Eclampsia is a pregnancy-specific multisystem disorder associated with substantial fetomaternal morbidity and mortality [1–6] The incidence of eclampsia is variable, but is generally low in well-resourced regions compared with resource-deficient countries However, once eclampsia ensues the potential for both morbidity (immediate and long term) and mortality is cause for equal concern In the context of its elusive aetiology, the prevention and management of this multiorgan disease challenge even the most experienced of clinicians This paper focuses on the definition of pre-eclampsia/eclampsia, the suggested pathophysiology of the disease, current potential preventative strategies and specific issues of concern in the management of the critically ill eclamptic patient

Prevention and management of eclampsia

Atosiban and nifedipine in acute tocolysis: a comparative study.

Risk factors and management patterns for emergency obstetric hysterectomy over 2 decades

Hyperandrogenic anovulation is characterized by polycystic appearance of the ovaries, elevated free serum testosterone with decreased concentrations of serum sex hormone binding globulin, an increased ratio of luteinizing hormone to follicle stimulating hormone and varying degrees of insulin resistance We hypothesize that this is the result of variably increased 'ovarian androgenic insulin responsiveness' acting in combination with body mass Women who develop hyperandrogenism and anovulation when lean (having normal serum insulin concentrations) represent the more severely affected individuals, whereas those who can resume ovulation by losing weight (and lowering their elevated serum insulin) represent a milder form The tendency of these women to develop ovarian hyperstimulation syndrome despite hypophyseal desensitization suggests a primary ovarian defect which is apparently more pronounced in lean subjects The unique ability of surgical damage to the ovary to induce ovulation, raises the possibility that inflammatory-like tissue remodelling has a major role in rescuing follicles from androgen-induced atresia Approaches that may facilitate the study of this possible mechanism may include examination of in-vitro perfused, post-surgery mammalian ovaries and the elucidation of signal transduction mechanism(s) of insulin in the ovary, with special reference to cells emanating from affected women

Hyperandrogenic anovulation (the polycystic ovary syndrome) - back to the ovary?

In-vitro maturation can have deleterious effects on spindle formation and proper chromosome alignment in human oocytes and can be profoundly affected by culture conditions. This study compared the spindle presence and location with the maturation rate of germinal vesicle (GV) oocytes cultured in two different media: G1.2 and G1.2 supplemented with follicle-stimulating hormone, human chorionic gonadotrophin and 17beta-oestradiol. A total of 304 oocytes were retrieved from 101 women undergoing IVF treatment with intracytoplasmic sperm injection. Spindle presence was recorded using the Polscope. Spindle morphology was evaluated with immunocytological staining for alpha-tubulin and chromatin. Twenty-one in-vitro matured oocytes with the presence of spindle and ten of their corresponding polar bodies (PB) were also assessed for aneuploidy. A significantly increased maturation rate (69.7%) was observed after 24h in the supplemented culture media compared with the G1.2 media (56.6%; P<0.05). The proportions of metaphase II (MII) oocytes with spindle presence and abnormal spindle morphology were similar in the two culture media. Also, 76.9% of MII and 70% of PB had chromosomal abnormalities. In conclusion, supplementing culture media may increase the oocyte maturation rate in vitro, but does not necessarily indicate the presence of a birefringent spindle, or normal spindle and chromosomal alignment.

https://www.rbmojournal.com/article/S1472-6483(10)00061-1/pdf

J P Greenhill

Papers

Progress in obstetrics and gynecology.