 2019 on Medline/PubMed (1966-2019), Scopus/Elsevier (1950-2019), and Google Scholar (up to 2019). Search terms included "congenital cervical malformations/anomalies," "uterocervical aplasia/dysgenesis/agenesis," "cervical aplasia/dysgenesis/ agenesis," "müllerian anomalies/dysgenesis/agenesis," "utero-vaginal anastomosis," "cervical reconstruction," "uterocervical reconstruction/canalization," "cervical canalization," "reproductive/pregnancy/functional outcome," "menstruation," "pregnancy," and "regular periods."
    Methods of study selection: Studies were chosen and included with clear description of preoperative diagnosis via sonography, magnetic resonance imaging, and surgical confirmation; assessment and clear description of gynecologic anatomy and any concomitant anomalies; meticulous description of the operative technique; follow-up of at least 6 weeks postoperatively; and postoperative end points including menstrual and reproductive outcomes. We included randomized controlled trials, case-control studies (both prospective and retrospective), and case reports. Data registries, studies without clearly described primary or secondary outcomes, and studies not in the English language were excluded from the analyses.
    Tabulation, integration, and results: The literature search returned 745 studies; 546 records were initially excluded (397 not related to the topic, 15 not related to humans, 134 non-English language); 111 full-text articles were further excluded (patients underwent hysterectomy or no surgery); 88 studies with a total of 249 patients were suitable for analysis. Almost all patients had preoperative amenorrhea (248/249, 99.6%). Postoperatively, of 249 patients, resolution of menstruation occurred in 228 patients (91.6%), and hysterectomy was performed in 22 patients (8.8%); overall, there were 30 (12.0%) conceptions that resulted in 27 (10.8%) viable and 24 (9.6%) term pregnancies. Indications for hysterectomy were stenosis of the genital tract and sepsis. Coexisting vaginal agenesis and use of full thickness skin graft for creation of neocervix was associated with negative surgical outcomes.
    Conclusion: This review suggests that conservative surgical approaches result in better clinical and reproductive outcomes than more aggressive reconstructive surgeries for patients with malformations of the cervix.
    MeSH term(s) Cervix Uteri/diagnostic imaging ; Cervix Uteri/surgery ; Female ; Humans ; Pregnancy ; Retrospective Studies ; Urogenital Abnormalities ; Uterus/diagnostic imaging ; Uterus/surgery
    Language English
    Publishing date 2021-05-29
    Publishing country United States
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 2186934-0
    ISSN 1553-4669 ; 1553-4650
    ISSN (online) 1553-4669
    ISSN 1553-4650
    DOI 10.1016/j.jmig.2020.10.030
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  6. Article ; Online: Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 32 and 36 weeks.

    Ciobanu, A / Anthoulakis, C / Syngelaki, A / Akolekar, R / Nicolaides, K H

    Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology

    2019  Volume 53, Issue 5, Page(s) 630–637

    Abstract: Objective: To assess the additive value of fetal growth velocity between 32 and 36 weeks' gestation to the performance of ultrasonographic estimated fetal weight (EFW) at 35 + 0 to 36 + 6 weeks' gestation for prediction of delivery of a small-for- ... ...

    Abstract Objective: To assess the additive value of fetal growth velocity between 32 and 36 weeks' gestation to the performance of ultrasonographic estimated fetal weight (EFW) at 35 + 0 to 36 + 6 weeks' gestation for prediction of delivery of a small-for-gestational-age (SGA) neonate and adverse perinatal outcome.
    Methods: This was a prospective study of 14 497 singleton pregnancies undergoing routine ultrasound examination at 30 + 0 to 34 + 6 and at 35 + 0 to 36 + 6 weeks' gestation. Multivariable logistic regression analysis was used to determine whether addition of growth velocity, defined as the difference in EFW Z-score or abdominal circumference (AC) Z-score between the early and late third-trimester scans divided by the time interval between the scans, improved the performance of EFW Z-score at 35 + 0 to 36 + 6 weeks in the prediction of, first, delivery of a SGA neonate with birth weight < 10
    Results: Multivariable logistic regression analysis demonstrated that significant contributors to the prediction of a SGA neonate were EFW Z-score at 35 + 0 to 36 + 6 weeks' gestation, fetal growth velocity, by either AC Z-score or EFW Z-score, and maternal risk factors. The area under the receiver-operating characteristics curve (AUC) and detection rate (DR), at a 10% screen-positive rate, for prediction of a SGA neonate < 10
    Conclusion: The predictive performance of EFW at 35 + 0 to 36 + 6 weeks' gestation for delivery of a SGA neonate and adverse perinatal outcome is not improved by addition of estimated growth velocity between 32 and 36 weeks' gestation. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
    MeSH term(s) Biometry/methods ; Birth Weight ; Female ; Fetal Development ; Fetal Weight ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Small for Gestational Age ; Logistic Models ; Multivariate Analysis ; Predictive Value of Tests ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Third ; Prospective Studies ; ROC Curve ; Ultrasonography, Prenatal/statistics & numerical data
    Language English
    Publishing date 2019-04-08
    Publishing country England
    Document type Evaluation Study ; Journal Article
    ZDB-ID 1073183-0
    ISSN 1469-0705 ; 0960-7692
    ISSN (online) 1469-0705
    ISSN 0960-7692
    DOI 10.1002/uog.20267
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    Zs.A 3214: Show issues Location:
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  7. Article ; Online: Prediction of adverse perinatal outcome by cerebroplacental ratio in women undergoing induction of labor.

    Fiolna, M / Kostiv, V / Anthoulakis, C / Akolekar, R / Nicolaides, K H

    Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology

    2019  Volume 53, Issue 4, Page(s) 473–480

    Abstract: Objective: To investigate the performance of screening for adverse perinatal outcome by the cerebroplacental ratio (CPR) measured within 24 h prior to induction of labor.: Methods: This was a prospective observational study of 1902 singleton ... ...

    Abstract Objective: To investigate the performance of screening for adverse perinatal outcome by the cerebroplacental ratio (CPR) measured within 24 h prior to induction of labor.
    Methods: This was a prospective observational study of 1902 singleton pregnancies undergoing induction of labor at ≥ 37 weeks' gestation. Doppler ultrasound was used to measure the pulsatility index (PI) in the umbilical artery (UA) and fetal middle cerebral artery (MCA) within 24 h before induction of labor. The measured UA-PI and MCA-PI and their ratio were converted to multiples of the median after adjustment for gestational age. Univariable and multivariable logistic regression analysis was used to determine whether CPR improved the prediction of adverse perinatal outcome provided by maternal characteristics, medical history and obstetric factors. The detection rate (DR) and false-positive rate (FPR) of screening by CPR were estimated for Cesarean section for presumed fetal distress and adverse neonatal outcome, which included umbilical arterial or venous cord blood pH ≤ 7 and ≤ 7.1, respectively, 5-min Apgar score < 7, admission to the neonatal intensive care unit for > 24 h or hypoxic ischemic encephalopathy.
    Results: A combination of maternal and pregnancy characteristics, including age, weight, racial origin, previous obstetric history, pre-eclampsia, gestational age at delivery and amniotic fluid volume, identified 39% of pregnancies requiring Cesarean section for fetal distress at a FPR of 10%; addition of CPR did not improve the performance of screening. In screening for adverse neonatal outcome by a combination of parity and CPR, the DR was 17% at a FPR of 10%.
    Conclusion: Low CPR, measured within 24 h prior to induction of labor, is associated with increased risk of Cesarean section for fetal distress and adverse neonatal outcome, but the performance of CPR for such surrogate measures of fetal hypoxic morbidity is poor. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
    MeSH term(s) Adult ; Case-Control Studies ; Cesarean Section/statistics & numerical data ; Female ; Fetal Distress/diagnostic imaging ; Fetal Distress/epidemiology ; Fetal Hypoxia/diagnostic imaging ; Fetal Hypoxia/prevention & control ; Gestational Age ; Humans ; Infant, Newborn ; Labor, Induced/adverse effects ; Labor, Induced/statistics & numerical data ; Middle Cerebral Artery/diagnostic imaging ; Middle Cerebral Artery/embryology ; Predictive Value of Tests ; Pregnancy ; Pregnancy Outcome/epidemiology ; Prospective Studies ; Pulsatile Flow ; Ultrasonography, Doppler ; Ultrasonography, Prenatal ; Umbilical Arteries/diagnostic imaging ; Young Adult
    Language English
    Publishing date 2019-03-04
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 1073183-0
    ISSN 1469-0705 ; 0960-7692
    ISSN (online) 1469-0705
    ISSN 0960-7692
    DOI 10.1002/uog.20173
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  8. Article ; Online: Arterial Stiffness as a Cardiovascular Risk Factor for the Development of Preeclampsia and Pharmacopreventive Options.

    Anthoulakis, Christos / Mamopoulos, Apostolos / Rousso, David / Karagiannis, Asterios / Athanasiadis, Apostolos / Grimbizis, Grigoris / Athyros, Vasilios

    Current vascular pharmacology

    2021  Volume 20, Issue 1, Page(s) 52–61

    Abstract: Arterial Stiffness (AS) describes the rigidity of the arterial walls. Epidemiological studies have shown that increased AS is an independent predictive marker of Cardiovascular (CV) morbidity and mortality in both pregnant and non-pregnant women. ... ...

    Abstract Arterial Stiffness (AS) describes the rigidity of the arterial walls. Epidemiological studies have shown that increased AS is an independent predictive marker of Cardiovascular (CV) morbidity and mortality in both pregnant and non-pregnant women. Preeclampsia (PE), a form of pregnancy-induced hypertension, affects approximately 5% of pregnancies worldwide. Preeclamptic women have a higher risk of CV Disease (CVD), mainly because PE damages the heart's ability to relax between contractions. Different pharmacological approaches for the prevention of PE have been tested in clinical trials (e.g., aspirin, enoxaparin, metformin, pravastatin, and sildenafil citrate). In current clinical practice, only low-dose aspirin is used for PE pharmacoprevention. However, low-dose aspirin does not prevent term PE, which is the most common form of PE. Compromised vascular integrity precedes the onset of PE and therefore, AS assessment may constitute a promising predictive marker of PE. Several non-invasive techniques have been developed to assess AS. Compared with normotensive pregnancies, both Carotid-Femoral Pulse Wave Velocity (cfPWV) and Augmentation Index (AIx) are increased in PE. In view of simplicity, reliability, and reproducibility, there is an interest in oscillometric AS measurements in pregnancies complicated by PE.
    MeSH term(s) Aspirin ; Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/prevention & control ; Female ; Heart Disease Risk Factors ; Humans ; Pre-Eclampsia/diagnosis ; Pre-Eclampsia/epidemiology ; Pre-Eclampsia/prevention & control ; Pregnancy ; Pulse Wave Analysis ; Reproducibility of Results ; Risk Factors ; Vascular Stiffness
    Chemical Substances Aspirin (R16CO5Y76E)
    Language English
    Publishing date 2021-10-05
    Publishing country United Arab Emirates
    Document type Journal Article
    ZDB-ID 2192362-0
    ISSN 1875-6212 ; 1570-1611
    ISSN (online) 1875-6212
    ISSN 1570-1611
    DOI 10.2174/1570161119666211006114258
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  9. Article ; Online: Pain Perception during Levonorgestrel-releasing Intrauterine Device Insertion in Nulliparous Women: A Systematic Review.

    Anthoulakis, Christos / Iordanidou, Eirini / Vatopoulou, Anastasia

    Journal of pediatric and adolescent gynecology

    2018  Volume 31, Issue 6, Page(s) 549–556.e4

    Abstract: Study objective: Intrauterine devices (IUDs) still remain underused in adolescents. Pain during insertion might prevent adolescents to opt for a levonorgestrel-releasing IUD. This study aimed to conduct a systematic review, following the Preferred ... ...

    Abstract Study objective: Intrauterine devices (IUDs) still remain underused in adolescents. Pain during insertion might prevent adolescents to opt for a levonorgestrel-releasing IUD. This study aimed to conduct a systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and critically appraise published data with respect to the efficacy of various substances (analgesics or not) in preventing pain during levonorgestrel-releasing IUD insertion in nulliparous women as a proxy for adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A comprehensive computerized systematic literature search of all English language studies between 2006 and 2016 was performed in PubMed, EMBASE, Scopus, Evidence Based Medicine Reviews (Cochrane Database and Cochrane Central Register of Controlled Trials), and Google Scholar. Relevant article reference lists were manually searched.
    Results: The computerized database search revealed 31 citations of relevance, 9 of which with a total of 355 treated women and 345 controls fulfilled the inclusion/exclusion criteria. In women treated with misoprostol (n = 150) vs placebo (n = 145), the median visual analogue scale (VAS) score ± SD were 5.7 ± 2.1 vs 5.1 ± 2.2, respectively. In the previously mentioned population, there was a nonsignificant change in VAS score (odds ratio, 1.44; 95% confidence interval, 0.86-2.40). In women treated with lidocaine (n = 140) vs placebo (n = 136), the median VAS score ± SD were 4.6 ± 2.1 vs 5.8 ± 2, respectively. In the aforementioned population, there was a significant decrease in VAS score (odds ratio, 0.12; 95% confidence interval, 0.02-0.91).
    Conclusion: In nulliparous women, lidocaine treatment seems to be a reasonable choice. However, further studies are required to examine the different routes and modes of administration as well as optimal quantities.
    MeSH term(s) Adolescent ; Adult ; Female ; Humans ; Intrauterine Devices, Medicated ; Levonorgestrel/administration & dosage ; Pain Perception ; Pain, Procedural/etiology ; Pain, Procedural/psychology ; Parity ; Prosthesis Implantation/adverse effects ; Young Adult
    Chemical Substances Levonorgestrel (5W7SIA7YZW)
    Language English
    Publishing date 2018-06-08
    Publishing country United States
    Document type Journal Article ; Systematic Review
    ZDB-ID 1325079-6
    ISSN 1873-4332 ; 1083-3188
    ISSN (online) 1873-4332
    ISSN 1083-3188
    DOI 10.1016/j.jpag.2018.05.008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: The Outcome of Fertility-Sparing and Nonfertility-Sparing Surgery for the Treatment of Adenomyosis. A Systematic Review and Meta-analysis.

    Mikos, Themistoklis / Lioupis, Matteo / Anthoulakis, Christos / Grimbizis, Grigoris F

    Journal of minimally invasive gynecology

    2019  Volume 27, Issue 2, Page(s) 309–331.e3

    Abstract: Objective: The purpose of this systematic review was to identify the operative issues and specific dysmenorrhea and menorrhagia outcomes in women who had undergone fertility-sparing surgery, as well as determine the expected outcome for extirpative ... ...

    Abstract Objective: The purpose of this systematic review was to identify the operative issues and specific dysmenorrhea and menorrhagia outcomes in women who had undergone fertility-sparing surgery, as well as determine the expected outcome for extirpative surgery.
    Data sources: PROSPERO (ID no. 125692). Search was conducted for eligible studies up to March 31, 2019, on MEDLINE/PubMed (1966-2019), Scopus/Elsevier (1950-2019), and Google Scholar (up to 2019). The search terms applied for the search strategy were as follows: adenomyosis, adenomyomas, uterus-sparing surgery, fertility-sparing surgery, pain, dysmenorrhea, menorrhagia, uterine volume, adenomyotic volume, case-control studies, cohort studies, and prospective studies.
    Methods of study selection: A total of 443 studies were initially identified. Exclusion criteria was as follows: (1) inadequate description of preoperative adenomyosis or absence of postoperative histology confirmation of adenomyosis, (2) no statement of use of a standardized instrument for measurement of pain, bleeding, or adenomyotic/uterine volume, (3) follow-up <12 months postoperatively, (4) study population <20 women, and (5) non-English language.
    Tabulation, integration, and results: Nineteen studies with a total of 1843 patients with adenomyosis were included. Twelve studies were further analyzed in the meta-analysis. Complete excision of adenomyosis was associated with improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 6.2, 3.9, and 2.3, respectively; the partial excision of adenomyosis was associated with improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 5.9, 3.0, and 2.9, respectively; the studies with a mixed volume of patients with complete and partial excision of adenomyosis reported improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 4.0, 6.3, and 5.1, respectively.
    Conclusion: The surgical treatment of adenomyosis results in the satisfactory control of pain and bleeding, as well as in the reduction of uterine volume. Further research is warranted to investigate the long-term control of symptoms to identify any parameters related to the recurrence of adenomyosis, as well as to compare the conservative surgical treatment of adenomyosis with other treatment options.
    MeSH term(s) Adenomyosis/epidemiology ; Adenomyosis/pathology ; Adenomyosis/surgery ; Case-Control Studies ; Cohort Studies ; Dysmenorrhea/epidemiology ; Dysmenorrhea/surgery ; Female ; Fertility/physiology ; Fertility Preservation/methods ; Fertility Preservation/statistics & numerical data ; Gynecologic Surgical Procedures/adverse effects ; Gynecologic Surgical Procedures/methods ; Humans ; Menorrhagia/epidemiology ; Menorrhagia/surgery ; Organ Sparing Treatments/methods ; Prospective Studies ; Treatment Outcome
    Language English
    Publishing date 2019-08-06
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 2186934-0
    ISSN 1553-4669 ; 1553-4650
    ISSN (online) 1553-4669
    ISSN 1553-4650
    DOI 10.1016/j.jmig.2019.08.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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