Pregnancy is considered a natural process for the majority of women. However, a limited proportion of pregnancies and deliveries can present with a broad variety of complications that may require admission to a Critical Care Unit (CCU). In the present review, the indications of admission of obstetrical and postpartum patients to CCUs were critically evaluated with a particular focus on the management of their complications. The management of critically ill obstetric patients remains challenging due to the physiological changes that occur during pregnancy, pregnancy-related diseases and the need to carefully consider the well-being of the fetus before any intervention can be recommended/performed. Indications for admission to CCUs include both obstetric and non-obstetric conditions that may require continuous monitoring and further interventions. Hypertensive disorders of pregnancy and mass hemorrhage are amongst the most common causes of admission to CCUs in pregnant and postpartum women. The establishment of a diagnostic and care algorithm based on the contribution of a multidisciplinary team is of critical importance to aid in the determination of which patients will require intensive care, and to assist in deciding what type of critical care each critically ill patients receives.
Introduction Functional Hypothalamic Amenorrhea (FHA) has been associated with excessive-chronic stress, eating disorders and weight loss. A common feature is the increased serum cortisol, but its measurement has many limitations. Currently, salivary cortisol (SC) has been proposed as a more sensitive and adequate index. Aim To investigate the SC alterations through a 24-hour period and the possible correlation with the severity of stress in women with FHA. Methods Between July 2019 and March 2021, 12 FHA women and 12 healthy controls of comparable age were included. Psychological, eating and physical abnormalities were evaluated by applying equivalent validated self-questionnaires. Results No significant differences were found between FHA women and healthy individuals with respect to morning (8:00 am) serum cortisol and ACTH (522.5±155.3 vs 443.1±138.4; p=0.23 and 37±47.7 vs 17.4±10.2;p=0.18 respectively). Women with FHA had statistically significant higher morning SC compared to control subjects (21.81±5.63 nmol/l vs 12.76±3.64 nmol/l;p<0.0001), while no significant differences were found regarding the afternoon (4:00 pm) and midnight (12:00 am) SC. A significant positive correlation was found between morning SC and morning serum cortisol (r=0.532,p=0.007), as well as with EAT-26 (r=0.527,p=0.008) and HADS-Anxiety score (r=0.471,p=0.02). Additionally, a significant negative correlation between morning SC and BMI was observed (r=-0.53, p=0.009). Conclusion Compared to serum cortisol, SC seems to express better the hypercortisolemic state of women with FHA and correlates well with the underlying contributing factors. Larger studies are needed in order to confirm these results and validate the optimal SC cut-off value associated with the development of FHA.
Introduction Functional Hypothalamic Amenorrhea (FHA) has been associated with excessive-chronic stress, eating disorders and weight loss. A common feature is the increased serum cortisol, but its measurement has many limitations. Currently, salivary cortisol (SC) has been proposed as a more sensitive and adequate index. Aim To investigate the SC alterations through a 24-hour period and the possible correlation with the severity of stress in women with FHA. Methods Between July 2019 and March 2021, 12 FHA women and 12 healthy controls of comparable age were included. Psychological, eating and physical abnormalities were evaluated by applying equivalent validated self-questionnaires. Results No signi cant differences were found between FHA women and healthy individuals with respect to morning (8:00 am) serum cortisol and ACTH (522.5±155.3 vs 443.1±138.4; p=0.23 and 37±47.7 vs 17.4±10.2;p=0.18 respectively). Women with FHA had statistically signi cant higher morning SC compared to control subjects (21.81±5.63 nmol/l vs 12.76±3.64 nmol/l;p<0.0001), while no signi cant differences were found regarding the afternoon (4:00 pm) and midnight (12:00 am) SC. A signi cant positive correlation was found between morning SC and morning serum cortisol (r=0.532,p=0.007), as well as with p=0.008) and HADS-Anxiety score (r=0.471,p=0.02). Additionally, a signi cant negative correlation between morning SC and BMI was observed (r=-0.53, p=0.009). Conclusion Compared to serum cortisol, SC seems to express better the hypercortisolemic state of women with FHA and correlates well with the underlying contributing factors. Larger studies are needed in order to con rm these results and validate the optimal SC cut-off value associated with the development of FHA.
Purpose: The aim of this study was to investigate the aberrations of cortisol secretion, measured by salivary cortisol in women with FHA. Methods The study, an observational study, was performed in a gynecological outpatient clinic of a university hospital in Greece, between July 2019 and March 2021. The study included 12 (twelve) patients with diagnosed FHA and 12 (twelve) women of comparative demographics, with a normal menstrual cycle who were used as controls. Results: 24 women were included in the study. Women with FHA had significantly higher levels of morning salivary cortisol (21.81 ± 5.63 nmol/l vs 12.76 ± 3.64 nmol/l; P <0.0001) when compared to normal controls. Measurements in the afternoon and midnight were not significantly different. There was a negative correlation between morning salivary cortisol levels and ΒΜΙ (rho: -0.53, p = 0.009), while there was a positive correlation between morning salivary cortisol levels and disordered eating habits (rho: 0.53, p = 0.00) and a positive correlation between morning salivary cortisol levels and reported stress levels (rho: 0.47, p = 0.02). Conclusion: Cortisol levels were raised in women with FHA, suggesting increased stress levels. This was particularly obvious the measurement of salivary cortisol levels could be a promising research tool and be used as a potential biomarker of recovery of menses. In addition, it could be used as a tool for the management of the disease and follow-up of patients suffering from functional hypothalamic amenorrhea. Further studies should be conducted to indicate and clarify the specific salivary cortisol levels associated with the occurrence of the disease or recovery of menses.
Oxidative stress may play a role in implantation failure on multiple levels. Oxidative stress is found widely in several biological systems, as well as it acts on various molecular levels with different mechanisms. It has been shown that it is rather the disequilibrium between reactive oxygen species causing oxidative stress and antioxidant mechanisms counteracting their effects, than reactive oxygen species levels themselves. Reactive oxygen species play a role in implantation and fertilisation by acting on different levels of embryo-formation and endometrial changes. Additionally, it is widely abundant in the female reproductive tract including ovaries, oocytes, tubal as well as follicular fluid. Moreover, it has been shown that male fertility is affected by reactive oxygen species by determining sperm quality. Last but not least, oxidative stress may affect IVF indirectly through its actions on peritoneal fluid. As long as research studies on elucidating the development of oxidative stress markers on patients undergoing IVF continue, ever more new possibilities emerge on predicting the pregnancy outcome.
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