Showing papers in "Gynecologic and Obstetric Investigation in 2012"
TL;DR: Abdominal pregnancies should be considered in all patients until an intrauterine location can be confirmed, and treatment options by pregnancy location may be helpful in the management of this potentially life-threatening condition.
Abstract: Objective: To define abdominal ectopic pregnancy outcomes by both location and treatment. Methods: Literature review of abdominal pregnancies from 1965 to August of 2009. Ectopic pregnancy exclusions were interstitial, tubal, cervical, ovarian, or those beyond 20 weeks at diagnosis/ treatment. Results: There were 511 cases identified with 225 meeting the inclusion criteria. There were 7 maternal deaths (3.0%) with 18 (8%) of the early abdominal ectopic pregnancies occurring with an intrauterine device in place. Mean gestational age at the time of treatment was 10 weeks 0 days and mean maternal age was 29.7 years. The average blood loss associated with treatment was 1,450 ml. The top three sites of early abdominal ectopic pregnancies were pouches around the uterus (24.3%), serosal surface of the uterus and tubes (23.9%), and multiple sites (12.8%). Primary surgical management was performed in 208 cases (87.8%). Nonsurgical adjuvant or primary therapy included intramuscular methotrexate, intralesional methotrexate, intracardiac KCl, and artery embolization. Conclusion: Abdominal pregnan
102 citations
TL;DR: TENS improved LBP more effectively than did exercise and acetaminophen and no adverse effect of TENS application on pregnant women was observed during the study.
Abstract: Background: To compare the efficiency of transcutaneous electrical nerve stimulation (TENS) with those of exercise and acetaminophen for the treatment of pregnanc
74 citations
TL;DR: This study supports the potential benefit of universal screening and L-T4 treatment for autoimmune thyroid disease during pregnancy and proposes thyroxine treatment in particular cases to further decrease miscarriage rates.
Abstract: BACKGROUND/AIMS: Universal screening for thyroid diseases during pregnancy is controversial. Targeted screening does not identify all women with thyroid dysfunction. Furthermore, antithyroid peroxidase antibodies (TPOAb) are suspected to be associated with an increased risk of fetal loss, premature delivery and hypothyroidism. The aim of our study was to assess the rationale behind universal screening and propose thyroxine treatment in particular cases. METHODS: Between January 2008 and May 2009, 537 consecutive iodine-supplemented women with a singleton pregnancy [441 TPOAb- controls and 96 TPOAb+ women (47 nontreated and 49 treated)] were evaluated using thyroid and obstetric parameters. According to our algorithm for thyroid screening in pregnancy, if thyroid-stimulating hormone (TSH) exceeded 1 mU/l in TPOAb+ women, 50 µg of levothyroxine (L-T4) was prescribed. RESULTS: The miscarriage rate was significantly higher in the nontreated TPOAb+ group compared with the treated group (16 vs. 0%; p = 0.02). Compared to the control group, TSH in TPOAb+ patients was higher at the first prenatal visit prior to L-T4 treatment (p < 0.01), while free thyroxine was higher than in the control group after the 20th week (p < 0.05). CONCLUSIONS: Our study supports the potential benefit of universal screening and L-T4 treatment for autoimmune thyroid disease during pregnancy. Efforts are still needed to further decrease miscarriage rates.
65 citations
TL;DR: Investigating the reproductive outcome after hysteroscopic resection of uterine septum in women with septate uterus and unexplained infertility found that hysteroscopic metroplasty could improve clinical pregnancy rate and live birth rate in patients with otherwise unexplained infertility.
Abstract: Background/Aims: To investigate the reproductive outcome after hysteroscopic resection of uterine septum in women with septate uterus and otherwise idiopathic primary infertility. Methods: Sixty-eight patients with septate uterus and idiopathic primary infertility were included in this prospective observational study. All patients underwent hysteroscopic metroplasty with scissors under general anesthesia. Main outcome measures were clinical pregnancy rate, live birth and abortion rate at 12 months’ follow-up and at mean follow-up time. Results: At 12 months’ follow-up, the clinical pregnancy rate, the live birth rate and the abortion rate were 44% (30/68), 36.8% (25/68) and 16.6% (5/30), respectively. At total follow-up time, the overall pregnancy rate, the live birth rate and the abortion rate were 53.8% (35/65), 41.5% and 14.2% (7/35), respectively, while the stillbirth rate was 2.8% (1/35). Conclusion: Hysteroscopic metroplasty in women with septate uterus and unexplained infertility could improve clinical pregnancy rate and live birth rate in patients with otherwise unexplained infertility. If such a patient is looking for a spontaneous pregnancy, this is more likely to occur during the first 15 months following the procedure.
58 citations
TL;DR: It is determined that PTNS improved the quality of life of women with CPP by decreasing the intensity of pain and contributed to a more comfortable performance of their daily activities.
Abstract: Objective: This research is a prospective study which was designed to determine the effects of percutaneous tibial nerve stimulation (PTNS) therapy on the quality of life and sexual life of patients with chronic pelvic pain (CPP). Methods: The sample consisted of an experimental group (n = 12) and a control group (n = 12), in total 24 patients. The experimental group was treated with PTNS once a week (in total 12 sessions), while the control group received routine intervention. Results: The pain frequency and intensity in women who underwent PTNS decreased considerably. Women had less pain during sexual intercourse after PTNS. We determined in our study that PTNS improved the quality of life of women with CPP by decreasing the intensity of pain and contributed to a more comfortable performance of their daily activities. Conclusions: PTNS is a type of treatment which contributes to the quality of life of women with CPP by decreasing the intensity of pain.
50 citations
TL;DR: Vaginal DQC has been shown to be equally effective as CLM cream, to be well tolerated with no systemic safety concerns, and is therefore a valid alternative therapy for women with BV.
Abstract: Aims: To investigate if vaginal application of dequalinium chloride (DQC, Fluomizin ) is as effective as vaginal clindamycin (CLM) in the treatment of bacterial vaginosis (BV). Methods: This was a multinational, multicenter, single-blind, randomized trial in 15 centers, including 321 women. They were randomized to either vaginal DQC tablets or vaginal CLM cream. Follow-up visits were 1 week and 1 month after treatment. Clinical cure based on Amsel’s criteria was the primary outcome. Secondary outcomes were rate of treatment failures and recurrences, incidence of post-treatment vulvovaginal candidosis (VVC), lactobacillary grade (LBG), total symptom score (TSC), and safety. Results: Cure rates with
46 citations
TL;DR: Whether pregnant women with chronic kidney disease adapt poorly to increases in renal blood flow can exacerbate renal function and impair perinatal outcome, as there is a major interplay between CKD and preeclampsia (PE), is evaluated.
Abstract: Aim: To evaluate whether pregnant women with chronic kidney disease (CKD) adapt poorly to increases in renal blood flow. This can exacerbate renal function and impair perinatal outcome, as there is a major interplay between CKD and preeclampsia (PE). Methods: We analyzed the outcomes of 90 pregnant women with preexisting CKD. The estimated glomerular filtration rate (eGFR) was measured along with the levels of angiogenic factors, soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor, which might act in the pathophysiology of PE. Results: In pregnancies with CKD, PE and preterm delivery were increased and the increased blood pressure worsened the perinatal outcomes much more than the increased proteinuria. All pregnancies with severe renal insufficiency were delivered preterm because of impaired renal function. The eGFR was correlated significantly with 24-hour creatinine clearance (r = 0.830). Significant differences in sFlt-1 and placental growth factor levels were found between severe PE without any complications and severe superimposed PE (p Conclusion: Pregnancies with CKD have a high risk of obstetrical complications. The eGFR might serve for evaluating renal function during pregnancy. Angiogenic factors might be potential markers for a differential diagnosis between PE and worsening renal function.
42 citations
TL;DR: Endometriomas ≤3 cm in diameter per se did not have a deleterious effect on ovarian reserve in ICSI cycles, and the number of oocytes retrieved from ovaries and contralateral normal ovaries was comparable.
Abstract: Background: Our aim was to determine the effect of single endometriomas ≤3 cm in diameter per se on ovarian reserve in intracytoplasmic sperm injection (ICSI) cycles. Methods: We enrolled 19 consecutive infertile patients (29 cycles) who had unilateral single endometriomas ≤3 cm in diameter and who underwent ICSI. Results: The mean age of the patients was 33.3 ± 4.9 years. The mean diameter of endometriomas was 21.8 ± 4.9 mm. Left- and right-sided endometriomas were 34.5 and 65.5%, respectively. The number of oocytes retrieved from ovaries with endometriomas and contralateral normal ovaries was comparable (5.9 ± 4.3 vs. 5.4 ± 3.8). Conclusion: Endometriomas ≤3 cm in diameter per se did not have a deleterious effect on ovarian reserve in ICSI cycles.
40 citations
TL;DR: Both postoperative DMPA and postoperative OC pills for 24 weeks were found to be effective and acceptable options for treating endometriosis-associated pain.
Abstract: Background/Aim: To evaluate the efficacy and tolerability of postoperative depot medroxyprogesterone acetate (DMPA) versus postoperative continuous oral contracep
39 citations
TL;DR: Because of the side effects profile and contraindications of M, this systematic review and meta-analysis believes M should not be indicated as a primary ovulation induction agent in women with PCOS.
Abstract: Background: A recent meta-analysis has proven that metformin (M) is highly effective for ovulation induction in the clomiphene citrate (CC)-resistant patient. The
39 citations
TL;DR: The hypothesis that a placental PG deficiency may contribute to the placental thrombotic lesions characteristic of PE is supported.
Abstract: Background/Aims: Pre-eclampsia (PE) is one of the leading causes of maternal and perinatal morbidity and mortality. PE is defined clinically as the onset of mater
TL;DR: Increasing maternal uric acid concentrations were associated with slightly impaired kidney function and SGA in normotensive pregnant women and multiple linear regression analysis indicated that uric Acid is an independent risk factor for SGA.
Abstract: Aim: Elevated maternal serum uric acid is associated with small-for-gestational-age (SGA) fetuses. We investigated whether uric acid concentrations in normotensive pregnant women are correlated with fetal growth and related to kidney function. Methods: We carried out a case-control study using 40 patients who delivered SGA fetuses identified from the perinatal database and 80 patients who delivered appropriate-for-gestational-age (AGA) fetuses as the controls at Okayama University Hospital. Blood pressure, serum uric acid and creatinine level were measured in the patients’ third trimester. Results:Maternal serum uric acid (p = 0.0003) and creatinine (p = 0.006) and a significant positive correlation between maternal serum uric acid and creatinine levels (r = 0.43; p Conclusions: Increasing maternal uric acid concentrations were associated with slightly impaired kidney function and SGA in normotensive pregnant women.
TL;DR: Most patients with urge and mixed urinary incontinence can be cured by surgery, according to a nonrandomized clinical trial performed in a general hospital and a university clinic.
Abstract: Background/Aims: The etiology of urge urinary incontinence is unknown. Pharmacological treatments are disappointing, since they are only slightly more effective than a placebo. In this study, we analyzed whether the surgical replacement of the uterosacral ligaments by an alloplastic tape can cure patients with mixed and urge urinary incontinence. Methods: This study was a nonrandomized clinical trial. The study was performed in the Department of Gynecology of a general hospital and a university clinic. 135 women with urge or mixed urinary incontinence were operated on. The utero-sacral ligaments as well as the pubo-urethral ligaments – if necessary – were replaced by alloplastic tapes. Clinical outcome was evaluated immediately after surgery, 3 months later and 1 year later. Outcome was classified as cure, improvement or failure and recurrences. Results: 102 patients (77%) were cured and a further 24 patients (18%) showed improvement after surgery. 19 patients developed a recurrence between 5 and 33 months after surgery. Conclusion: We therefore conclude that most patients with urge and mixed urinary incontinence can be cured by surgery.
TL;DR: Findings suggest that HDACs may be involved in adenomyosis, and also suggest the possibility thatHDAC2 may be involvement in dysmenorrhea and its severity and that HD ACs mayBe potential therapeutic targets in adanomyosis.
Abstract: Background/Aims: Adenomyosis is a common condition with a poorly understood pathogenesis. Recent data suggest that it may be an epigenetic disease. This study inv
TL;DR: The administration of NS is effective in reversing tissue damage induced by ischemia and/or I/R in ovaries, and reversed the trend in MDA levels, MPO activity, SOD activity, and GSH levels.
Abstract: Background: To evaluate biochemically and histopathologically the effects of Nigella sativa (NS) in experimental ischemia and ischemia/reperfusion (I/R) injury in rat ovaries. Methods: Thirty-six female rats were divided into 6 groups: group I = sham operation; group II = 500 mg/kg NS + sham operation; group III = bilateral ovarian ischemia; group IV = 500 mg/kg NS + ischemia; group V = 3-hour period of ischemia + 3-hour reperfusion, and group VI: 3-hour period of ischemia + 500 mg/kg NS 2.5 h after the induction of ischemia + 3-hour reperfusion. At the end of ischemia, the bilateral vascular clips were removed, and 3-hour reperfusion was continued. IL-1β, IL-6, and TNF-α cytokine levels in serum, and superoxide dismutase (SOD), myeloperoxidase (MPO), glutathione (GSH), and malondialdehyde (MDA) levels were determined. Results: I/R increased the MDA level and MPO activity while significantly decreasing the SOD activity and GSH level when compared to the sham. The 500-mg/kg dose of NS before I/R reversed the trend in MDA levels, MPO activity, SOD activity, and GSH levels. Ischemia and I/R increased the serum levels of IL-1β, IL-6, and TNF-α, while the administration of NS decreased the serum levels of these cytokines. Conclusions: The administration of NS is effective in reversing tissue damage induced by ischemia and/or I/R in ovaries.
TL;DR: The data do not support the theory that overexpression ERα, ERβ and aromatase in uterine leiomyomas compared to adjacent myometrium are the cause of tumor growth and may be due to different amounts of estrogen receptors in normal and myoma tissues.
Abstract: Background: Leiomyomas are the most common tumors of the female reproductive tract and a major public health problem. The mechanism of tumorigenesis is unknown, but evidence suggests that estrogens regulate cell proliferation and myoma growth. This effect might be due to different amounts of estrogen receptors (ERα and ERβ) in normal and myoma tissues and overexpression of aromatase P450 in myomas. Purpose: To assess protein expression of ERs and aromatase in leiomyomas and normal adjacent myometrium of premenopausal women. Methods: Samples were collected from 12 premenopausal women admitted for abdominal hysterectomy due to fibroids. Results: The protein expression of ERα, ERβ and aromatase was similar in leiomyoma and normal myometrium (p = 0.239, p = 0.695 and p = 0.203, respectively). Conclusions: In this analysis of 12 matched leiomyoma and myometrial samples, the data do not support the theory that overexpression ERα, ERβ and aromatase in uterine leiomyomas compared to adjacent myometrium are the cause of tumor growth. The estrogens may exert their growth-stimulatory effects on leiomyomas intermediated by other elements, such as cytokines and growth or apoptosis factors. The effect of estrogen on the growth and development of fibroids is complex and far from being completely understood.
TL;DR: This nonrandomized study precluded the conclusion that VRR is a safe and effective operation, but improved sexual function improved by 18.75% following VRR in group I.
Abstract: Background: No paper on vaginal columnar rugation rejuvenation has been published so far. Objectives: To evaluate a new surgical technique of vaginal rugae restor
TL;DR: All published cases of primary pulmonary choriocarcinoma are summarized, including a recent case of the patient presented to the authors' clinic because of a positive urine pregnancy test despite taking oral contraceptives, and a complete resection of the tumor was possible.
Abstract: Primary pulmonary choriocarcinoma is a rare disease with only 31 reported cases in the literature so far. Here, we summarize all published cases, including a recent case of our own clinic. Patients usually presented with symptoms like dyspnea, cough, chest pain, weight loss or hemoptysis. In some cases, the nodule in the lung was found in a routine check-up in asymptomatic patients. In the present case, the patient presented to our clinic because of a positive urine pregnancy test despite taking oral contraceptives. Patients in the analyzed cases were either treated with surgery, chemotherapy, radiotherapy or best supportive care. In the present case, a complete resection of the tumor was possible and the patient has not had any signs of recurrence so far. When looking at the published cases and corresponding outcomes, a slight tendency toward a complete resection followed by chemotherapy or close follow-up examinations seems to give the patients the best survival chances. Nevertheless, the overall prognosis of primary pulmonary choriocarinoma is poor and the 5-year survival rate is below 5%.
TL;DR: The finding thatDNMT3B correlates with the severity of dysmenorrhea suggests that DNMTs may be involved in adenomyosis-caused dysmenorhea and its severity, and therapeutics based on epigenetic rectification may hold promise in the management of adenomeosis.
Abstract: Objectives: To investigate the expression and localization of deoxyribonucleic acid methyltransferases (DNMTs) in women with and without adenomyosis. <
TL;DR: Clotrimazole significantly decreased plasma levels of serum malondialdehyde, ischemia-modified albumin, and total oxidant status in a rat ovarian-torsion model and showed the ovarian-protective effects of clotrimazoles on ovarian ischemIA/reperfusion injury.
Abstract: Background/Aims: To evaluate the ovarian-protective effects of clotrimazole on ovarian ischemia/reperfusion injury in a rat ovarian-torsion model
TL;DR: A case of uterine inversion due to Müllerian uterine adenosarcoma whose preoperative workup and diagnosis took advantage of the application of magnetic resonance imaging is reported.
Abstract: Non-puerperal uterine inversion due to uterine sarcomas represents a very rare event with no reliable estimate of frequency in the literature. Clinically, the diagnosis of inversion may be difficult, as far as imaging procedures are concerned, although ultrasonography may prove to be useful. However, some characteristics such as the indentation of the fundic area and a depressed longitudinal groove extending from the uterus to the center of the inverted portion are difficult to recognize. Moreover, there is no specific computed tomography feature accurate enough to aid in the differential diagnosis. Here, we report a case of uterine inversion due to Mullerian uterine adenosarcoma whose preoperative workup and diagnosis took advantage of the application of magnetic resonance imaging.
TL;DR: Introducing a rapid recovery program was associated with shorter hospitalization and did not appear to compromise surgical outcome, indicating that external pressures contributed minimally to the observed changes.
Abstract: Objective: To review the impact of implementing a rapid recovery protocol (RRP) for patients undergoing abdominal hysterectomy. Setting: Metropolitan teaching hospital. Population: Women undergoing abdominal hysterectomy for non-malignant indications. Methods: We conducted a retrospective review of consecutive cases performed during study periods before and after the introduction of an elective rapid recovery program emphasizing regional anesthesia. To control for universal improvements in medical practice, charts from a comparable local hospital without an RRP were also reviewed. Results: 400 charts were reviewed and 366 cases met inclusion criteria and had sufficient information. Patients were well matched for demographic and medical variables between the study periods and between the institutions. The median length of stay (LOS) fell dramatically from 3 (range 1–12) days prior to RRP introduction to 1 (range 1–17) day after RRP (p Conclusions: Introducing a rapid recovery program was associated with shorter hospitalization and did not appear to compromise surgical outcome.
TL;DR: The conversion rate of type 2 DM increased at an average rate of 1.6% per year after a pregnancy affected by GD, and insulin resistance at 8 years postpartum could refine a future diabetic risk in women with prior history of GD.
Abstract: Aims: The progression to type 2 diabetes mellitus (DM) and other long-term cardiometabolic risks in Chinese women with prior history of gestational diabetes (GD) was studied at 15 y
TL;DR: It is recommended that universal screening for hypothyroidism in pregnancy in the population, as the prevalence of hyp Timothyroidism is high, is recommended.
Abstract: Background and Objective: There is a controversy regarding universal versus targeted screening for hypothyroidism during pregnancy. We studied the prevalence and the associated risk factors of hypothyroidism. The secondary objective of the study was to compare the maternal and perinatal outcomes in overt and subclinical hypothyroidism. Methods: We screened 1,005 antenatal patients for hypothyroidism with a thyrotropin assay. Patients diagnosed with hypothyroidism were further tested for anti-thyroid peroxidase antibodies and free thyroxin to determine the cause and type (overt or subclinical) of hypothyroidism. Maternal and perinatal outcomes were compared in the overt, subclinical and euthyroid groups. Results: The overall prevalence of hypothyroidism was 6.3% (overt 2.9% and subclinical 3.4%). Thirty-four (3.4%) new hypothyroid cases could be detected by universal screening. The risk factors for thyroid dysfunction were not significantly different in the screen-positive versus screen-negative patients except for excessive weight gain (p = 0.00). Targeted screening could have missed one third of subclinical hypothyroid cases. Gestational hypertension was significantly greater in the overt hypothyroid group (p = 0.007), and more patients required induction in this group (p = 0.013) but other maternal complications and perinatal outcomes were similar. Conclusion: We recommend universal screening for hypothyroidism in pregnancy in our population, as the prevalence of hypothyroidism is high.
TL;DR: Hispanic women and women with a BMI <30 are more likely to have severe PPH and when mode of delivery is controlled for, BMI ≧30 is associated with a reduced risk of severe P PH.
Abstract: Background/Aims: The purpose of this study was to determine the relationship between maternal characteristics and severe postpartum hemorrhage (PPH). Methods: Medical records of women who delivered at Duke University Hospital between 2001 and 2004 with an ICD-9 code for PPH were reviewed. Women with PPH who received blood component therapy (severe PPH) were selected as cases and compared with controls matched for age, parity and mode of delivery. Results: Among 12,476 deliveries, there were 109 women with severe PPH. Hispanic women had an almost fourfold increase in the odds of severe PPH [OR 3.9 (1.8, 8.7)] that persisted when controlling for other significant predictors of PPH. Women with PPH were almost two times more likely [OR 1.8 (1.1, 3.1)] to have a BMI Conclusion: Systemic factors as well as obstetrical factors modify the risk of severe PPH. Hispanic women and women with a BMI
TL;DR: IL-10 plays an immunoprotective role and improves the pregnancy outcome of T. gondii-infected mice and shows a better mental state, had larger fetuses and placentas with a better blood supply and a lower resorption ratio compared to IG mice.
Abstract: Aims: To investigate the immunoprotective effect of IL-10 on pregnancy in Toxoplasma gondii -infected C57BL/6 mice.
TL;DR: The HRP Special Programme (HRP) began addressing ‘reproduction’ problems (infertility) at the same time as ‘fertility regulation’ (contraception) in 2011.
Abstract: Background/Aims: The HRP Special Programme (HRP) began addressing ‘reproduction’ problems (infertility) at the same time as ‘fertility regulation’ (contraception)
TL;DR: The availability and use of standardized terminology and its translation into Dutch will add to a more standardized communication between professionals responsible for the practice of ART and for those responsible for national, regional, and international registries.
Abstract: Background: A standardized set of definitions was needed in the field of medically assisted reproduction (MAR) to standardize and harmonize international data acquisition and to monitor the availability, efficacy, and safety of assisted reproductive technology (ART) worldwide. In order to provide accurate national data, the use of a terminology list which was composed and negotiated by the International Committee for Monitoring Assisted Reproductive Technology (ICMART) is essential, and a translation into Dutch was crucial for its implementation in Belgium and the Netherlands. Method: The authors of the Dutch article translated the English publication that appeared simultaneously in Human Reproduction and Fertility and Sterility in 2009. A consensus text was obtained after evaluation by experts in the field of MAR both in the Netherlands and in Belgium and then by the board of the respective organizations of obstetrics and gynecology. It was then sent to the World Health Organization (WHO) for approval of publication. Result: A translation into Dutch of the ICMART terminology of 2009 was obtained after consensus was reached on clinical and laboratory procedures, outcome variables, and birth. Conclusion: The availability and use of standardized terminology and its translation into Dutch will
TL;DR: LESS for benign adnexal disease is feasible in patients with or without previous surgery and is comparable to traditional laparoscopic surgery, according to age, body mass index, preoperative diagnosis, indication of surgery and history of previous abdominal surgery.
Abstract: Background: Laparoendoscopic single-site surgery (LESS) is becoming increasingly popular in different disciplines. Evidence is scarce about its utility in gynecol
TL;DR: In myoma uteri cases larger than 14 weeks in size, LigaSure vessel sealing is a secure and comfortable method for surgeons to achieve shorter operation times in abdominal hysterectomy.
Abstract: Objective: To compare electrosurgical bipolar vessel sealing with conventional suturing during abdominal hysterectomy. Methods: