生殖医学杂志最新文献

Backround: Primary ovarian pregnancy is a rare form of ectopic gestation and one that is often diagnosed only at the time of surgery.

Case: A 17-year-old primi- gravid woman presented to our clinic with lower abdom- inal pain, vaginal bleeding, and missed period. Trans- vaginal sonography revealed an empty uterus, normal- looking right fallopian tubes, and the presence of a gestational sac containing 2 yolk sacs and 2 embryos with cardiac activity on the right ovary. Methotrexate therapy failed and the patient was successfully treated with laparoscopic enucleation of the ectopic pregnancy mass.

Conclusion: Surgery is the primary treatment modality of choice in twin ovarian pregnancy. Therefore, the differential diagnosis of ovarian pregnancy is of great importance in order to plan immediate surgery and save the patient from unnecessary medical treatment, and thus preserving future fertility.

Objective: To probe the rate of folliculogenesis among women with polycystic ovary syndrome (PCOS) who are oligomenorrheic, and to compare parameters among the group that de- veloped follicles with those who did not to determine how the 2 groups differed.

Study design: A pro- spective cohort study per- formed on women with PCOS who gave a history of regular menstrual cycles less frequent than every 35 days. Transvaginal ultra- sound and urinary luteinizing hormone kits (ovulation predictor) were used to determine the development of a dominant follicle.

Results: A total of 55% of patients developed an ovulatory follicle with menstrual cycle lengths less frequent than every 35 days. The calculated cycle length for this group was 36-45 days.

Conclusion: Among women with PCOS and oligo- menorrhea, rates of ovulation seem to be consistent with -the one study in the literature and lower than the other.

Objective: To identify trends in the diagnostic work- up of polycystic ovarian syndrome (PCOS) performed by specialists in general medicine, endocrinology, and gynecology.

Study design: Ret- rospective electronic chart review of adolescents and young women whose workup for PCOS was initiated by specialists in endocrinology, general medicine, or gyne- cology.

Results: Of 530 charts reviewed, 84 patients quali- fied for inclusion. Approximately two-thirds of patients seen by generalists and endocrinologists had lipid test- ing done; no gynecologist in this study ordered lipid tests. Cortisol levels and markers of congenital adrenal hyperplasia were more often ordered for patients seen by endocrinologists than for those seen by generalists or gynecologists. There was no significant difference among specialties in the use of diagnostic criteria for PCOS, including menstrual irregularity, hyperandrogenism, ovarian imaging, or exclusion of other etiologies. Women seen by endocrinologists tended to be prescribed met- formin more often; however, there was no significant difference in the use of hormonal contraceptives, piogli- tazone, and spironolactone among specialties.

Conclusion: Across 3 clinical practice specialties commonly evaluating menstrual irregularity and/or hirsutism in young women, patients were consistently diagnosed with PCOS based on appropriate, clinically- accepted criteria. However, no patients seen by gyne- cologists received lipid test- ing, which is considered an important screening study for cardiovascular disease risk in this population.

Background: Synchronous (bilateral) ectopic preg- nancy is a very rare gynecological entity resulting in most cases from assisted reproduction techniques. Al- though few cases of bilater- al ectopic pregnancy have been reported in Nigeria, spontaneous bilateral tubal pregnancy in a woman with a diagnosis of bilateral tubal blockage and prior success- ful in vitro fertilization and embryo transfer (IVF-E T) is paradoxically rare and, to the best of our knowledge, has not been reported in Nigeria.

Case: A 37-year-old Nigerian woman presented with ruptured ectopic pregnancy associated with hemoperito- neum with previous diagnosis of bilateral tubal blockage and prior successful IVF-ET She subsequently under- went a laparotomy and the diagnosis of bilateral tubal pregnancy was made during surgery and confirmed by histology. Bilateral salpingectomy was done.

Conclusion: This was the first case of spontaneous bilateral tubal pregnancy in a woman with previous di- agnosis of bilateral tubal blockage and prior successful IVF-ET in Nigeria. There is no evidence-based guideline presently available on the management of bilateral ectopic pregnancy.

Objective: To characterize efforts to improve obstetric hemorrhage education by state health departments and to evaluate them for guiding public policy.

Study design: A survey with questions about maternal mortality/hemorrhage assessments and hemorrhage education for health professionals was emailed to public health officials in all 50 states. Follow-up phone calls and emails were sent over 5 months to maximize participation. A nationwide initiative for educating health professionals in treating chest pain was also examined.

Results: Responses were received from 34 states; 31 had legislative or regulatory requirements for identification and/or investigation of maternal deaths. Obstetric hemorrhage education among states is voluntary with the exception of Illinois, which had a regulatory require- ment. In contrast, a nationwide voluntary accreditation program for chest pain had over 1,000 accredited centers in the 10 years or so since being established.

Conclusion: Only a few states had. voluntary efforts in place for obstetric hemorrhage education. A sin- gle state, Illinois, has a. mandatory education require- ment. A voluntary niodel of accreditation based on the example of Chest Pain Centers might serve as a faster way to provide education to large numbers of health pro- fessionals.

Objective: To analyze the clinical characteristics and outcomes of patients with re-recurrent gestational trophoblastic neoplasia (GTN).

Study design: A total of 547 patients with typical GTN at our institution from 2000-2012 were enrolled in this retrospective study. Of 547 cases, 29 relapsed after initial remission, and 7 of 29 patients with recurrent GTN had repeat relapses. The detailed clinical charac- teristics of patients with re-recurrent GTN were eval- uated.

Results: The recurrence and re-recurrence rates in 547 patients with GTN were 5.3% and 24%, respective- ly. In 7 patients with re-recurrent GTN the mean age was 43 years. The mean level of serum [-hCG before each treatment was 11,405 IU/L. The mean time interval from last treatment to recurrence was 38 months. All 7 patients received first- and second-line chemotherapy, and 4 of them required salvage chemotherapy. The total number of chemotherapy courses administered was 137 (mean= 6). In conjunction with chemotherapy, surgery was performed in all 7 patients. After final treatment 7 patients had a median follow-up of 20 months. Although 1 died secondary to disease progression, the remaining 6 achieved serologic complete remission.

Conclusion: Our anal- ysis suggests that surgical intervention and intensive chemotherapy could be equally important for the treatment of . the patients with re-recurrent GTN. Be- cause the patients have a favorable prognosis, the principles of treatment for re-recurrent GTN should strive to cure.disease rather than simply relieve the symptoms of disease or delay the time of relapse.

Objective: To determine the manuscript publication rate and associated predictors of publication for abstracts submitted to the Reproductive Health Conference from 2004-2010.

Study design: We re- viewed all abstracts and determined publication. We identified and analyzed as- sociated factors potentially related to publication.

Results: We reviewed 577 abstracts: 142 oral presenta- tions (25%) and 435 poster presentations (75%). The majority were published (58%). Abstracts that were published had a higher average number of abstract authors: published abstracts mean=4.26, standard deviation (SD)=1.7, vs. unpub- lished abstracts mean=3.78, SD=1.9 (p=0.001). Multivariable analysis found oral presentation (odds ratio [OR) =2.1, 95% confidence interval [CII 1.4-3.2), high- volume authorship (defined as an author who was listed on >6 abstracts) (OR=1.6, 95% CI 1.1-2.3), and pro- spective study design (OR=1.4, 95% CI 1.0-2.0) to be independent predictors of publication.

Conclusion: A high percentage of the abstracts selected by the Reproductive Health abstract selection committees are likely to be published, and thus it is an important venue for the dissemination of cutting-edge research.

Objective: To compare intraoperative and postopera- tive surgical outcomes of robotic versus abdominal myo- mectomy.

Study design: A retrospective chart review was performed using electronic medical records from Janu- ary 1, 2008-December 31, 2011, with 2008 being the first year that robotic- assisted myomectomy was performed at our institution. Intraoperative outcome data and postoperative complica- tions were reviewed as well as length of hospital stay.

Results: A total of 214 abdominal myomectomy cases and 165 robotic-assisted laparoscopic cases were available for review. Total operating time in minutes.was significantly longer for the robotic-assisted cases (236 ± 96) versus the abdom- inal cases (110 ± 46). Total myoma weight in grams removed was significantly greater in the abdominal myo- mectomy cases (391 ± 518) versus the robot-assisted- cases (229 ± 253). Length of stay in days was longer for abdominal cases as compared to robotic (3.3 ±1.2 vs. 1.6 ± 1). Estimated blood loss in milliliters was similar between abdominal and robotic cases (258 ± 335' vs. 241± 370).

Conclusion: Robotic-assisted and abdominal myo- mectomies have similar surgical outcomes. However, the longer total operating time for robotic-assisted myomec- tomies is a drawback which may not be completely offset by the benefit of a shorter hospital stay.

Objective: To present our experiences with an innovative surgical approach for vaginal agenesis that uses amnion as the allograft to create a functional neovagina.

Study design: This study involved 5 patients with diagnosed vaginal agenesis. One patient had karyotype 46,XY and was diagnosed with complete androgen insensitivity syn- drome, whereas the others had karyotype 46,XX and were diagnosed with Mayer-Rokitansky-Kiister-Hauser syndrome. All patients underwent Mclndoe vagino- plasty using amnion and were followed up at 2 weeks, 3 months, 6 months, and 12 months postsurgery. Functionality of the neovagina was assessed by Rosen Female Sexual Function Index (FSFI) questionnaire.

Results: At the 12-month follow-up 1 patient report- ed. an inability to use the vaginal dilator effectively; for the other 4 patients the mean depth of the neovagina was 9.5 cm and the mean width was 3.5 cm. The mean overall FSFI score was 28.3.

Conclusion: McIndoe vaginoplasty is a simple, safe, and quick operative method that results in a ftnctional vagina. The amnion is a suitable material to apply to the surface of the neovagina because it is readily avail- able and does not have any associated immune reiection problems or costs.

Objective: To compare incidence and severity of neo- natal abstinence syndrome (NAS) in neonates exposed to methadone and selective serotonin reuptake inhibitors (SSRIs) with neonates ex- posed to methadone alone.

Study design: Retro- spective cohort study of women on methadone main- tenance with live births be- tween January 1, 2003, and December 31, 2009, at a tertiary care hospital. Data were abstracted from electronic medical records, exclud- ing cases of multiple gestations and lack of neonatal abstinence score documentation. Data analysis included Mann-Whitney U, Fisher's exact test, a receiver operat- ing characteristic curve, and a scatter diagram.

Results: A total of 91 cases comprised our study population, with 85 (93.4%) assigned to the methadone- only group and 6 (6.6%) assigned to the methadone and SSRIs group. NAS incidence was not significantly different between the methadone/SSRI group and the methadone group (5/6 [83.3%] vs. 43/85 [50.6%], p=0.21). However, severity of NAS (median 14.0 vs. 10.0, p=0.04) and neonatal intensive care unit stay were significantly higher and longer in the methadone/ SSRI group.

Conclusion: While currently neonates exposed to SSRIs are not screened for NAS, health care providers may need to pay closer attention to the effects of SSRIs on neonates.