Pub Date : 2023-05-02DOI: 10.29328/journal.cjog.1001127
Vu Annie, Moaddel Victoria, Emmerich Bradley, Ross Linda, Bach Jennifer, Seamon Jason, Barnes Mariah, Ouellette Lindsey, J. Jeffrey
Background: It is unknown what effect the menstrual cycle can have on the susceptibility to trauma following sexual assault. Objectives: To compare the incidence of genital injuries following sexual assault in women with relationship to the three phases of the menstrual cycle Methods: The design was a retrospective, cohort analysis set in a community-based nurse examiner program over a five-year study period. Sexual assault victims were between the ages of 13 - 40 years and agreed to a forensic examination. The menstrual cycle was divided into three phases: follicular, luteal and menses phase. The primary outcomes were the frequency and type of genital injuries documented in relation to the different phases of the menstrual cycle. Results: Case files of 1376 cases of sexual assault were reviewed; 682 (49.6%) met the inclusion criteria. A total of 220 victims (32.3%) were in the follicular phase, 361 (52.9%) were in the luteal phase and 101 (14.8%) were in the menses phase. The three groups were comparable in terms of demographics, assault characteristics, and overall frequency of non-genital injuries. Assault victims in the follicular phase of the menstrual cycle had significantly more documented genital injuries (72.3%; 95% CI 66.4 - 78.2) compared to the luteal phase (64.0%; 95% CI 59.0 - 68.9) and the menses phase (58.4%; 95% CI 48.8 - 68.0). Conclusion: Forensic examiners documented more genital injuries in the follicular phase of the menstrual cycle. Sex hormones may have confounding effects through influences on vaginal epithelial and mucosal integrity.
背景:目前尚不清楚月经周期对性侵犯后创伤易感性的影响。目的:比较女性性侵犯后生殖器损伤的发生率与月经周期的三个阶段的关系方法:设计是一个回顾性的队列分析，设置在一个基于社区的护士检查项目中，为期五年的研究期。性侵受害者年龄在13到40岁之间，并同意接受法医检查。月经周期分为卵泡期、黄体期和月经期三个阶段。主要结果是记录的与月经周期不同阶段有关的生殖器损伤的频率和类型。结果:查阅了1376起性侵案件的案卷;682例(49.6%)符合纳入标准。其中卵泡期220例(32.3%)，黄体期361例(52.9%)，月经期101例(14.8%)。这三组在人口统计学、攻击特征和非生殖器损伤的总体频率方面具有可比性。在月经周期卵泡期的性侵受害者有更多记录在案的生殖器损伤(72.3%;95% CI 66.4 - 78.2)与黄体期(64.0%;95% CI 59.0 ~ 68.9)和月经期(58.4%;95% ci 48.8 - 68.0)。结论:法医在月经周期的卵泡期记录了更多的生殖器损伤。性激素可能通过对阴道上皮和粘膜完整性的影响而产生混淆效应。
{"title":"Association between the victim’s menstrual cycle phase and genital injuries following sexual assault","authors":"Vu Annie, Moaddel Victoria, Emmerich Bradley, Ross Linda, Bach Jennifer, Seamon Jason, Barnes Mariah, Ouellette Lindsey, J. Jeffrey","doi":"10.29328/journal.cjog.1001127","DOIUrl":"https://doi.org/10.29328/journal.cjog.1001127","url":null,"abstract":"Background: It is unknown what effect the menstrual cycle can have on the susceptibility to trauma following sexual assault. Objectives: To compare the incidence of genital injuries following sexual assault in women with relationship to the three phases of the menstrual cycle Methods: The design was a retrospective, cohort analysis set in a community-based nurse examiner program over a five-year study period. Sexual assault victims were between the ages of 13 - 40 years and agreed to a forensic examination. The menstrual cycle was divided into three phases: follicular, luteal and menses phase. The primary outcomes were the frequency and type of genital injuries documented in relation to the different phases of the menstrual cycle. Results: Case files of 1376 cases of sexual assault were reviewed; 682 (49.6%) met the inclusion criteria. A total of 220 victims (32.3%) were in the follicular phase, 361 (52.9%) were in the luteal phase and 101 (14.8%) were in the menses phase. The three groups were comparable in terms of demographics, assault characteristics, and overall frequency of non-genital injuries. Assault victims in the follicular phase of the menstrual cycle had significantly more documented genital injuries (72.3%; 95% CI 66.4 - 78.2) compared to the luteal phase (64.0%; 95% CI 59.0 - 68.9) and the menses phase (58.4%; 95% CI 48.8 - 68.0). Conclusion: Forensic examiners documented more genital injuries in the follicular phase of the menstrual cycle. Sex hormones may have confounding effects through influences on vaginal epithelial and mucosal integrity.","PeriodicalId":36268,"journal":{"name":"Journal of Clinical Obstetrics and Gynecology","volume":"34 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82717552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The gold standard for advanced-stage ovarian cancer surgery entails exploration via a midline vertical laparotomy. Studies have shown that minimally invasive surgery (MIS) can be a safe and effective method for the surgical management of early ovarian cancer. In some cases, MIS can also be selectively used for cytoreductive surgery in cases with advanced-stage ovarian cancer. The robotic platform has the potential to provide similar outcomes to the laparotomy-based standard of care in advanced complex surgery while accelerating recovery, minimizing morbidity, and reducing perioperative complications. The primary objective of this study was to evaluate surgical and perioperative outcomes in patients with advanced ovarian carcinoma who underwent robotic-assisted cytoreduction. A chart review of a nonselected consecutive series of all patients undergoing surgical management of advanced ovarian cancer between 7/1/2017 and 12/31/2021 was conducted. All patients that were diagnosed with Stage III to IV ovarian cancer between the timeframe underwent robotic-assisted cytoreductive surgery at two urban community teaching hospitals in Los Angeles. Twenty-five patients were identified and included in this study. All surgeries were performed by a single surgeon. Optimal or complete CRS was achieved in 96% of the patients (24 of 25 cases). Seven (28%) underwent primary cytoreduction (PCRS) and 18 (72%) underwent interval cytoreduction (ICRS). The estimated median blood loss was 100 mL (25-500 mL), the median operative time was 5.9 hours (3.1-10.5 hours), and the conversion rate to open laparotomy was 0%. There were no intraoperative complications and the readmission rate within 30 days was 4% (1 patient) for ileus, which was managed conservatively. Currently, 64% of the patients in the case series remain alive. The median survival has not been reached. The median follow-up is 4.08 years. Results presented from this nonselected, consecutive case series illustrate how a minimally invasive robotic approach can be safely used in place of the standard exploratory laparotomy for ovarian cytoreduction.
晚期卵巢癌手术的金标准需要通过中线垂直剖腹探查。研究表明，微创手术(MIS)是一种安全有效的早期卵巢癌手术治疗方法。在某些情况下，MIS也可以选择性地用于晚期卵巢癌的细胞减少手术。机器人平台有可能在晚期复杂手术中提供与开腹手术相似的结果，同时加速恢复，最小化发病率，减少围手术期并发症。本研究的主要目的是评估接受机器人辅助细胞减少术的晚期卵巢癌患者的手术和围手术期预后。对2017年7月1日至2021年12月31日期间接受手术治疗的所有晚期卵巢癌患者的非选择性连续系列进行了图表回顾。在此期间，所有被诊断为III期至IV期卵巢癌的患者都在洛杉矶的两家城市社区教学医院接受了机器人辅助的细胞减少手术。25例患者被确定并纳入本研究。所有手术均由一名外科医生完成。96%的患者(25例中有24例)达到了最佳或完全的CRS。7例(28%)进行了原发性细胞减少(PCRS)， 18例(72%)进行了间歇细胞减少(ICRS)。估计中位失血量为100 mL (25 ~ 500 mL)，中位手术时间为5.9小时(3.1 ~ 10.5小时)，开腹转复率为0%。术中无并发症，肠梗阻30天内再入院率为4%(1例)，采用保守治疗。目前，该病例系列中有64%的患者仍然存活。中位生存期尚未达到。中位随访时间为4.08年。从这个非选择的，连续的病例系列中提出的结果说明了微创机器人方法如何可以安全地取代标准的剖腹探查卵巢细胞减少术。
{"title":"Minimally invasive cytoreductive surgery in advanced ovarian cancer: A nonselected consecutive series of robotic-assisted cases","authors":"Shammas Natalie, Avila Rosa, Khatchadourian Christopher, Spencer-Smith Erland Laurence, Stern Lisa, Vasilev Steven","doi":"10.29328/journal.cjog.1001126","DOIUrl":"https://doi.org/10.29328/journal.cjog.1001126","url":null,"abstract":"The gold standard for advanced-stage ovarian cancer surgery entails exploration via a midline vertical laparotomy. Studies have shown that minimally invasive surgery (MIS) can be a safe and effective method for the surgical management of early ovarian cancer. In some cases, MIS can also be selectively used for cytoreductive surgery in cases with advanced-stage ovarian cancer. The robotic platform has the potential to provide similar outcomes to the laparotomy-based standard of care in advanced complex surgery while accelerating recovery, minimizing morbidity, and reducing perioperative complications. The primary objective of this study was to evaluate surgical and perioperative outcomes in patients with advanced ovarian carcinoma who underwent robotic-assisted cytoreduction. A chart review of a nonselected consecutive series of all patients undergoing surgical management of advanced ovarian cancer between 7/1/2017 and 12/31/2021 was conducted. All patients that were diagnosed with Stage III to IV ovarian cancer between the timeframe underwent robotic-assisted cytoreductive surgery at two urban community teaching hospitals in Los Angeles. Twenty-five patients were identified and included in this study. All surgeries were performed by a single surgeon. Optimal or complete CRS was achieved in 96% of the patients (24 of 25 cases). Seven (28%) underwent primary cytoreduction (PCRS) and 18 (72%) underwent interval cytoreduction (ICRS). The estimated median blood loss was 100 mL (25-500 mL), the median operative time was 5.9 hours (3.1-10.5 hours), and the conversion rate to open laparotomy was 0%. There were no intraoperative complications and the readmission rate within 30 days was 4% (1 patient) for ileus, which was managed conservatively. Currently, 64% of the patients in the case series remain alive. The median survival has not been reached. The median follow-up is 4.08 years. Results presented from this nonselected, consecutive case series illustrate how a minimally invasive robotic approach can be safely used in place of the standard exploratory laparotomy for ovarian cytoreduction.","PeriodicalId":36268,"journal":{"name":"Journal of Clinical Obstetrics and Gynecology","volume":"107 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86702577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-24DOI: 10.29328/journal.cjog.1001125
Lende Michelle N, Feustel Paul J, Nicasio Erica K, Lynch Tara A
Background: Pregnant individuals with early cervical dilation have a high risk for preterm birth. The authors encountered cases where cervical dilation increased after anesthesia administration for a cerclage. Objective: The primary objective was to assess if a change in cervical dilation after anesthesia administration for a cerclage was associated with a shorter latency to delivery. Study design: This was a retrospective chart review of pregnancies from January 1, 2011, to December 31, 2021, who had a cerclage and delivered at our institution. Maternal demographics, obstetrical history, operative details, and delivery information were collected. Multi-fetal gestations, un-indicated cerclages, and abdominal cerclages were excluded. The primary outcome was the difference in cervical dilation between the office and the operating room after spinal anesthesia administration. A multivariable regression was performed. Results: A total of 183 pregnancies were included. The mean gestational age at cerclage placement was 18 weeks (STDEV 3.6). Twenty-nine percent of patients (53/183) were more dilated in the operating room compared to the office The latency between cerclage and delivery was not different if there was a cervical change between these settings (p = 0.655). There was an increased risk for preterm delivery with dilation in the office (OR 1.01, CI 1.01 to 2.5), but not with dilation in the operating room (OR 1.4, CI 0.9 to 2.0). Conclusion: Cervical dilation between the office and the operating room is different. Pregnancies with more dilation delivered at earlier gestations. However, a change in dilation between the office and the operating room was not associated with a shorter latency.
背景:早期宫颈扩张的孕妇有早产的高风险。作者遇到的情况下，宫颈扩张增加麻醉后，环扎术。目的:主要目的是评估环扎术麻醉后宫颈扩张的改变是否与较短的分娩潜伏期有关。研究设计:本研究是对2011年1月1日至2021年12月31日期间在我院行环扎术并分娩的孕妇进行回顾性图表回顾。收集产妇人口统计、产科病史、手术细节和分娩信息。排除多胎妊娠、无指征环扎术和腹部环扎术。主要观察结果是脊髓麻醉后办公室和手术室宫颈扩张的差异。进行多变量回归分析。结果:共纳入183例妊娠。结扎放置时的平均胎龄为18周(STDEV 3.6)。29%的患者(53/183)在手术室比在办公室更容易扩张。如果宫颈发生改变，结扎和分娩之间的潜伏期没有差异(p = 0.655)。在办公室进行子宫扩张会增加早产的风险(OR 1.01, CI 1.01 ~ 2.5)，但在手术室进行子宫扩张不会增加早产的风险(OR 1.4, CI 0.9 ~ 2.0)。结论:宫颈扩张在办公室和手术室有所不同。妊娠期较早，妊娠期扩张较多。然而，办公室和手术室之间的扩张变化与较短的潜伏期无关。
{"title":"Does change in cervical dilation after anesthesia impact latency after cerclage placement?","authors":"Lende Michelle N, Feustel Paul J, Nicasio Erica K, Lynch Tara A","doi":"10.29328/journal.cjog.1001125","DOIUrl":"https://doi.org/10.29328/journal.cjog.1001125","url":null,"abstract":"Background: Pregnant individuals with early cervical dilation have a high risk for preterm birth. The authors encountered cases where cervical dilation increased after anesthesia administration for a cerclage. Objective: The primary objective was to assess if a change in cervical dilation after anesthesia administration for a cerclage was associated with a shorter latency to delivery. Study design: This was a retrospective chart review of pregnancies from January 1, 2011, to December 31, 2021, who had a cerclage and delivered at our institution. Maternal demographics, obstetrical history, operative details, and delivery information were collected. Multi-fetal gestations, un-indicated cerclages, and abdominal cerclages were excluded. The primary outcome was the difference in cervical dilation between the office and the operating room after spinal anesthesia administration. A multivariable regression was performed. Results: A total of 183 pregnancies were included. The mean gestational age at cerclage placement was 18 weeks (STDEV 3.6). Twenty-nine percent of patients (53/183) were more dilated in the operating room compared to the office The latency between cerclage and delivery was not different if there was a cervical change between these settings (p = 0.655). There was an increased risk for preterm delivery with dilation in the office (OR 1.01, CI 1.01 to 2.5), but not with dilation in the operating room (OR 1.4, CI 0.9 to 2.0). Conclusion: Cervical dilation between the office and the operating room is different. Pregnancies with more dilation delivered at earlier gestations. However, a change in dilation between the office and the operating room was not associated with a shorter latency.","PeriodicalId":36268,"journal":{"name":"Journal of Clinical Obstetrics and Gynecology","volume":"119 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79414271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-21DOI: 10.29328/journal.cjog.1001124
Alqralleh Muna, Al-Hajjaj Maher, Alasfoor Sadiq, Salman Zainab, Mohammad Salman Farah Bilal, Banihani Majd J
Alkaline Phosphatase (ALP) is produced from the liver, kidney, bone and placenta. During pregnancy, ALP may raise markedly with no clear reason. Here, we present a rare case of highly elevated ALP in a 21 years old pregnant woman during the third trimester who had no important past medical history. It was 2800 U/L. Bone, renal, or liver was all normal. Close monitoring of the fetus and his mother until birth was the way of treatment. We had seven weeks postpartum to decline in ALP concentration but did not return to the normal range. The placenta showed lesions of chronic villitis. The extreme incline in ALP during the gestational stages is riskier because the threat here is posed to 2 lives. In such conditions, constant monitoring of ALP in the maternal serum backed with necessary medication is required.
{"title":"A pregnant with markedly elevated alkaline phosphatase: a case report","authors":"Alqralleh Muna, Al-Hajjaj Maher, Alasfoor Sadiq, Salman Zainab, Mohammad Salman Farah Bilal, Banihani Majd J","doi":"10.29328/journal.cjog.1001124","DOIUrl":"https://doi.org/10.29328/journal.cjog.1001124","url":null,"abstract":"Alkaline Phosphatase (ALP) is produced from the liver, kidney, bone and placenta. During pregnancy, ALP may raise markedly with no clear reason. Here, we present a rare case of highly elevated ALP in a 21 years old pregnant woman during the third trimester who had no important past medical history. It was 2800 U/L. Bone, renal, or liver was all normal. Close monitoring of the fetus and his mother until birth was the way of treatment. We had seven weeks postpartum to decline in ALP concentration but did not return to the normal range. The placenta showed lesions of chronic villitis. The extreme incline in ALP during the gestational stages is riskier because the threat here is posed to 2 lives. In such conditions, constant monitoring of ALP in the maternal serum backed with necessary medication is required.","PeriodicalId":36268,"journal":{"name":"Journal of Clinical Obstetrics and Gynecology","volume":"104 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87127027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-07DOI: 10.29328/journal.cjog.1001123
Campitiello Mara, Cruz `María, González-Ravina Cristina, Vergara Vanessa, Pacheco Alberto, Remohí José, Miranda Antonio Requena
Information regarding the effects of the novel coronavirus on human reproduction is currently limited. The objective of our work was to assess whether, in women who have passed the disease, there was a variation in the ovarian reserve through the determination of AMH levels. During May-June 2020, women performing an Assisted Reproductive treatment and who had a positive IgG for SARS-CoV-2 were included in the study; this group of women had a previous AMH determination of no more than 6 months. Women were stratified into two groups, according to their previous AMH levels: low responders (AMH<1 ng/ml) or normal-high responders (AMH ≥ 1 ng/ml) Statistical analyses were performed using the Statistical Package for Social Sciences 19.0 (IBM Corporation, Armonk, NY, USA). A total of 46 patients were included in the study; 16 women were diagnosed as having low ovarian reserve (AMH < 1 ng/ml), with an average age of 38.6 years, whereas 30 were classified as having normal ovarian reserve (AMH ≥ 1 ng/ml), with an average age of 34.7 years. Generally, the data show no variation in AMH levels before and after SARS-CoV-2 infection (1.73 ng/ml vs. 1.61 ng/ml, respectively). However, when we analyzed these differences according to the study groups, the results were consistent with the patient's ovarian status. It is possible to conclude that the fact of having passed the disease does not affect the ovarian reserve status but the degree of the variation of AMH levels depending on the patient was a low or high responder.
{"title":"SARS-CoV-2 infection does not affect ovarian reserve in women undergoing assisted reproduction","authors":"Campitiello Mara, Cruz `María, González-Ravina Cristina, Vergara Vanessa, Pacheco Alberto, Remohí José, Miranda Antonio Requena","doi":"10.29328/journal.cjog.1001123","DOIUrl":"https://doi.org/10.29328/journal.cjog.1001123","url":null,"abstract":"Information regarding the effects of the novel coronavirus on human reproduction is currently limited. The objective of our work was to assess whether, in women who have passed the disease, there was a variation in the ovarian reserve through the determination of AMH levels. During May-June 2020, women performing an Assisted Reproductive treatment and who had a positive IgG for SARS-CoV-2 were included in the study; this group of women had a previous AMH determination of no more than 6 months. Women were stratified into two groups, according to their previous AMH levels: low responders (AMH<1 ng/ml) or normal-high responders (AMH ≥ 1 ng/ml) Statistical analyses were performed using the Statistical Package for Social Sciences 19.0 (IBM Corporation, Armonk, NY, USA). A total of 46 patients were included in the study; 16 women were diagnosed as having low ovarian reserve (AMH < 1 ng/ml), with an average age of 38.6 years, whereas 30 were classified as having normal ovarian reserve (AMH ≥ 1 ng/ml), with an average age of 34.7 years. Generally, the data show no variation in AMH levels before and after SARS-CoV-2 infection (1.73 ng/ml vs. 1.61 ng/ml, respectively). However, when we analyzed these differences according to the study groups, the results were consistent with the patient's ovarian status. It is possible to conclude that the fact of having passed the disease does not affect the ovarian reserve status but the degree of the variation of AMH levels depending on the patient was a low or high responder.","PeriodicalId":36268,"journal":{"name":"Journal of Clinical Obstetrics and Gynecology","volume":"149 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86784959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-31DOI: 10.29328/journal.cjog.1001122
Elnashar Aboubakr Mohamed
A large systematic review and meta-regression analysis found that sperm counts all over the world appeared to be declining rather than stabilizing. The decline in male sperm counts does not necessarily translate to a decline in male fertility. The cause of declining sperm counts remains unknown; however, several potential causative factors have been identified: 1. Chronic diseases: diabetes mellitus, hypertension; hyperlipidemia, hyperuricemia and skin Diseases & metabolic syndrome. 2. Environmental factors: bisphenol a; phthalates; heavy metals and heat. 3. Lifestyle: obesity, diet, tobacco, alcohol, marijuana, stress, reduced sleep & sedentary life. Addressing these causes is required to stop or decrease male fertility decline. Action to improve semen quality such as prevention & treatment of chronic disease, decreasing unhealthy lifestyle behaviors such as smoking, poor diet, or lack of physical activity & eliminating toxic environmental chemicals.
{"title":"Decline in human sperm parameters: How to stop?","authors":"Elnashar Aboubakr Mohamed","doi":"10.29328/journal.cjog.1001122","DOIUrl":"https://doi.org/10.29328/journal.cjog.1001122","url":null,"abstract":"A large systematic review and meta-regression analysis found that sperm counts all over the world appeared to be declining rather than stabilizing. The decline in male sperm counts does not necessarily translate to a decline in male fertility. The cause of declining sperm counts remains unknown; however, several potential causative factors have been identified: 1. Chronic diseases: diabetes mellitus, hypertension; hyperlipidemia, hyperuricemia and skin Diseases & metabolic syndrome. 2. Environmental factors: bisphenol a; phthalates; heavy metals and heat. 3. Lifestyle: obesity, diet, tobacco, alcohol, marijuana, stress, reduced sleep & sedentary life. Addressing these causes is required to stop or decrease male fertility decline. Action to improve semen quality such as prevention & treatment of chronic disease, decreasing unhealthy lifestyle behaviors such as smoking, poor diet, or lack of physical activity & eliminating toxic environmental chemicals.","PeriodicalId":36268,"journal":{"name":"Journal of Clinical Obstetrics and Gynecology","volume":"40 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85108387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-16DOI: 10.29328/journal.cjog.1001121
Al-Hajjaj Maher, Riyadh Alabdaly Abdilya, Alqralleh Muna, Ibrahim Dana Issa Juma, Mohamed Amna Elrayah
Hyperemesis gravidarum may prompt hypovolemia and significant electrolyte anomalies. Hypokalemia is one of the most common abnormalities. When practical, it may lead to rhabdomyolysis. We report a rare case of rhabdomyolysis in a 24 years old pregnant woman due to hyperemesis gravidarum. She had a profound weakness. Physical examination and laboratory findings showed a need for the hospital admission. Aggressive rehydration and electrolytes were the definite treatment. Her serum creatinine kinase (CK) concentration during entry was 80,01 units/L. Continuous rehydration led to complete recovery clinically. On discharge, she had normal laboratories.
{"title":"Rhabdomyolysis in a pregnant woman: A case report","authors":"Al-Hajjaj Maher, Riyadh Alabdaly Abdilya, Alqralleh Muna, Ibrahim Dana Issa Juma, Mohamed Amna Elrayah","doi":"10.29328/journal.cjog.1001121","DOIUrl":"https://doi.org/10.29328/journal.cjog.1001121","url":null,"abstract":"Hyperemesis gravidarum may prompt hypovolemia and significant electrolyte anomalies. Hypokalemia is one of the most common abnormalities. When practical, it may lead to rhabdomyolysis. We report a rare case of rhabdomyolysis in a 24 years old pregnant woman due to hyperemesis gravidarum. She had a profound weakness. Physical examination and laboratory findings showed a need for the hospital admission. Aggressive rehydration and electrolytes were the definite treatment. Her serum creatinine kinase (CK) concentration during entry was 80,01 units/L. Continuous rehydration led to complete recovery clinically. On discharge, she had normal laboratories.","PeriodicalId":36268,"journal":{"name":"Journal of Clinical Obstetrics and Gynecology","volume":"65 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84500975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Ovarian fibroma is a very unusual epithelial tumor representing less than 1% of all ovarian tumors. It can be asymptomatic and discovered during surgery or be associated with a pleural effusion preferentially located on the right side and a more or less abundant free ascites in the framework of the so-called Meigs syndrome. The challenge of management then lies in distinguishing benign from malignant since clinically, radiologically, and biologically everything points towards malignant which requires radical surgical treatment. We report here the case of a 69-year-old postmenopausal patient with a clinical form of Meigs' syndrome that strongly suggested ovarian cancer. Case presentation: We hereby report here the case of a 69-year-old patient, menopausal, gravida 4 para 3 with 3 live children delivered vaginally and one miscarriage. She presented with ascites, hydrothorax, and a solid tumor of the ovary. Serum CA 125 and HE 4 levels were very high. ROMA score was highly suggestive of malignancy. A hysterectomy with adnexectomy was performed. It was only the histological evidence of ovarian fibroma and the rapid resolution of its effusions that confirmed Meigs syndrome. Conclusion: Meigs syndrome is an anatomical-clinical entity that associates a benign tumor of the ovary, ascites, and hydrothorax. Highly elevated CA 125 and HE-4 tumor markers often point clinicians toward a malignant tumor and compel radical surgical treatment. This case report reminds us once again that only histology confirms the diagnosis of cancer.
{"title":"Meigs syndrome: About an uncommon case report","authors":"Slaoui Aziz, Lazhar Hanaa, Amail Noha, Zeraidi Najia, Lakhdar Amina, Kharbach Aicha, Baydada Aziz","doi":"10.29328/journal.cjog.1001120","DOIUrl":"https://doi.org/10.29328/journal.cjog.1001120","url":null,"abstract":"Background: Ovarian fibroma is a very unusual epithelial tumor representing less than 1% of all ovarian tumors. It can be asymptomatic and discovered during surgery or be associated with a pleural effusion preferentially located on the right side and a more or less abundant free ascites in the framework of the so-called Meigs syndrome. The challenge of management then lies in distinguishing benign from malignant since clinically, radiologically, and biologically everything points towards malignant which requires radical surgical treatment. We report here the case of a 69-year-old postmenopausal patient with a clinical form of Meigs' syndrome that strongly suggested ovarian cancer. Case presentation: We hereby report here the case of a 69-year-old patient, menopausal, gravida 4 para 3 with 3 live children delivered vaginally and one miscarriage. She presented with ascites, hydrothorax, and a solid tumor of the ovary. Serum CA 125 and HE 4 levels were very high. ROMA score was highly suggestive of malignancy. A hysterectomy with adnexectomy was performed. It was only the histological evidence of ovarian fibroma and the rapid resolution of its effusions that confirmed Meigs syndrome. Conclusion: Meigs syndrome is an anatomical-clinical entity that associates a benign tumor of the ovary, ascites, and hydrothorax. Highly elevated CA 125 and HE-4 tumor markers often point clinicians toward a malignant tumor and compel radical surgical treatment. This case report reminds us once again that only histology confirms the diagnosis of cancer.","PeriodicalId":36268,"journal":{"name":"Journal of Clinical Obstetrics and Gynecology","volume":"53 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78699647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Among the different forms of ectopic pregnancy, cesarean scar pregnancy is one of the most uncommon with an estimated incidence of 1/1800 pregnancies. A major risk of massive hemorrhage, it requires active management as soon as it is diagnosed because it can affect the functional prognosis of the patient (hysterectomy) but can also be life-threatening. Different surgical techniques are generally proposed in first intention to patients who no longer wish to have children, who are hemodynamically unstable and/or in case of failure of medical treatment. Case presentation: We hereby report the case of a young 19-year-old patient with no particular medical history, gravida 2 para 1 with a live child born after a cesarean section for fetal heart rhythm abnormalities during labor 5 months earlier and who presented to the emergency room of our structure for the management of a cesarean pregnancy scar diagnosed at 6 weeks of amenorrhea. She was successfully managed with an intramuscular injection of methotrexate. The follow-up was uneventful. Conclusion: The implantation of a pregnancy on a cesarean section scar is becoming more and more frequent. With consequences that can be dramatic, ranging from hysterectomy to life-threatening hemorrhage, clinicians must be familiar with this pathological entity and be prepared for its management. The latter must be rapid and allow, if necessary, the preservation of the patient's fertility. In this sense, conservative medical treatment with methotrexate injections should be proposed as a first-line treatment in the absence of contraindication.
{"title":"Cesarean scar pregnancy: A clinical case report","authors":"Slaoui Aziz, B. Aicha, Tayeb Roughaya, Zeraidi Najia, Lakhdar Amina, Baydada Aziz, Kharbach Aicha","doi":"10.29328/journal.cjog.1001119","DOIUrl":"https://doi.org/10.29328/journal.cjog.1001119","url":null,"abstract":"Background: Among the different forms of ectopic pregnancy, cesarean scar pregnancy is one of the most uncommon with an estimated incidence of 1/1800 pregnancies. A major risk of massive hemorrhage, it requires active management as soon as it is diagnosed because it can affect the functional prognosis of the patient (hysterectomy) but can also be life-threatening. Different surgical techniques are generally proposed in first intention to patients who no longer wish to have children, who are hemodynamically unstable and/or in case of failure of medical treatment. Case presentation: We hereby report the case of a young 19-year-old patient with no particular medical history, gravida 2 para 1 with a live child born after a cesarean section for fetal heart rhythm abnormalities during labor 5 months earlier and who presented to the emergency room of our structure for the management of a cesarean pregnancy scar diagnosed at 6 weeks of amenorrhea. She was successfully managed with an intramuscular injection of methotrexate. The follow-up was uneventful. Conclusion: The implantation of a pregnancy on a cesarean section scar is becoming more and more frequent. With consequences that can be dramatic, ranging from hysterectomy to life-threatening hemorrhage, clinicians must be familiar with this pathological entity and be prepared for its management. The latter must be rapid and allow, if necessary, the preservation of the patient's fertility. In this sense, conservative medical treatment with methotrexate injections should be proposed as a first-line treatment in the absence of contraindication.","PeriodicalId":36268,"journal":{"name":"Journal of Clinical Obstetrics and Gynecology","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91220292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims: To analyze the prevalence and risk factors for postoperative lower urinary tract symptoms (LUTS) in women submitted to robot-assisted sacrocolpopexy (RASC) for correction of pelvic organ prolapse (POP). Methods: A longitudinal prospective study was carried out on 51 consecutive women who underwent RASC to treat POP. We recorded preoperatively the presence of LUTS urgency, symptomatic stress urinary incontinence (SUI), and voiding difficulty. We also performed an urodynamic study prior to surgical intervention including an incontinence test for overt and occult stress urinary incontinence (with POP reduction). A transobturator suburethral sling (TOT) was implanted in patients with demonstrable urodynamic SUI (overt or occult). Patients' LUTS were reassessed at 6 months after the surgical intervention. McNemar test and the Fisher exact test were used to analyzing dependent variables and Student’s t - test for independent variables. Statistical significance was set at p ≤ 0.05. Results: Postoperative voiding difficulty and symptomatic SUI were significantly reduced. No significant differences were observed in the postoperative prevalence of urgency. The presence of preoperative urinary urgency was the only significant risk factor of postoperative urgency, whereas TOT placement was the only significative factor associated with postoperative symptomatic SUI. TOT placement in patients with occult SUI significantly reduced postoperative Symptomatic SUI. Conclusion: RASC reduces the prevalence of voiding difficulty but not urgency. Concomitant implantation of TOT in patients with preoperative urodynamic SUI (overt or occult) is useful to reduce symptomatic postoperative SUI.
{"title":"Prevalence and risk factors of lower urinary tract symptoms after robotic sacrocolpopexy","authors":"Vírseda-Chamorro Miguel, Salinas-Casado Jesús, Moreno-Sierra Jesús","doi":"10.29328/journal.cjog.1001118","DOIUrl":"https://doi.org/10.29328/journal.cjog.1001118","url":null,"abstract":"Aims: To analyze the prevalence and risk factors for postoperative lower urinary tract symptoms (LUTS) in women submitted to robot-assisted sacrocolpopexy (RASC) for correction of pelvic organ prolapse (POP). Methods: A longitudinal prospective study was carried out on 51 consecutive women who underwent RASC to treat POP. We recorded preoperatively the presence of LUTS urgency, symptomatic stress urinary incontinence (SUI), and voiding difficulty. We also performed an urodynamic study prior to surgical intervention including an incontinence test for overt and occult stress urinary incontinence (with POP reduction). A transobturator suburethral sling (TOT) was implanted in patients with demonstrable urodynamic SUI (overt or occult). Patients' LUTS were reassessed at 6 months after the surgical intervention. McNemar test and the Fisher exact test were used to analyzing dependent variables and Student’s t - test for independent variables. Statistical significance was set at p ≤ 0.05. Results: Postoperative voiding difficulty and symptomatic SUI were significantly reduced. No significant differences were observed in the postoperative prevalence of urgency. The presence of preoperative urinary urgency was the only significant risk factor of postoperative urgency, whereas TOT placement was the only significative factor associated with postoperative symptomatic SUI. TOT placement in patients with occult SUI significantly reduced postoperative Symptomatic SUI. Conclusion: RASC reduces the prevalence of voiding difficulty but not urgency. Concomitant implantation of TOT in patients with preoperative urodynamic SUI (overt or occult) is useful to reduce symptomatic postoperative SUI.","PeriodicalId":36268,"journal":{"name":"Journal of Clinical Obstetrics and Gynecology","volume":"42 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79197924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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