Showing papers in "Taiwanese Journal of Obstetrics & Gynecology in 2017"

Fetal programming of the metabolic syndrome.

Abstract: Prenatal development is currently recognized as a critical period in the etiology of human diseases. This is particularly so when an unfavorable environment interacts with a genetic predisposition. The fetal programming concept suggests that maternal nutritional imbalance and metabolic disturbances may have a persistent and intergenerational effect on the health of offspring and on the risk of diseases such as obesity, diabetes, and cardiovascular diseases.

Preeclampsia: A review of the pathogenesis and possible management strategies based on its pathophysiological derangements.

Abstract: This review is divided into three parts. The first part briefly describes the pathogenesis of preeclampsia. This is followed by reviewing previously reported management strategies of the disease based on its pathophysiological derangements. Finally, the author defines the safe and acceptable methods/medications that may be used to 'prevent' preeclampsia (in high risk patients) and those that may be used to 'treat' preeclampsia (meant to prolong the pregnancy in patients with established preeclampsia). The review concludes that multi-center trials are required to include multiple drugs in the same management protocol.

Molecular regulation and role of angiogenesis in reproduction.

Abstract: Angiogenesis is an essential process for proper functioning of the female reproductive system and for successful pregnancy realization. The multitude of factors required for physiological angiogenesis and the complexity of regulation of their temporal-spatial activities contribute to aberrations in human fertilization and pregnancy outcomes. In this study, we reviewed the current knowledge of the temporal expression patterns, functions, and regulatory mechanisms of angiogenic factors during foliculogenesis, early implantation/placentation and embryo development, as well as recurrent spontaneous abortions. Angiogenic factors including vascular endothelial growth factors and angiopoietins have documented roles in the development of primordial follicles into mature antral follicles. They also participate in decidualization, which is accompanied by the creation of an extensive network of vessels in the stromal bed that support the growth of the embryo and the placenta, and maintain early pregnancy. During placentation angiogenic and angiomodulatory cytokines, T and B lymphocytes and macrophages affect angiogenesis in a context-dependent manner. Defects in angiogenesis at the maternal-fetal interface contribute to miscarriage in humans. The establishment of more polymorphisms in the genes involved in angiogenesis/vasculogenesis, and their pathological phenotype and expression could give opportunities for prediction, creating a therapeutic strategy, and treatment of diseases related to female reproductive health and problematic conception.

Maternal dyslipidemia during pregnancy may increase the risk of preterm birth: A meta-analysis

Abstract: Epidemiological studies have reported an inconsistent relationship between maternal lipid levels and preterm birth (PTB). We performed this meta-analysis to evaluate the association between maternal dyslipidemia and PTB. Overall, three nested case-control studies and eight cohort studies were eligible. Effect estimates [odds ratio(OR)/relative risk] were pooled using a fixed-effects or a random-effects model. Subgroup and metaregression analyses were conducted to evaluate the sources of heterogeneity. Eleven studies involving 13,025 pregnant women were included. Compared with pregnant women with normal lipid levels, the women with elevated levels of lipids had an increased risk of PTB, and the pooled OR was 1.68 [95% confidence interval (CI): 1.25-2.26)]; meanwhile, women with lower levels of lipids also had a trend of an increased risk of PTB (OR=1.52, 95% CI=0.60-3.82). The pooled ORs for elevated levels of total cholesterol, triglycerides, low density lipoprotein-cholesterol, and lower levels of high density lipoprotein-cholesterol were 1.71 (95% CI: 1.05-2.79), 1.55 (95% CI: 1.13-2.12), 1.19 (95% CI: 0.95-1.48), and 1.33 (95% CI: 1.14-1.56), respectively. The present meta-analysis found that maternal dyslipidemia during pregnancy, either the elevated total cholesterol or triglycerides, was associated with an increased risk of PTB. These findings indicate that a normal level of maternal lipid during pregnancy may reduce the risk of PTB.

Unusual clinical presentations of choriocarcinoma: A systematic review of case reports.

Abstract: Choriocarcinoma (CC) is a highly malignant tumor originating in the trophoblastic tissue. The clinical presentation of CC is so much varied that every case may be one of its kinds and thus can be a diagnostic challenge. Numerous case reports have been published in various journals regarding the unusual clinical presentations of this cancer. Therefore, we conducted a systematic review of all case reports in English language on gestational CC published in PubMed-indexed journals from 1998 to 2015. The main aim was to provide a summary and critical analysis of all the data and evidence published regarding the atypical clinical presentations of CC in recent years. In total, 121 case reports pertaining to unusual clinical manifestations of gestational CC were analyzed. The age of patients in whom cases were reported ranged from 17 to 67 years, and the time period between the index pregnancy and development of CC varied from 4 weeks to as long as 25 years. Cardiopulmonary complaints (20.66%) followed by gastrointestinal (18.43%) and central nervous system manifestations (17.67%) were found to be the most common. Through this review, the authors have made an attempt to discuss various manifestations with which a patient with gestational CC can present to clinician so that early diagnosis and timely management can be initiated, thus improving clinical prognosis.

Intravenous leiomyomatosis of the uterus: A clinicopathological analysis of nine cases and literature review

Abstract: Objective Intravenous/intravascular leiomyomatosis is characterized by intravenous proliferation of a histologically benign smooth muscle cell tumor mass that is non-tissue-invasive. Although benign, intravenous leiomyomatosis may cause remarkable systematic complications, presents significant diagnostic difficulties, and also is characterized by a relatively increased possibility of recurrence. We determine patients’ characteristics, and recurrence and treatment of intravenous leiomyomatosis. Materials and methods Prognostic factors are analyzed with univariate analysis. Differences in categorical data are evaluated by the X2 test. A P value below 0.05 is regarded as indicating a significant difference. Results The data results accord with the widely held view that complete excision of intravenous leiomyomata achieves favorable prognoses regarding remission. The efficacy of using Gonadotropin releasing hormone agonists to prevent growth or recurrence of tumors in unresected or incompletely resected intravenous leiomyomatosis foci. Conclusion If complete surgical resection is not possible, partial resection followed by hormone therapy using gonadotropin-releasing hormone agonists is recommended, which in this study achieved the same favorable prognosis with regard to remission.

Maternal outcome after conservative management of abnormally invasive placenta.

Abstract: Objective The purpose of this study was to describe our preliminary experience of the efficacy and safety of a conservative strategy for abnormally invasive placenta. Materials and Methods A retrospective review of eight pregnant women with abnormally invasive placenta (one with placenta previa accrete, three with placenta previa increta, and four with previa percreta) was performed. The diagnosis was made by prenatal ultrasonography, and was confirmed by operative and histopathological findings. Patients who desired future fertility or who had extensive diseases were selected as candidates after panel meeting. Conservative management after obtaining informed consent was defined by a primary cesarean delivery before 35 weeks of gestation with the abnormally adherent placenta left in situ, partially or totally. The primary outcome was successful uterine preservation. The secondary outcome was severe maternal morbidity including sepsis, coagulopathy, immediate or delayed hemorrhage bladder injury, and fistula. Results Among the eight patients, the mean age was 34 ± 3 years (range, 30–40 years). All women had risk factors, such as placental previa, previous cesarean delivery and/or dilation & curettage, for abnormally invasive placenta. Seven women underwent planned cesarean delivery at the mean gestation age of 34 weeks (range, 31–37 weeks). One woman received hysterotomy at 18 weeks. In our series, the uterus was preserved in only two cases (25%), one who received hysterotomy at a relatively young gestational age and another who had mild disease. Mean maternal blood loss during primary cesarean delivery was 528 ± 499 ml (range, 100 ml–1,500 ml). Severe maternal morbidity was recorded in seven out of eight patients (87.5%). Conclusion In this small series, we observed a low successful uterine preservation rate and a high maternal complication rate. We recommend that primary cesarean hysterectomy should be used as the treatment of choice for mild to severe abnormally invasive placenta. Conservative management should be reserved for women with a strong fertility desire and women with extensive disease that precludes primary hysterectomy due to surgical difficulty.

The effect of oxytocin and Kisspeptin-10 in ovary and uterus of ischemia-reperfusion injured rats

Abstract: Objective Ischemia/reperfusion (I/R) injuries result in damage to endothelial and parenchymal cells. Oxytocin (OXY) stimulates uterine contraction during parturition and myoepithelial cells during suckling. OXY has been used as a protective antioxidant. Kisspeptin plays a key role in the central control of reproductive functions and onset of puberty. Recent studies show that these reproductive hormones have protective potential as antioxidant. The aim of this study is to investigate the potential protective effects of Kisspeptin and OXY as antioxidants on I/R injured ovary and uterus of female rats. Materials and methods Rats were separated into five groups. Group 1, is control group; Group 2, rats were subjected to ischemia followed by reperfusion. Group 3, OXY administration 30 min prior to I/R applied rats; Group 4, Kisspeptin administration 30 min prior to I/R applied rats; Group 5, OXY and Kisspeptin administration 30 min prior to I/R. Ovary and uterus were removed for histopathological and biochemical observations. Malondialdehyde, glutathione levels, and superoxide dismutase activities were analyzed in order to observe antioxidant potential of OXY and Kisspeptin. Hematoxylin and Eosin staining was applied for histopathologic scoring. Results Stromal and granulosa cells in ovary, endometrial cells in uterus were damaged in I/R group. The cellular damage of ovary and uterus were reduced in OXY and Kisspeptin administered I/R group when compared to only Kisspeptin injected I/R group and I/R group. There is no significant difference between OXY and OXY + Kisspeptin injected I/R groups. MDA levels were decreased in Kisspeptin and/or Oxytocin applied I/R group compared to I/R group. SOD activity and GSH levels were increased in Kisspeptin and/or OXY applied I/R group compared to I/R group. Conclusions The present results suggest that exogenous application of oxytocin and kisspeptin can have antioxidant effects on the uterus and ovary.

Effect of non-ablative laser treatment on overactive bladder symptoms, urinary incontinence and sexual function in women with urodynamic stress incontinence

Abstract: Objective To investigate the effects of non-ablative laser treatment on overactive bladder (OAB) syndromes, stress urinary incontinence and sexual function in women with urodynamic stress incontinence (USI). Materials and methods Between April 2015 and June 2015, consecutive patients with USI with OAB syndromes underwent two sessions of Erbium:YAG laser treatment in a tertiary hospital. Patients received validated urological questionnaires, urodynamic studies, 1-h pad test and measurement of vaginal pressure before, one and three months after laser treatment. Questionnaires at 12 months were completed by telephone interview. Adverse effects and patients’ satisfaction were also assessed. Results We included 30 patients with a mean age of 52.6 ± 8.8 years. Three months after therapy, mean 1-h pad test significantly decreased (P = 0.039). Significant improvement in OAB symptoms in four questionnaires were noted at three months post treatment, but not sustained for 12 months in two of them. Three months after therapy, mean vaginal pressure significantly improved (P = 0.009). Of 24 (82.7%) sexually active patients, 62.5% (15/24) and 54.2% (13/24) of their sexual partners reported improved sexual gratification three months later. No major adverse effects were noticed. Conclusions Erbium:YAG laser treatment can resolve USI and coexistent OAB symptoms three months after therapy. Sexual experience is also improved. However, repeated laser therapy may be necessary after six months.

First trimester maternal serum analytes and second trimester uterine artery Doppler in the prediction of preeclampsia and fetal growth restriction

Abstract: Objective This study aimed to determine whether pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (β-hCG), a disintegrin and metalloprotease 12 (ADAM12), and placenta protein 13 (PP13) in the first trimester, and uterine artery Doppler (UAD) in the second trimester, predict preeclampsia and fetal growth restriction (FGR). Materials and methods Maternal serum levels of PAPP-A, free β-hCG, ADAM12, and PP13 at 11–13 +6 weeks of gestation and bilateral uterine artery pulsatility index (PI) at 22–24 weeks of gestation were measured in a nested case–control study within a prospective cohort. The serum analytes and Doppler measurements were compared for uncomplicated pregnancies and pregnancies complicated by preeclampsia and FGR. The efficacy of biochemical and Doppler measurements for the prediction of preelampsia and FGR was investigated. Results Compared with gestational age-matched controls (n = 200), the mean PAPP-A and ADAM12 were lower (P 0.05). In screening for preeclampsia and FGR, assuming a fixed false positive rate (FPR) of 10%, the detection rates were 72% and 68% for a combination of PAPP-A, ADAM12, and UAD, respectively. Conclusion First trimester PAPP-A and ADAM12 levels and second trimester uterine artery PI are associated with adverse pregnancy outcomes. The combination of biochemical markers and UAD improves the screening efficiency for the prediction of preeclampsia and FGR.

The value of hysteroscopic management of cesarean scar pregnancy: a report of 44 cases.

Abstract: Objective With the incidence of cesarean scar pregnancy (CSP) rising, the reports of serious adverse outcomes of it have increased gradually. The management of CSP remains an inadequately explored clinical field, and there is no consensus on it presently. The present study was performed to investigate the efficacy and safety of operative hysteroscopy in the diagnosis and treatment of CSP. Materials and methods Forty-four patients with CSP underwent operative hysteroscopy for removal of scar ectopic pregnancy in our institution. Among them, hysteroscopy was combined with laparoscopy in two patients, three cases with massive hemorrhage were pretreated with bilateral uterine artery embolization before hysteroscopic surgery, and four patients were pretreated with mifepristone (200 mg for 3 days) and methotrexate (25 mg for 2 days). Clinical data, serum β-human chorionic gonadotropin, myometrial thickness, residual conceptus, cesarean scar defect, operation time, blood loss, and hospital stay were recorded. Results All of the ectopic gestations were removed entirely by operative hysteroscopy. Mean operation time was 34.8±16.5 minutes (range 20–120 minutes), and mean blood loss was 35.3±24.4 mL (range 5–100 mL). The mean hospital stay was 5.0±3.01 days (range 1–19 days). Cesarean scar defect could be diagnosed in 70% (31/44) of patients, while in 20/32 cases (63%), a conceptus remained after uterine curettage only was performed. Conclusion Operative hysteroscopy might be recommended as a first-line treatment modality for patients with a cesarean scar ectopic pregnancy, especially when myometrium thickness between bladder and gestational sac is more than 3 mm.

The impact of situation-background-assessment-recommendation (SBAR) on safety attitudes in the obstetrics department.

Abstract: Objective Previous studies evaluating the situation-background-assessment-recommendation (SBAR) have been shown to increase effective nurse–physician communication and collaboration. The purpose of this study is to evaluate the impact of the SBAR technique on safety attitudes in the obstetrics department. Materials and Methods This study implemented the SBAR Collaborative Communication Education course and was conducted in a medical center from February 2012 to March 2015, which included an educational session on fetal heart rate monitoring, a case-based discussion, and a video demonstration on traditional and SBAR communication. The nurses in the obstetrics department were requested to report their clinical findings and recommendations using a novel SBAR list when abnormal fetal heart beat tracings occurred. All obstetric nurses were requested to complete the Chinese-version of the Safety Attitudes Questionnaire before and after the SBAR educational course. The primary outcome was to evaluate the effect of the SBAR technique on the safety attitudes of the obstetrics department. The secondary outcome was to evaluate the effect of the SBAR technique on the 5-minute Apgar score for neonates. Results Most values, including teamwork climate, safety climate, job satisfaction, and working conditions, significantly improved at both postintervention surveys compared with the preintervention survey. There were no significant differences in the number of the neonates with less than seven 5-minute Apgar scores between the pre- and postintervention periods. Conclusion The SBAR technique, which uses a novel structured handover list, is a feasible tool for nurse–obstetrician communication, and it may improve most dimensions of safety attitudes in the obstetrics department.

Placenta associated pregnancy complications in pregnancies complicated with placenta previa

Abstract: Objectives The purpose of our study was to examine the hypothesis that pregnancies complicated with placenta previa have an increased risk of placental insufficiency associated pregnancy complications (IUGR, preeclampsia, placental abruption and perinatal mortality). Materials and methods Our study included all deliveries that occurred at Soroka University Medical Center (Beer Sheva, Israel) between January 1998 and December 2013. Of them 1,249 were complicated by placenta previa and represented our study group. A composite outcome was created to include conditions associated with placental insufficiency. It included hypertensive disorders (i.e. gestational hypertension, mild and severe preeclampsia, HELLP and eclampsia), small for gestational age neonates and placental abruption. Results Patients with pregnancy complicated by placenta previa had significantly different obstetrical characteristics including bad obstetric history (8% vs. 4%, p Conclusions Our study demonstrated an increased rate of placental insufficiency associated complications in women with placenta previa. This is of clinical relevance and suggests that a careful surveillance for women with placenta previa may help in minimizing maternal, fetal and neonatal complications.

Modern human sperm freezing: Effect on DNA, chromatin and acrosome integrity.

Abstract: Objective Presence of vitrification method in sperm freezing and the introduction of solid surface vitrification beside rapid freezing in vapour, opens an easy and safe way to help infertility centres. While the effects of cryopreservation on motility, morphology and viability of sperm are documented, the question of the probable alteration of sperm DNA, chromatin and acrosome integrity after freezing and thawing procedures in different methods is still controversial. Materials and methods Normal sample were collected according to WHO strict criteria. Sperm suspensions were mixed 1:1 with 0.5 M sucrose and divided into four equal aliquots for freezing: fresh, nitrogen direct immersion vitrification (Vit), solid surface vitrification (SSV) and in vapour (Vapour). Sperm suspensions were transferred into a 0.25 ml sterile plastic. Then straw was inserted inside the 0.5 ml straw. For thawing, the straws were immersed in a 42 °C water bath. Beside the sperm parameters, we assessed the acrosome reaction by double staining, chromatin integrity by toluidine blue (Tb) and chromomycin A3 (CMA3) and DNA integrity by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) respectively. Results In progressive motility, the highest rate occurred in Vit (39.9 ± 13.3). Moreover, the lowest rate of immotile sperm was in Vit (32.7 ± 16.3). In normal morphology, the group Vit was similar to the fresh, while SSV and Vapour were significantly different from the fresh. The percentage of acrosome-reacted sperms was more in Vit (81.3 ± 10.2) than the fresh group. TUNEL+ results showed that DNA fragmentation was significantly increased in Vit (p-value = 0.025). While in SSV and Vapour results were comparable to fresh. There was a significant correlation between TUNEL+ and normal morphology, TB, CMA3 and presence of intact acrosome. Conclusion Sperm in Vapour was healthier in terms of DNA, chromatin and acrosome integrity. In contrast of higher motility and normal morphology; DNA, chromatin and acrosome integrity were decreased in Vit. However, these findings were more acceptable in SSV or Vapour.

Intraoperative aortic balloon occlusion in patients with placenta previa and/or placenta accreta: a retrospective study

Abstract: Objective To introduce the primary experience of using aortic balloon catheters during cesarean section for placenta previa and/or placenta accreta. Materials and Methods From January 2013 to May 2015, 43 patients who were preoperatively diagnosed with major placenta previa and/or placenta accreta and who underwent prophylactic aortic catheterization before caesarean section (CS) were included in the study. We analyzed the clinical data of the study population. Surgery- and catheterization-related complications were also reported. Results Major placenta previa or placenta accreta was surgically confirmed in 42 patients, 28 of whom had both conditions. The mean patient age was 32.3 ± 5.5 years, whereas the median gestational age at delivery was 260 (range, 153–280) days. Twenty-nine (67.4%) patients had previously undergone CS, and 13 (30%) patients had undergone emergency surgery for antenatal hemorrhage. The median estimated blood loss during surgery was 500 (range, 100–3,000) mL, and the median duration of occlusion was 20 (range, 5–32) minutes. Hysterectomy was performed in five (11.6%) patients and uterine artery embolization in two (4.6%) patients. Two patients with placenta percreta experienced surgery-related complications, and two patients required hospital readmission. No major catheterization-related complications were observed. Forty-two live births were recorded, and the Apgar score of the infants at 5 minutes was > 7. Conclusion Intraoperative aortic balloon occlusion is a relatively safe method for treating placenta previa and/or placenta accreta during scheduled and emergency CS and might be helpful to prevent hysterectomy and embolization in women wishing to preserve fertility.

Dyspnea in pregnancy

Abstract: Dyspnea in pregnancy is common. It can result from adaption to body changes in pregnancy and also from complications therein. Understanding the mechanisms of change in the respiratory system during pregnancy helps with the differential diagnosis of dyspnea in normal pregnancy as opposed to pathological dyspnea.

Efficacy of PET/CT to exclude leiomyoma in patients with lesions suspicious for uterine sarcoma on MRI.

Abstract: Objective To analyze the efficacy of positron emission tomography/computed tomography (PET/CT) for the diagnosis of uterine sarcoma. Materials and methods Thirty-four patients evaluated between January 2010 and March 2015 were retrospectively enrolled. All patients in whom uterine sarcoma was suspected based on contrast-enhanced magnetic resonance imaging (MRI) findings (heterogeneous, high signal intensity on T2-weighted images and/or high intensity on T1-weighted images) underwent PET/CT for further assessment. Patients were divided into 2 groups based on postoperative pathological findings: uterine sarcoma (n = 15) and leiomyoma (n = 19). The maximum standardized uptake value (SUVmax) of all lesions was measured using PET/CT; we calculated the optimal cutoff value for diagnosing sarcoma. Results The median SUVmax for uterine sarcoma and leiomyoma was 12 and 4.1, respectively; these values were significantly different. An SUVmax of greater than 7.5 was able to exclude leiomyoma with 80.8% sensitivity and 100% specificity (area under the curve, 95.3%). A cutoff SUVmax of 7.5 yields 100% specificity, and a cutoff SUVmax of 4.4 yields a 100% negative predictive value (NPV). The combination of PET/CT and lactate dehydrogenase (LDH) levels had a sensitivity of 86.6%, specificity of 100%, positive predictive value of 100%, and an NPV of 90.4%. No relation between histopathology or International Federation of Gynecology and Obstetrics (FIGO) stage and 18-fluoro-2-deoxy- d -glucose uptake value on PET/CT was seen. The surgical outcome trended toward a correlation with the SUVmax, although this was not statistically significant. Conclusions In patients with MRI findings consistent with either uterine sarcoma or leiomyoma, PET/CT can decrease the false-positive rate by setting an optimal cutoff SUVmax of 7.5. Using this cutoff can avoid unnecessary surgery.

A systematic review of massive transfusion protocol in obstetrics.

Abstract: Post-partum obstetric haemorrhage is a leading cause of mortality among Japanese women, generally treated with haemostatic measures followed by supplementary transfusion. Commonly used in the setting of severe trauma, massive transfusion protocols (MTPs), preparations of red blood cell concentrate (RBC) and fresh frozen plasma (FFP) with additional supplements, have proved effective in decreasing patient mortality following major obstetric bleeding events. Although promising, the optimal configuration of RBC and FFP utilized for obstetric bleeding needs to be verified. Here, we conducted a systematic literature review to define the optimal ratio of RBC to FFP for transfusion therapy during instances of obstetric bleeding. Our analysis extracted four retrospective, observational studies, all demonstrating that an FFP/RBC ratio of ≥1 was associated with improved patient outcomes following obstetric haemorrhage. We therefore conclude that, from the standpoint of haemostatic resuscitation, an FFP/RBC ratio of ≥1 is a necessary condition for optimal clinical management during MTP administration in the field of obstetrics. Hence, we further propose an optimized MTP strategy to be utilized in the setting of severe obstetric bleeding.

Teriparatide and denosumab treatment for pregnancy and lactation-associated osteoporosis with multiple vertebral fractures: A case study.

Abstract: Objective Pregnancy and lactation-associated osteoporosis (PLO) is a rare disease, which can lead to vertebral fractures in women of reproductive age. No treatment strategy for PLO has been established. Here we report a case of PLO treated with teriparatide followed by denosumab, in which remarkable improvement in bone mineral density (BMD) was achieved. Case report A 27-year-old woman experienced severe back pain two weeks after her first delivery. PLO was diagnosed from her low BMD and multiple vertebral compression fractures. She was treated with teriparatide for 6 months, followed by denosumab. After 1 year, her BMD increase from baseline was 16.5% in L2∼4 and her pain had been relieved. Conclusion In addition to weaning, administration of teriparatide followed by denosumab led to remarkable improvement in the patient's symptoms and BMD. Therefore, we regard this method as a promising choice for the treatment of PLO.

Acute small bowel obstruction caused by barbed suture on the second day after laparoscopic hysterosacropexy: A case report and literature review

Abstract: Objective To report a case of small bowel obstruction caused by barbed suture applied in hysterosacropexy, and possible solutions. Case Report A 57-year-old woman underwent laparoscopic hysterosacropexy for a Stage 2 uterine prolapse, presenting with acute abdominal pain and a bowel obstruction syndrome 2 days following the surgery. Conservative treatment was given, but the symptoms did not improve and gradually became worse. Diagnostic laparoscopy was performed on the 7th day after the hysterosacropexy, and the volvulus was found. The residual end of the barbed V-Loc adopted in the peritoneal closure was incidentally hooked to the mesentery and caused small bowel obstruction. The redundant V-Loc was released and cut off at 2 cm. Neither bowel ischemia nor significant bowel injury was noted. Two days later, she was discharged without complication. Conclusion A barbed suture has a risk of bowel obstruction when used in surgery. To avoid a grave prognosis, early diagnosis and prompt management of complication is necessary.

Laboratory and clinical significance of macroprolactinemia in women with hyperprolactinemia.

Abstract: The role of macroprolactinemia in women with hyperprolactinemia is currently controversial and can lead to clinical dilemmas, depending upon the origin of macroprolactin, the presence of hyperprolactinemic symptoms and monomeric prolactin (PRL) levels. Macroprolactinemia is mostly considered an extrapituitary phenomenon of mild and asymptomatic hyperprolactinemia associated with normal concentrations of monomeric PRL and a predominance of macroprolactin confined to the vascular system, which is biologically inactive. Patients can therefore be reassured that macroprolactinemia should be considered a benign clinical condition, resistant to antiprolactinemic drugs, and that no diagnostic investigations or prolonged follow-up should be necessary. However, a significant proportion of macroprolactinemic patients appears to suffer from hyperprolactinemia-related symptoms and radiological pituitary findings commonly associated with true hyperprolactinemia. The symptoms of hyperprolactinemia are correlated to the levels of monomeric PRL excess, which may be explained as coincidental, by dissociation of macroprolactin, or by physiological, pharmacological and pathological causes. The excess of monomeric PRL levels in such cases is of primarily importance and the diagnosis of macroprolactinemia is misleading or inadequate. However, macroprolactinemia of pituitary origin associated with radiological findings of pituitary adenomas may rarely occur with similar hyperprolactinemic manifestations, exclusively due to bioactivity of macroprolactin. Therefore, in such cases with hyperprolactinemic signs and pituitary findings, macroprolactinemia should be considered a pathological biochemical condition of hyperprolactinemia. Accordingly, individualized diagnostic investigations with the introduction of dopamine agonists, or other treatment with prolonged follow-up, should be mandatory. The review analyses the laboratory and clinical significance of macroprolactinemia in hyperprolactinemic women suggesting clinically useful diagnostic and treatment strategies.

The association of enchondromatosis with malignant transformed chondrosarcoma and ovarian juvenile granulosa cell tumor (Ollier disease)

Abstract: Objective Ovarian juvenile granulosa cell tumor has an interesting association with multiple enchondromatosis (Ollier disease and Maffucci syndrome) and should be considered a leading diagnosis when an ovarian mass is found in young patients with these conditions. Besides the association with nonskeletal malignancies, there is a high risk of malignant transformation of enchondroma in chondrosarcoma as was also the case in this instance. Case Report The report uses multiple images to document the representative and characteristic markers of multiple enchondromas in a 22-year-old patient with Ollier disease complicated by malignant transformation of chondrosarcoma and in whom the disease is associated with ovarian juvenile granulosa cell tumor of the right ovary. Conclusion It is important to recognize that when the female patient presents with enchondromatosis and a large unilateral multilocular-solid ovarian mass, the specific diagnosis of granulosa cell tumor can be made with high accuracy.

Radiofrequency ablation for selective reduction in complex monochorionic multiple pregnancies: A case series.

Abstract: Objective To determine the safety and efficacy of radiofrequency ablation (RFA) for selective fetal reduction in complex monochorionic multiple pregnancies. Materials and methods From July 2011 to January 2015, data on all cases treated with RFA were collected prospectively in our hospital. Indications, procedure details, cause of fetal demise and pregnancy outcomes were analyzed. Sonography and magnetic resonance imaging were performed to detect fetal brain damage. Information regarding development after birth was collected according to the Gesell Development Schedule®. Results There were 22 cases of twins (6 presenting with twin-twin transfusion syndrome, 10 with malformations, 4 with selective intrauterine growth restriction, and 2 with twin reversed arterial perfusion sequence); and 11 cases of triplets (9 dichorionictriamniotic, 2 monochorionictriamniotic). All surgeries were completed with one puncture. No maternal complications presented during RFA procedure, and the PPROM rate before 32 w was 9% (3/33). There were 3 cases of intrauterine fetal demise and 4 twin cases where pregnancy was terminated. The fetal survival rate was 77% (17/22) in twins, 91% (20/22) in triplets. Total fetal survival rate was 84% (37/44). The neurodevelopmental follow-up investigations showed no abnormalities in any of the survivors. Conclusion RFA for selective fetal reduction in complex monochorionic multiple pregnancies is effective, minimally invasive, and safe.

Unexpected epithelial ovarian cancers arising from presumed endometrioma: A 10-year retrospective analysis.

Abstract: Objective To evaluate the incidence and prognosis of unexpected epithelial ovarian cancers (EOCs) occurring in presumed benign endometrioma. Materials and Methods Patients who underwent primary surgery at Chang Gung Memorial Hospital between November 2003 and October 2013 were searched with the Systematized Nomenclature of Medicine code followed by chart review. Results The incidence of unexpected EOCs in presumed ovarian endometrioma was 0.14%, as 11 patients were revealed after reviewing 497 patients of pathology-proven EOCs in the current series. All patients were aged ≥ 40 years; seven (63.6%) had inward mass within ovarian cyst in preoperative images, six had cancer antigen-125 (CA-125) > 200 U/mL, and two with CA-125 > 1500 U/mL. Ten patients underwent laparoscopy initially, including five with ovarian preservation at the beginning. Ten patients subsequently completed concurrent or secondary staging surgery, including four totally with laparoscopy. The histologic subtypes had clear-cell (8/11), endometrioid (1/11), mixed clear-cell and endometrioid (1/11), and low-grade serous adenocarcinoma (1/11). Seven patients had endometriosis-associated ovarian carcinoma (EAOC), while the other four were non-EAOC with no endometriosis component. The only mortality was a patient of non-EAOC in Stage IIIc, whereas the other 10 in Stage I were alive. The overall survival rate was 90.9% (10/11) with follow-up ranging from 23 months to 130 months. Conclusion Unexpected EOCs occurring in presumed ovarian endometrioma was rare and, if present, the prognosis was good in Stage I disease with laparoscopic management. Combining parameters of patient's age, CA-125 level, and inward solid mass at imaging could help to raise the precautions.

Vaginal birth after cesarean section-The world trend and local experience in Taiwan

Abstract: Objective The trend of increasing cesarean section rates had evoked worldwide attention. Many approaches were introduced to diminish cesarean section rates. Vaginal birth after cesarean section (VBAC) is a route of delivery with diverse agreements. In this study, we try to reveal the world trend in VBAC and our experience of a 10-year period in a medical center in northern Taiwan. Materials and methods This is a retrospective study of all women who underwent elective repeat cesarean delivery or trial of labor after cesarean (TOLAC) following primary cesarean delivery by a general obstetrician–gynecologist in the Tamshui Branch of MacKay Memorial Hospital (Taipei, Taiwan) between 2006 and 2015. We excluded cases of preterm labor, two or more cesarean deliveries, and major maternal diseases. We compared the characteristics and outcomes between these groups. Results We included 400 women with subsequent pregnancies who underwent elective repeat cesarean delivery or TOLAC during the study period. Among the study population, 112 women were excluded and 11 underwent repeat VBAC. A total of 204 (73.65%) cases underwent elective repeat cesarean delivery and 73 (26.35%) chose TOLAC. The rate of successful VBAC among the women who chose TOLAC was 84.93%. Conclusion With respect to maternal and fetal safety, and success rates and adverse effects of VBAC, the results of this study are promising and compatible with the global data. It shows that a trial of VBAC can be offered to pregnant women without contraindications with high success rates.

Evaluation of HLA-G 14-bp ins/del and +3142G>C polymorphisms with susceptibility to recurrent spontaneous abortion.

Abstract: Objective HLA-G is critically important for successful implantation during pregnancy. Increasing evidence supposed that HLA-G plays a key role in tolerance of the semi-allogeneic graft in pregnancy by inhibiting the cytotoxic functions of T and NK cells. The present study aimed to evaluate the impact of HLA-G rs1063320 (+3142G>C) and 14-bp insertion (ins)/deletion (del) polymorphisms on recurrent spontaneous abortion (RSA). Materials and Methods Genomic DNA from 93 RSA patients and 93 normal fertile women was isolated using the salting out method. Genotyping of HLA-G +3142G>C and 14-bp ins/del variants was done by polymerase chain reaction restriction fragment length polymorphism (PCR-RFP) and PCR method, respectively. Results The HLA-G +3142G>C polymorphism increased the risk of RSA in codominant (OR = 2.39, 95%CI = 1.27–4.49, p = 0.010, GC vs GG; OR = 3.28, 95%CI = 1.16–9.72, p = 0.040, CC vs GG) and dominant (OR = 2.52, 95%CI = 1.37–4.64, p = 0.004, GC + CC vs GG) tested inheritance models. HLA-G rs1063320 C allele was associated with increased risk of RSA (OR = 1.84, 95%CI = 1.20–2.83, p = 0.007). The del/del genotype as well as del allele of 14-bp ins/del variant increased that risk of RSA (OR = 3.02, 95%CI = 1.23–7.41, p = 0.025 and OR = 1.65, 95%CI = 1.09–2.50, p = 0.022, respectively). Conclusion In summary, our results showed that HLA-G gene polymorphisms significantly increased the risk of RSA in a sample of the Iranian population.

Single incision anterior apical mesh and sacrospinous ligament fixation in pelvic prolapse surgery at 36 months follow-up.

Abstract: Objective To compare the clinical efficacy, recurrence, complications and quality of life changes 3 years after Elevate-A/single incision mesh surgery anterior apical (SIM A) and sacrospinous ligament fixation (SSF) in the management of pelvic organ prolapse (POP). Materials and methods A prospective cohort study, 139 women, underwent transvaginal surgery for anterior and/or apical POP > stage 2, 69 patients had SIM A and 70 patients had SSF. The objective cure was defined as POP ≤ stage 1 anterior, apical according to POP-Q. Subjective cure is patient's negative feedback to question 2 and 3 of pelvic organ prolapse distress inventory 6 (POPDI-6). Patient's satisfaction was reported using validated quality of life questionnaires. Multi-channel urodynamic study was used to report any voiding problems related to the prolapse surgery 6 months after surgery. Results 119 patients completed a minimum of 3 years follow-up. 89.8% is the overall prolapse correction success rate for SIM A and 73.3% for SSF group (p = 0.020), and 96.6% versus 73.4% at the anterior vaginal compartment respectively (p ≤ 0.001). Statistically significant difference was noticed in apical compartment with 98.3% with SIM A and 85.0% with SSF (p = 0.009). The subjective success rate, 86.4% in the SIM A and 70.0% in the SSF arm (p = 0.030) was significantly noted. Only, Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) showed significant improvement. Operation time and intra-operative blood loss tend to be more with SIM A. Conclusion SIM A has better 3 years objective and subjective cure rate than SSF in the anterior and/or apical compartment prolapse.

Transvaginal endoscopic surgery-assisted versus conventional laparoscopic adnexectomy (TVEA vs. CLA): A propensity-matched study and literature review

Abstract: Objective Natural orifice transluminal endoscopic surgery (NOTES) may be useful in gynecologic endoscopic surgery. This study evaluated the efficacy, safety, and perioperative outcomes of combined NOTES and vaginal approach, transvaginal endoscopic surgery-assisted adnexectomy (TVEA), for the surgical treatment of presumed benign ovarian tumors. Materials and methods Records were reviewed for 33 consecutive TVEA procedures performed between May 2011 and March 2014. Patient age, body mass index, parity, mass size, and mass bilaterality were used to select comparable patients who had undergone conventional laparoscopic adnexectomy (CLA). Results A total of 236 patients were included in this study (203 CLAs and 33 TVEAs). No cases switched to abdominal laparotomy. Operating time and length of postoperative stay were significantly longer in the CLA group than in the TVEA group, while total hospital charges were higher in the TVEA group ( p conclusion TVEA can be safely performed for benign and large ovarian tumors. In addition, TVEA offers superior operative efficiency compared to CLA.

The role of resveratrol on full - Thickness uterine wound healing in rats

Abstract: Objective Healing of the uterus after cesarean section and myomectomy operation is clinically important. In this study, we aimed to investigate the effects of resveratrol (3,5,4′-o-trihydroxystilbene) on the wound healing process of the uterus in rats treated with resveratrol following full thickness injury of the uterus. Materials and methods Twenty-one female wistar albino rats were divided randomly into three groups (1) control group with no intervention (2) injury group with uterine full thickness injury (3) resveratrol group with uterine full thickness injury and treated with resveratrol. Resveratrol was injected by oral gavage at the doses of 0.5 mg/kg/day for 30 days following uterine full thickness injury. Vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) distributions were assessed using the immunohistochemical methods in tissue and ELISA methods in the tissue homogenate. Glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities were evaluated with colorimetric method and malondialdehyde (MDA) levels also were measured using high performance liquid chromatography in the tissue homogenate. The effects of resveratrol on the uterine histology also were evaluated histologically with the light microscopy. Results Histological evaluation and immunohistochemical evaluations showed that treatment with a resveratrol significantly increased the thickness of the uterine wall and VEGF expression and decreased expression PDGF during wound healing. Biochemically, GPx and SOD activities were increased significantly after treatment with resveratrol. Additionally, resveratrol administration decreased MDA levels. Conclusion These results showed that the antioxidant effects of resveratrol has been shown to have a positive influence on wound healing of the uterus.

Does different BMI influence oocyte and embryo quality by inducing fatty acid in follicular fluid

Abstract: Objective We aimed to assess the effects of obesity-related follicular fluid (FF) fatty acids (FAs) on the number and quality of oocytes, good embryo quality rate, and pregnancy rate. Materials and Methods This prospective cohort study was conducted on 105 infertile women under the age of 38, who underwent intracytoplasmic sperm injection (ICSI) from March 2015 to October 2015. They were grouped into three body mass index (BMI) categories. The fatty acids composition of the FF was analyzed by GC–MS head space method. We studied the FAs correlation with BMI and ICSI outcomes. Results The distribution of fatty acids did not differ significantly in each BMI group, with the exception for stearic that was marginally significant ( p = 0.05). The mean number of mature oocytes did not differ significantly between the BMI groups, the percent of Metaphase II (MII) oocytes was inversely associated with the BMI ( r s = −0.21, p = 0.03). Kruskal–Wallis test showed that the distribution of good quality embryos' percentages were different in at least two categories of studied BMI groups ( p = 0.009, p = 0.02). The mean concentration of palmitic acid was higher in nonpregnant patients for all of the studied BMI classes ( p = 0.02, p = 0.03, p = 0.05), however, stearic ( p p = 0.01) were higher in nonpregnant normal weight patients. Conclusion Differences in BMI are not associated with the fatty acid composition of the FF. The FF fatty acid possibly affects the outcome of ICSI through the achievement of clinical pregnancy. Therefore, it is essential to provide patients with nutritional counseling before they use assisted reproductive techniques.