Showing papers in "Archives of Gynecology and Obstetrics in 2007"

Genital tuberculosis: an important cause of Asherman’s syndrome in India

Abstract: Objective To demonstrate the association between genital endometrial tuberculosis and Asherman's syndrome.

Homocysteine, folic acid and B12 serum levels in pregnancy complicated with preeclampsia

Abstract: Elevated plasma homocysteine has been implicated in vascular changes compatible with atherosis and endothelial dysfunction similar to the vascular changes of the placenta in preeclampsia. Previous reports have indicated an increased incidence of hyperohomocysteinemia in preeclamptic patients. The aim of this study was to examine the association of homocysteine levels and preeclampsia in our patients. Prospective study of 28 preeclamptic patients that were matched with 26 normal controls of the same gestational age. The preeclamptic group had an increased incidence of cesarean sections (75%), of growth retarded fetuses (50%), intrauterine deaths (7%) and placental abruptions (7%). Mean levels of homocysteine were significantly elevated in the preeclamptic than in control group (11.11 vs. 6.40 μmol/l, P < 0.001). There were no differences between the groups regarding the levels of folic acid (11.12 vs. 9.73 ng/ml, P = 0.55) and vitamin B12 (295.76 vs. 356.15 pg/ml, P = 0.43). It is concluded that in our study homocysteine levels are significantly elevated in patients with preeclampsia compared with control group, while no vitamin deficiencies were observed.

Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review

Abstract: Interest in non-hormonal therapies for the treatment of menopausal symptoms has increased since the publication of adverse effects of estrogen replacement therapy. To provide information on the efficacy of non-hormonal therapies for menopausal vasomotor symptoms based on evidence from published randomised controlled studies. The Cochrane Database of Systematic Reviews (CDSR), MEDLINE, Alternative Therapies in Health and Medicine database (ATHMD) and Allied and Complementary Medicine database (AMED) were searched for randomised controlled trials in the English language reporting data on treatment of menopausal vasomotor symptoms. Trials including cancer breast patients were included. Our search identified 58 randomised controlled trials of which 11 involved the use of clonidine, six for SSRIs, four for gabapentin, seven for black cohosh, seven for red clover, 18 for phytoestrogens, two for ginseng, one for evening primrose, one for dong quai and one for vitamin E. Most trials had methodological deficiencies. There is evidence that clonidine, paroxetine, venlafaxine, gabapentin and black cohosh may be beneficial in the treatment of menopausal vasomotor symptoms in some women. Current evidence does not support the use of fluoxetine, red clover, phytoestrogens, Ginseng, evening primrose, dong quai and vitamin E. The side effects profile of these therapies should be considered.

Menopausal symptoms and associated risk factors among postmenopausal women screened for the metabolic syndrome

Abstract: Although the frequency of menopausal symptoms may vary according to the studied population, in general severe intensity has been related to lower quality of life. To assess the frequency of menopausal symptoms and involved risk factors in an Ecuadorian postmenopausal population. Postmenopausal women that participated in a metabolic syndrome screening program were interviewed with the Menopause-specific quality of life questionnaire (MENQOL) in order to determine the most frequently presenting menopausal symptoms and correlate these symptoms with socio-demographic data and the main results of the screening program. Three hundred and twenty-five postmenopausal women (n = 325) were surveyed with the MENQOL. Mean age of participants was 55.9 ± 8.1 years (median: 54 years). The most frequently presenting symptoms were: hot flushes (53.3%), sweating (49.2%), poor memory (80.6%), feeling depressed (67.4%), aching in muscles and joints (84%), drying of their skin (85.5%), avoiding intimacy (76.2%) and change in their sexual desire (76.5%). Multivariate analysis determined that abdominal obesity was a significant risk factor for presenting hot flushes, depression and muscle and joint pain. High triglyceride levels were associated to higher rates of sweating and depression. While women with basal hyperglycemia were associated to dry skin and changes in sexual desire in a higher proportion, those who were older and with more years of menopause onset were related less frequently to vasomotor symptoms. Older age was also significantly associated in a higher rate to dry skin. In this postmenopausal Ecuadorian population, the frequency of menopausal symptoms, as assessed with the MENQOL, was found to be relatively similar to other Latin and non-Latin American populations and associated to age, hormonal status and related metabolic conditions.

Therapeutic options for adenomyosis: a review

Abstract: To review the literature on various therapeutic modalities for uterine adenomyosis. Reviews, case-controlled studies and reports from November 1949 until August 2006 written in English or summarized in English abstracts retrieved from Medline and Pubmed using the key words: adenomyosis and adenomyosis therapy. Symptoms of adenomyosis may be alleviated by antiprostaglandins, sex hormones, danazol and GnRH analogs. Minor surgical procedures for therapy include endomyometrial ablation, laparoscopic myometrial electrocoagulation and adenomyoma excision. Patient’s age and symptoms, desired fertility, site and extent of lesion and surgeon’s skills should be considered in choosing the appropriate procedure. Endomyometrial ablation is effective for lesions deeper than the endometrial–myometrial junction whereas the efficacy of hysteroscopic ablation is limited to foci 2–3 mm deep. Focal and diffuse disease may be managed by laparoscopic electrocoagulation or myometrial excision with preservation of fertility but risk of recurrence exists. Uterine artery embolization assumingly invokes infarction and necrosis. Encouraging results reported in some cases warrant expanding its use for more experience. Hysterectomy is the ultimate solution for women with deep myometrial involvement or if future fertility is not desired. Various therapeutic options for adenomyosis, including few minimally invasive procedures became available in the last two decades but need evaluation and improvement.

Malignant transformation in mature cystic teratoma of the ovary: report of five cases and review of the literature.

Abstract: The incidence of malignant transformation in mature cystic teratoma (MCT) of the ovary is less than 2% as reported in gynaecological and pathological literature. Here we present a series of five patients, who developed malignant transformation in MCT of the ovary, over a 6-year period (1999-2004). The morphological and clinico-pathological features of malignant transformation in MCT of the ovary are discussed.

Elevated level of cell-free plasma DNA is associated with breast cancer

Abstract: Background We analysed cell-free DNA (cfDNA) in the plasma of patients with both malignant and benign breast lesions by real-time quantitative PCR to determine whether the finding may have diagnostic and prognostic implications.

Psychotropic medication during pregnancy and lactation.

Abstract: Despite the traditional notion that pregnancy is a time of joy and emotional well being, evidence suggests that it does not protect women against mental illness. Untreated mental illness carries wide-ranging repercussions for mother, child and family that often outweigh those associated with treatment. Clinical management is complex, involving competing risks to mother and offspring; the challenge lies in effectively treating mental illness, whilst minimising exposure of the child to harmful medication. The paucity of robust published evidence on which to base the principles of psychiatric care further compounds the issue. Pregnancy significantly affects plasma drug levels and immature foetal/neonatal physiology renders the child prone to damage from pharmacological agents, all of which cross the placenta/enter breast-milk to varying degrees. Risks include teratogenicity, obstetrical complications, perinatal syndromes, and long-term behavioural problems. Despite evidence that some psychotropic drugs may be safe during pregnancy, knowledge regarding the risks of antenatal exposure to medications remains far from complete. The pregnant or breastfeeding woman requires an individualised risk-benefit analysis with regard to the commencement or continuance of psychotropic medication. If treatment is deemed necessary, monotherapy at the lowest possible dose should be prescribed. More robust safety data is available for older psychotropic drugs, which should be employed in preference to newer agents with unestablished safety profiles. Pregnant/breastfeeding women should also be educated with regard to early detection of signs of drug toxicity in both themselves and their babies. Despite shared responsibility, the ultimate decision with regard to reasonable risk, and what constitutes it, rests with the informed patient. Close psychiatric monitoring and coordinated multidisciplinary care with the obstetrician and paediatrician combine with such informed patient choices to comprise the components of a holistic model of care, targeted at optimizing the complex management of women with psychiatric illness during pregnancy.

Quality of life of women with gynecologic cancer: associated factors.

Abstract: To evaluate quality of life (QOL) and identify its associated factors in a cohort of women with gynecologic cancer. A cross-sectional study was conducted, including 103 women with cervical or endometrial cancer, aged between 18 and 75 years who were receiving their entire treatment at the institution where the investigation was carried out. QOL was measured by the World Health Organization’s QOL instrument-abbreviated version (WHOQOL-BREF). Clinical and sociodemographic characteristics, in addition to prevalence of cancer-related symptoms prior to radiotherapy were investigated. Bivariate analysis was performed, applying the Mann–Whitney test. Multivariate analysis was used to identify factors associated with QOL. The mean age of the participants was 56.8 ± 11.6 years. The study included 67 (65%) women with cervical cancer and 36 (35%) women with endometrial cancer. Most participants were at an advanced stage (63.1%). The most common complaints were pain (49.5%) and vaginal bleeding (36.9%). The prevalence of anemia was 22.3%. On multivariate analysis, it was observed that anemia (P = 0.006) and nausea and/or vomiting (P = 0.010) determined impairment in physical domain. Pain negatively influenced physical domain (P = 0.001), overall QOL (P = 0.024), and general health (P = 0.013), while the history of surgery positively affected general health (P = 0.001). Cancer-related symptoms were factors that most interfered with QOL in women with gynecologic cancer. Therefore, more attention should be focused on identifying these symptoms, adopting measures to minimize their repercussions on QOL.

Cystic hygroma and lymphangioma: associated findings, perinatal outcome and prognostic factors in live-born infants

Abstract: We aimed to determine associated ultrasonographic findings, chromosome abnormalities and the prognostic factors of cystic hygromas in live-born infants. We reported a series of 57 cystic hygroma cases, who were diagnosed in the first and the second trimester of pregnancy by means of the ultrasonographic morphology of cystic hygroma, associated structural abnormalities, karyotype analysis and the autopsy findings. Survivors were followed for their fetal outcome and prognosis. There were 57 new cases of cystic hygroma among 8,155 screenings (0.7%). 35 of the cases (61.4%) were nonseptated and 22 of the cases (38.6%) were septated cystic hygroma. Chromosomal abnormalities were found in 23 of the cases (40.3%). The most common abnormality in nonseptated cystic hygroma was trisomy 21 (8 cases, 25%) and in septated cystic hygroma was Turner syndrome (4 cases, 21.1%). The most common associated structural malformations were cardiac abnormalities (in 7 cases, 20%) in nonseptated cystic hygroma cases and nonimmune hydrops (in 12 cases, 54.5%) in septated cystic hygroma cases. Overall survival was poor; only one case of septated cystic hygroma with axillary location and seven cases of nonseptated cystic hygroma, of whom two died in the neonatal period, were alive (10.5%). This study had 80% power to detect 0.03% difference in diagnosis cystic hygroma (α = 0.05, β = 0.80). Fetuses with cystic hygroma are at high risk for adverse outcome. Prenatal diagnosis with invasive procedures should be done in order to inform the parents in detail. Axillary location of the hygroma and the depth of invasion had prognostic importance.

Vaginal fluid urea and creatinine in diagnosis of premature rupture of membranes

Abstract: Objective: To evaluate the reliability of vaginal fluid urea and creatinine for the diagnosis of premature rupture of membranes (PROMs).

Iron supplementation in pregnancy—does the preparation matter?

Abstract: Objective To assess the use, side effects and discontinuation rates of iron preparations during pregnancy.

Acupressure and vitamin B6 to relieve nausea and vomiting in pregnancy: a randomized study

Abstract: To compare the effectiveness of acupressure and vitamin B6 in the outpatient treatment of nausea and vomiting in early pregnancy. Pregnant volunteers with symptoms of mild to moderate nausea and vomiting between 6 and 12 weeks’ gestation participated in a 7-day clinical trial. Participants were randomly assigned to receive a device for acupressure therapy and placebo drug or an otherwise identical but non-stimulating placebo device and vitamin B6. The primary outcome measure was self-recorded symptoms according to Rhodes index. Secondary outcome measures were weight gain and medication use. The mean change in Rhodes index was not significantly different between the two groups. There were no statistically significant differences in weight gain and medication use between the two groups. Acupressure therapy is not more effective than vitamin B6 in reducing nausea and vomiting in symptomatic women in the first trimester of pregnancy.

Uterine prolapse complicating pregnancy

Abstract: Uterine prolapse is extremely rare during pregnancy. However in some cases significant complications may develop. We report a case of uterine prolapse which developed during pregnancy. Our case was managed conservatively and there were no fetal or maternal complications. Postnatally the uterine prolapse recovered spontaneously. Early recognition and close follow-up during pregnancy is essential. Successful pregnancy outcome requires individualized treatment but bed rest should always be considered.

Spontaneous preterm delivery and gestational diabetes: the impact of glycemic control.

Abstract: Opinions differ whether the rate of spontaneous preterm delivery (sPTD) increases in pregnancies complicated with GDM. We sought to characterize, which factors may influence the rate of sPTD in GDM. We conducted a retrospective study with 1,526 GDM patients, all treated at the same center by the same diabetic protocol using self-blood glucose monitoring. The rate of sPTD was compared to that of 10,560 non-diabetic women. Eligibility for the study was limited to women with a singleton pregnancy with spontaneous onset of delivery before 37 weeks of gestation with no history of chronic maternal illness, i.e., chronic hypertension or development of preeclampsia in the current pregnancy, and no clear indication for preterm delivery. Mean blood glucose < 105 mg dl−1 was defined as well controlled. Overall, no difference was found in the rate of sPTD in GDM (163/1,526, 10.7%) in comparison to non-GDM patients (1193/10,560, 11.3%, P = 0.2). In the GDM group, a comparison between women with and without sPTD found no difference in maternal age (28.1 ± 6 vs. 28.2 ± 6), prepregnancy BMI (28.1 ± 5 vs. 27.8 ± 6), rate of nulliparity (38 vs. 34%) or ethnicity origin. GDM patients with sPTD were characterized by higher glucose values in the OGTT and higher mean blood glucose (114 ± 16 vs. 106 ± 14, P < 0.0001). Sixty-five percent of patients with sPTD versus. 46% in the non-sPTD were in poor glycemic control (P = 0.004). Multiple logistic regressions, when the dependent variable was sPTD revealed that mean blood glucose (OR 1.94 95% CI 1.25–3.0), history of sPTD (OR 3.25 95% CI 2.1–4.8) and parity (OR 1.49 95% CI 1.05–2.2) were contributing factors. The rate of sPTD in GDM is not increased in comparison to non-GDM patients, but reaching established levels of glycemic control may reduce the rate of sPTD in GDM.

Extreme gigantomastia in pregnancy: case report and review of literature.

Abstract: We present an extreme case of Gigantomastia in pregnancy in a 24-year old woman, gravida 2, in a 28 weeks' of gestation, with a total breast weight of 33 kg, complicated by infection, ulcerations and subsequent hemorrhage. Thorough laboratory analyses did not reveal any hint as to the cause of this enormous breast enlargement. Gynecological examinations and ultrasound revealed a viable, progressive normal fetus. The severity of the problem is further emphasized by the patients' breathing problems and even big difficulty in standing and walking. We performed bilateral simple mastectomy as a life-saving procedure to prevent fatal complications. The procedure finished without any complications or large amount of blood loss. There are less than 100 cases of gravid gigantomastia reported, but never to such extreme breast weight. Etiology remains uncertain, and controversy exists in therapeutic modality. According to the literature the most reliable conservative treatment is bromocriptine therapy, but if the condition progresses surgical intervention, in the form of reduction mammoplasty or simple mastectomy, is the treatment of choice.

Awareness of the benefits of folic acid and prevalence of the use of folic acid supplements to prevent neural tube defects among Thai women

Abstract: To determine the level of knowledge about the usefulness of periconceptional folic acid supplementation among pregnant women. An anonymous questionnaire was completed by selected subjects to assess folic acid awareness. The questionnaire was administered to pregnant women who were seeking antenatal care at King Chulalongkorn Memorial Hospital May to December 2005. The questions covered their knowledge and use of folic acid supplements, pregnancy intention, and demographic and socioeconomic characteristics. Out of 401 women surveyed, 76.1% of them reported that they had heard of folate. Of these, only 24.4% of the total subjects knew that folate was something important. Overall, 9.7% of the total women took folic acid during periconceptional period. The most common information sources on folate were the media. Logistic regression analysis showed that education of mother was the strongest predictor of having taken folic acid during the correct period. Although some pregnant women are aware of the need to take folic acid, the actual impact of the present recommendations is almost negligible. Information to specifically inform patients about the need to take folic acid to prevent neural tube defects by medias and healthcare personnel seem to improve the final intake of folic acid during the protective period.

Three-dimensional ultrasound fetal urinary bladder volume measurement: reliability of rotational (VOCAL TM ) technique using different steps of rotation

Abstract: The aim of the study was to investigate the inter- and intraobserver reliability in measuring the fetal bladder volume by 3d ultrasound imaging by VOCALTM. In addition a comparison of 15° and 30° rotation steps calculation had been performed. Measurements (n = 240) of FB volume were performed in 30 low-risk patients with gestation times ranging from 22 to 39 weeks by two independent observers blind to each other. All fetuses were examined and no ultrasound detectable malformation was found. The volume for each FB was measured twice by the observers who used the Virtual Organ Computed-aided Analysis (VOCALTM) technique. Distinct sets of 12 and 6 planes were obtained after sequential rotations of 15° and 30°, respectively. The internal contour of fetal bladder was determined manually and carefully as to exclude adjacent structures from volume calculation. Wilcoxon signed-rank test was used for the comparison of paired samples in the cases of replication within and between observers. Spearman’s rank correlation was used to study the relationship among angles. Bland and Altman’s graphical approach was used to investigate the agreement between observers. Both techniques were shown to be highly reliable. No significant difference was found between the measurements of FB volume with the VOCALTM technique by varying either the steps of rotation or the observers. Excellent correlations were found for both observers in the use of rotation angles of 15° and 30°. Since a significantly faster evaluation was obtained by using a 30° rotation step it must be preferred to assess the FB volume. Our results show that the VOCALTM technique, with a plane rotation of 30°, can be used in a simple way to estimate fetal urine production.

Chemotherapeutic treatment of a pregnant patient with ovarian dysgerminoma

Abstract: Diagnosis of malignant ovarian tumours during pregnancy is uncommon. This report presents a case of a pregnant woman with ovarian dysgerminoma. At 24 weeks gestation, a 33-year-old patient was diagnosed with unilateral ovarian dysgerminoma. Because the tumour was considered to be at an advanced stage (FIGO III), she received three cycles of paclitaxel and carboplatin. At 36 weeks gestation, she underwent a caesarean section, abdominal hysterectomy, bilateral salpingovarectomy, omentectomy, and lymphadenectomy. After surgery, she received three additional cycles of chemotherapy in an adjuvant setting. At birth, the infant was responsive to stimuli, and 20 months after delivery, the infant exhibited normal development. This case report illustrates the difficulties arising from diagnosis of malignancy during pregnancy. Although combined treatment with paclitaxel and carboplatin is not considered a first-line therapy for ovarian dysgerminoma, in this case report it elicited an excellent response, and there were no adverse effects on the foetus.

Good pregnancy outcome after prenatal exposure to bleomycin, etoposide and cisplatin for ovarian immature teratoma: a case report and literature review

Abstract: Aim The administration of bleomycin plus etoposide and cisplatin during pregnancy is rare.

The management of accidental dural puncture in pregnant women: what does an obstetrician need to know?

Abstract: Post-dural puncture headache (PDPH) also known as spinal (or post-spinal) headache still remains a disabling complication of needle insertion into the subarachnoid space. Pregnant women are at particular risk of dural puncture, and the subsequent headache, because of sex, young age, and the widespread application of regional anesthesia. Accidental dural puncture complicating epidural anesthesia varies in incidence from 0.19 to 4.4%. The incidence of epidural needle-induced PDPH headache in pregnant women has been reported to range 76–85%. The classic symptoms of PDPH consist of photophobia, nausea, vomiting, neck stiffness, tinnitus, diplopia, and dizziness in addition to the often, severe cephalgia. This article reviews the current literature on the pathophysiology, incidence, prevention, and treatment of PDPH in pregnant women.

Communication skills training in obstetrics and gynaecology: whom should we train? A randomized controlled trial

Abstract: To determine whether patient–physician communication in obstetrics and gynaecology can be improved by a training program and to investigate if physicians with poorer performance before the training show greater improvement in communication skills scores over the course of the study. Intervention study with randomisation in training (n = 16) and control group (n = 16) and patient satisfaction and communication skills of physicians as outcome variables. Physicians’ communication skills were assessed by independent raters using a standardised evaluation instrument (adapted version of the MAAS-R) to analyse video recorded interviews before and after the training. Patient satisfaction was assessed with a patient satisfaction questionnaire. Using general linear model (GLM) for repeated measures no group × time interaction nor time effects were found for physicians’ communication skills. No group × time interaction was found for patients’ satisfaction scores; however the significant time effect was mostly attributable to positive changes in patients’ rating of the training group. Physicians with poorer performance at the beginning showed greater improvements over the course of the study, especially in the training group. In this randomized controlled trial marginal intervention effects for the improvement of communication skills and only partial changes in patient satisfaction scores from pre to post training were shown. However, physicians with poorer performance at the beginning showed greater improvements, suggesting that competence levels were already relatively high at the beginning of the study. Also, formation of communication training groups should be based on specific skill deficits rather than being implemented unspecifically for an entire team of physicians.

To compare the efficacy of two doses of intraperitoneal bupivacaine for pain relief after operative laparoscopy in gynecology

Abstract: To evaluate the effect of two doses of intraperitoneal bupivacaine administration for pain relief after operative gynecological laparoscopy. Prospective randomized study. The study group comprised 52 women undergoing gynecological laparoscopic surgery. A dose of either 0.125% bupivacaine 10 ml (50 mg) or 0.25% bupivacaine (100 mg) was instilled intraperitoneally at the end of the procedure. Pain scores were recorded in the postoperative period on a scale of 0–10 at 2, 4, 6 and 8 h intervals after the surgery. Any other side effect and the time and dose of analgesia required were noted. The results were compared in the two groups. One hundred milligrams of bupivacine provided pain relief for a longer duration (8 h), as compared to 50 mg of the drug (4–6 h). This difference was statistically significant. Analgesic requirement was also less in the 100 mg group. One hundred milligrams of intraperitoneal bupivacaine is much better than 50 mg in relieving pain after laparoscopic surgery.

Total laparoscopic hysterectomy: a 5-year experience

Abstract: To evaluate our surgical technique with regards to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus by analysing its intra-operative and post-operative outcomes and complications in the hope of reducing their occurrence. Retrospective study based on TLH operations performed from January 2001 to December 2005. The KOH Colpotomizer™ System and the RUMI Uterine Manipulator® were used. Five hundred and twelve women consented for TLH. Five hundred and three women (98.2%) had successful TLH with three mini-laparotomy and six laparotomy conversions (1.8% failure rate). Mean uterine size was 11 cm (5–17). Mean operating time was 133 min (40–257). Mean blood loss was 309 ml (50–1,500). Twenty patients (4%) required blood transfusion (five excessive bleeding). Injuries include bowel injury (5), bladder (2), uterine perforation (1), ureterovaginal fistula (1) and vaginal laceration (5). Post-operative complications include pyrexia (36), umbilical wound infection (5), urinary tract infection (UTI) (4) and vault haematoma (3). Mean hospital stay was 2.7 days (1–10). Eighteen patients (3.6%) were readmitted for vaginal bleeding (10), vault haematoma (2), UTI (1), anxiety (3), giddiness (1) and ureterovaginal fistula (1). Twenty-three women (4.5%) encountered major complications (laparotomy conversion, excessive bleeding requiring blood transfusion, hemorrhage ≥1,000 ml, ureteric injury, bowel injury and pulmonary embolus) which compares favourably with other centres (4–11%). Our mean operating time, mean estimated blood loss, mean hospital stay and readmission rate are comparable. TLH with adequate training is associated with low morbidity, few complications and a high success rate.

The association of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns.

Abstract: Objective This study was designed to investigate the relationship between the second trimester maternal serum markers and adverse pregnancy outcomes in healthy newborns.

Obstetric care of Jehovah's Witnesses: a 14-year observational study.

Abstract: Over a 14-year period, the obstetric outcome of Jehovah’s Witnesses in an inner city hospital was reviewed and the effect of refusal of blood on morbidity and mortality evaluated. Ninety women had 116 deliveries and of these, 24% were delivered by caesarean section, 10% had instrumental deliveries and 66% were normal vaginal deliveries. Postpartum haemorrhage of >1,000 mls occurred in 6% and postpartum anaemia was the commonest complication. The mean postdelivery haemoglobin (11.10 ± 1.15 g/dl) was not significantly less from the mean predelivery haemoglobin level (11.81 ± 1.62 g/dl) (P > 0.05, paired t test). The single maternal death occurred after caesarean hysterectomy, which when extrapolated, resulted in a 65-fold increased risk of maternal death compared to the national rate. The optimum management of pregnant women who decline transfusion is discussed.

High levels of CA125 (over 1,000 IU/ml) in patients with gynecologic disease and no malignant conditions: three cases and literature review

Abstract: Objective To report the very high serum levels of CA125 in patients with benign gynecologic disease which manifests as pelvic mass.

Three-dimensional transvaginal sonographic diagnosis of early and asymptomatic interstitial pregnancy.

Abstract: The interstitial gestation is a rare form of tubal pregnancy which is associated with high morbidity. The diagnosis of an interstitial gestation can be reached through a bidimensional transvaginal ultrasonography (2D-TVUS), however, sometimes when making use of this technique it is not possible to appropriately evaluate the position of the gestational sac in relation to the uterine cavity. The three-dimensional transvaginal ultrasonography (3D-TVUS) allows accessibility to plans that the bidimensional does not, thus it makes it possible to reach a more accurate diagnosis and it also allows for an appropriate therapeutic planning. We present a case of interstitial gestation diagnosed in the sixth week in an asymptomatic woman, who had a previous diagnosis of primary infertility. The 2D-TVUS revealed the presence of a gestational sac outside of the uterine cavity; moreover the colored Doppler and the power Doppler indicated a thriving vascular ring. The 3D-TVUS in the surface and transparency mode demonstrated that the gestational sac was located in the interstitial region of the uterine tube, and the niche mode accurately evaluated the relationship between the gestational sac and the uterine cavity. The patient was successfully treated with a local injection of methotrexate guided by a transvaginal ultrasonography. The 3D-TVUS was of great importance to confirm the diagnosis, to allow appropriate therapeutic choices and to decrease the morbidity.

Effect of postpartum counseling on postpartum contraceptive use

Abstract: Objective The aim of this study was to evaluate the effect of postpartum counseling on postpartum contraceptive use.

Comparison of human amniotic membrane and hyaluronate/carboxymethylcellulose membrane for prevention of adhesion formation in rats.

Abstract: Objectives To investigate the effectiveness of human amniotic membrane (HAM) in the prevention of postoperative adhesion formation and to compare it with the efficacy of hyaluronate/carboxymethylcellulose (HA/CMC) membrane in a rat model.