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The impact of depression on post-menopausal women is an important public health issue but remains largely unknown. The purpose of this study was to identify the prevalence of post-menopausal depression in Greece and outline the profile of the women it affects.A sample of post-menopausal women completed an anonymous, self-administered, web-based survey which included the Beck Depression Inventory-ΙΙ (BDI-II) and questions regarding socio-demographic data.The dependent variable of interest was a BDI-II score ≥ 20 (the cut-off for moderate depression according to the BDI).Overall, 502 post-menopausal women participated in the study. The median BDI-II score was 13 (range 0-50); 136 (27.1%) of the women scored ≥ 20 and were considered screen-positive for depression. According to the multivariate logistic regression model, age 55 years (OR: 1.621; 95% CI: 1.036-2.535), not working (OR: 1.580; 95% CI: 1.013-2.465), smoking (OR: 1.656; 95% CI: 1.081-2.536) and history of depression (OR: 1.650; 95% CI: 1.045-2.604) were independently associated with post-menopausal depression. Subgroup analyses revealed that current smokers (OR: 2.514; 95% CI: 1.485-4.256) had higher odds of moderate depression, while obesity (OR: 2.455; 95% CI: 1.206-4.996), absence of healthcare insurance (OR: 4.413; 95% CI: 1.970-9.887) and a history of depression (OR: 2.253; 95% CI: 1.212-4.190) were identified as independent risk factors for severe post-menopausal depression.More than one out of four post-menopausal women were screen-positive for symptoms indicative of depression, while a personal history of depression, age 55 years, smoking and current working status were independent predictors of its emergence.

Objective Uterine fibroids affect 2–10 % of pregnant women. Although usually asymptomatic, they may be associated with pregnancy complications. Myomectomy is preferably avoided antenatally, however, it has been reported in symptomatic cases that did not respond to conservative management. The aim of this study was to summarize the published literature and present the reported outcomes and associated risks of this procedure. Study Design A systematic research of the literature was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library, including case reports and case series. An effort was made to numerically analyse all parameters included in the case reports. Results Overall, 54 relevant articles were identified, including 97 patients. The median gestational age at diagnosis was 13 (range 6–26) weeks, while the median age at myomectomy was 16 (range 6–26) weeks. Abdominal pain, not responding to medical treatment was the most common indication for surgery. The median number of fibroids removed per patient was one (range 1–5). Most of them were subserous pedunculated or subserous and fundal. Laparotomy (78.4 %) was the principal surgical approach, however, laparoscopic and vaginal operations were also reported. The median duration of surgery was 53 (range 20–150) min. The histopathology revealed necrosis and degeneration as the main findings of removed fibroids. The pregnancy outcome was favourable in most of the cases, with few complications reported. Conclusion Based on the limited published data, myomectomy during pregnancy appears as a safe procedure in cases of symptomatic uterine fibroids not responding to conservative management and therefore it may be considered, following appropriate counselling regarding the associated risks.

Teenage pregnancies and associated induced abortions represent an important public health issue. The aim of this study was to investigate the prevalence, the time trends, and associated factors of teenage induced abortions in Greece.A cross-sectional study was conducted between 2018 and 2019.Third Academic Department of Obstetrics and Gynecology of the Aristotle University of Thessaloniki.All pregnant women who underwent a second trimester anomaly scan were eligible for the study.Epidemiological characteristics were recorded and 5 age groups were created. Trends in the rates of teenage induced abortions were analyzed and we compared several parameters between women with and without history of abortions.Overall, 3370 women were eligible and agreed to participate in the study. The prevalence of women who reported a history of at least 1 abortion at 15-19 years was 9.7% (n = 328/3370). The abortion rates across the 5 age groups were: 20-24: 7.5%; 25-29: 8.4%; 30-34: 8.2%; 35-39: 12%; and 40 years and older: 13.9%. Moreover, a history of 1 or more teenage abortions was more common in multiparous women (58.2% vs 46.5%; P .001; odds ratio, 1.605; 95% confidence interval, 1.274-2.022) and in current smokers (27.4% vs 11%; P .001; odds ratio, 3.066; 95% confidence interval, 2.346-4.008).A significant decline in the teenage induced abortion rates was identified in the study population. A history of teenage induced abortion was associated with smoking and multiparity. More efforts are needed to provide appropriate education on effective contraception and family planning.

Velamentous cord insertion may be identified prenatally, but the clinical implications of this diagnosis remain controversial. This meta-analysis aimed to quantitatively summarize current data on the association of velamentous cord insertion and adverse perinatal outcomes.A systematic search was performed in MEDLINE, Scopus, and the Cochrane Library from inception until May 22, 2022 to identify eligible studies.Observational studies including singleton pregnancies with velamentous cord insertion, either prenatally or postnatally identified, and comparing them with those with central/eccentric cord insertion were considered eligible.The quality of the studies was assessed with the Newcastle-Ottawa scale and the risk of bias with the Quality In Prognosis Studies (QUIPS) tool. The main outcome was small-for-gestational-age neonates. Heterogeneity of the studies was evaluated using a Q test and an IIn total, 9 cohort and 2 case-control studies, of which 4 had prenatal and 7 had postnatal velamentous cord insertion diagnosis, were included. The overall prevalence of velamentous cord insertion was estimated to be 1.4% among singleton pregnancies. Compared with the central/eccentric cord insertion control group, pregnancies with velamentous cord insertion were at higher risk of several adverse perinatal outcomes, namely small-for-gestational-age neonates (relative risk, 1.93; 95% confidence interval, 1.54-2.41), preeclampsia (relative risk, 1.85; 95% confidence interval, 1.01-3.39), pregnancy-induced hypertension (relative risk, 1.58; 95% confidence interval, 1.46-1.70), stillbirth (relative risk, 4.12; 95% confidence interval, 1.92-8.87), placental abruption (relative risk, 2.94; 95% confidence interval, 1.72-5.03), preterm delivery (relative risk, 2.14; 95% confidence interval, 1.73-2.65), emergency cesarean delivery (relative risk, 2.03; 95% confidence interval, 1.22-3.38), 1-minute Apgar score7 (relative risk, 1.53; 95% confidence interval, 1.14-2.05), 5-minute Apgar score7 (relative risk, 1.97; 95% confidence interval, 1.43-2.71), and neonatal intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.32-2.02). In a subgroup analysis, prenatally diagnosed velamentous cord insertion was associated with small-for-gestational-age neonates (relative risk, 1.66; 95% confidence interval, 1.19-2.32), stillbirth (relative risk, 4.78; 95% confidence interval, 1.42-16.08), and preterm delivery (relative risk, 2.69; 95% confidence interval, 2.01-3.60). In a sensitivity analysis of studies excluding cases with vasa previa, velamentous cord insertion was associated with an increased risk of small-for-gestational-age neonates (relative risk, 2.69; 95% confidence interval, 1.73-4.17), pregnancy-induced hypertension (relative risk, 1.94; 95% confidence interval, 1.24-3.01), and stillbirth (relative risk, 9.42; 95% confidence interval, 3.19-27.76), but not preterm delivery (relative risk, 1.92; 95% confidence interval, 0.82-4.54).Velamentous cord insertion is associated with several adverse perinatal outcomes, including stillbirth, and these associations persist when only prenatally diagnosed cases are considered and when vasa previa cases are excluded. According to these findings, the exact pathophysiology should be further investigated and an effective prenatal monitoring plan should be developed.

Highlights • Primary hydatid cysts of the ovaries represent a very rare entity that may be diagnosed incidentally. • Ultrasound is the gold standard diagnostic method for ovarian hydatid cysts. • Medical treatment may be successful in small asymptomatic cysts, however surgical management with removal of the intact cyst is the preferred method for large cysts., Introduction Hydatid cysts of the female reproductive system represent a rare entity. We report a case of a primary hydatid cyst of the right ovary of a postmenopausal woman that was diagnosed incidentally. Presentation of the case A 72-year old overweight woman with history of three vaginal deliveries was referred due to uterine prolapse. During clinical examination of the patient, preoperative pelvic ultrasound revealed an ovarian cyst with benign characteristics. After oncology review, a laparoscopically assisted vaginal hysterectomy with bilateral salpingo-oophorectomy was conducted; the histopathology of the cyst revealed a hydatid cyst. Postoperative abdominal computed tomography identified no other sites of infection, indicating the ovary as the primary site of infection. During follow-up no recurrence occurred. Discussion Hydatid cysts usually have a low progression and tend to be asymptomatic. Medical treatment may be successful in small asymptomatic cysts, however a close follow-up is needed after antihelminthic treatment. Surgical management with removal of the intact cyst is the preferred method for large cysts. Conclusion We report a rare case of ovarian hydatid cyst that was effectively removed intact during a laparoscopically assisted vaginal hysterectomy with no recurrence during follow-up.

Highlights • Cesarean scar pregnancies represent a severe obstetric entity, which is probably associated with the increasing rates of cesarean sections. • There is no consensus on the preferred mode of treatment for cesarean scar pregnancies. • Even after an initially effective conservative management, surgical management may be needed for the final treatment of cesarean scar pregnancies., Introduction The incidence of cesarean scar pregnancies (CSPs) is increasing, possibly due to higher rates of cesarean sections. We report a case of a CSP with severe bleeding following initial conservative management, that was eventually treated surgically. Presentation of the case A 33-year old woman with history of one cesarean section presented with abdominal pain and amenorrhea and was diagnosed with CSP. Conservative management with methotrexate was chosen and the treatment was regarded as successful after the expected reduction in serum hCG levels. Four days after the hospital discharge, the patient was readmitted with hemodynamic instability and an emergency laparotomy was performed to remove the remaining trophoblastic tissue. Discussion A CSP may present as a threatened miscarriage, or remain asymptomatic through the first trimester. Medical treatment may be successful, however a close follow-up is needed even after a reduction in serum hCG levels. Conclusion We report a case of CSP that, following an initial apparently “successful” treatment with methotrexate, required surgical management due to heavy bleeding.

Objective To investigate the impact of operator experience on amniocentesis-related adverse outcomes. Study design Retrospective study of mid-trimester amniocenteses performed by the same operator on singleton pregnancies in a single private institution during 1994–2007. Outcomes were hemorrhagic or dark amniotic fluid aspiration, insufficient volume aspiration, repeated puncture and fetal loss. Rates were estimated annually, as well as for every 10% of procedures up to the total number. The association of each outcome with epidemiological aspects was also examined. Results In total, 5913 amniocenteses were performed. The overall rate of adverse outcomes was 5.4%. The total adverse outcome rate reduced from 10.2% in the first 10% of cases to 3.0% in the last 10% ( P =.001). The rate of hemorrhagic fluid gradually decreased from 4.4% to 1.5% ( P =.05) over the same intervals. The fetal loss rate was also reduced from 0.5% during the first half to 0.3% in the second half of the study period ( P =NS). Logistic regression analysis indicated no significant correlations between adverse outcomes with any of epidemiological parameters of women undergoing amniocentesis. Conclusion Operator experience has a beneficial impact on preventing procedure-related adverse outcomes.

Objective To compare the efficacy of the long GnRH agonist and the fixed GnRH antagonist protocols in IVF poor responders. Study design This was a randomized controlled trial performed in the Iakentro IVF centre, Thessaloniki, from January 2007 to December 2011, concerning women characterised as poor responders after having 0–4 oocytes retrieved at a previous IVF cycle. They were assigned at random, using sealed envelopes, to either a long GnRH agonist protocol (group I) or a GnRH antagonist protocol (group II). Results Overall 364 women fulfilled the inclusion criteria and were allocated to the two groups: finally 330 participated in our trial. Of these, 162 were treated with the long GnRH agonist protocol (group I), and 168 with the fixed GnRH antagonist protocol (group II). Numbers of embryos transferred and implantation rates were similar between the two groups (P = NS). The overall cancellation rate was higher in the antagonist group compared to the agonist group, but the difference was not significant (22.15% vs. 15.2%, P = NS). Although clinical pregnancy rates per transfer cycle were not different between the two groups (42.3% vs. 33.1%, P = NS), the clinical pregnancy rate per cycle initiated was significantly higher in the agonist compared to the antagonist group (35.8% vs. 25.6%, P = 0.03). Conclusions Although long GnRH agonist and fixed GnRH antagonist protocols seem to have comparable pregnancy rates per transfer in poor responders undergoing IVF, the higher cancellation rate observed in the antagonist group suggests the long GnRH agonist protocol as the first choice for ovarian stimulation in these patients.

Objective To investigate whether diamniotic twin gestations are at increased risk of amniocentesis-related adverse outcomes compared to singleton pregnancies. Study design This was a retrospective study of mid-trimester amniocenteses performed during the period 1993–2009. Cases were divided in two groups, one including singleton (Group 1) and the other diamniotic twin pregnancies (Group 2). All amniocentesis-related adverse outcomes were reviewed, including aspiration of insufficient amniotic fluid, aspiration of hemorrhagic amniotic fluid, repeated puncture and miscarriage. The incidence of these adverse outcomes was compared between the two groups. Results In total, 6270 cases were included in the study (Group 1, n = 6150 and Group 2, n = 120). Advanced maternal age was the main indication for amniocentesis in both singleton and twin pregnancies. There was no difference in the incidence of insufficient sample aspiration (0.2% in singletons vs. 0.0% in twins, P = NS), in the incidence of blood-stained amniotic fluid (3.7% in singletons vs. 4.6% in twins, P = NS), in the rate of need for second attempt (2.1% in singletons vs. 1.7% in twins, P = NS) or in the miscarriage rate (0.24% in singletons vs. 0% in twins). Conclusion In our experience, the incidence of amniocentesis-related adverse outcomes is not increased in diamniotic twins compared to singleton pregnancies.

The objective of the study was to investigate the location of the front of the maxilla in relation to the forehead in fetuses with trisomy 21 at 11-13 weeks of gestation.A three-dimensional volume of the fetal head was obtained before karyotyping in 100 fetuses with trisomy 21 and 300 euploid fetuses. The frontomaxillary facial (FMF) angle, defined as the angle between the upper surface of the upper palate and the frontal bone in a midsagittal view of the fetal face, was measured.The FMF angle was significantly larger in the trisomy 21 than in the euploid fetuses (mean 88.7 degrees, range 75.4-104 degrees vs mean 78.1 degrees, range 66.6-89.5 degrees, P.001). The FMF angle was more than 85 degrees in 69% of the trisomy 21 fetuses and in 5% of the euploid fetuses. There was no significant association between the FMF angle and nuchal translucency thickness.Measurement of FMF angle is likely to be a useful adjunct in screening for trisomy 21.