生殖医学杂志最新文献

Objective: To compare the distribution of proopiomelanocortin (POMC) in decidua and placenta samples from missed abortion and voluntary termination cases in order to research the effects in the etiology of missed abortion.

Study design: Decidual materials were collected from patients who were diagnosed with missed abortion (n=19) and legal voluntary termination cases (n=15) under 10 gestational weeks. Materials were divided into 2 groups for examination. For all samples, POMC primary antibody was performed by immunohistochemical staining. The number of stained cells was calculated by using the H-score technique.

Results: In the missed abortion group the mean age was 28.7 (18–41), and in the control group the mean age was 27.5 (21–37). POMC immunoreactivity was determined to be lower in the parenchyma and placenta of the missed abortion group than those of the control group. POMC immunoreactivities were found to be higher in both the syncytiotrophoblast and cytotrophoblast cells of the missed abortion group than those of the control group (p<0.005).

Conclusion: POMC has become a paradigmatic polypeptide precursor and has a role in the parturition process. Local production of POMC in placenta and decidua may influence pregnancy and may have a role in missed abortion pathogenesis.

BACKGROUND: Pregnant women are susceptible to visual disturbances, particularly with hypertension. Vision generally recovers postpartum within hours to days. A rare condition known as Purtscher-like retinopathy presents abruptly postpartum with visual field defects and blindness. Recovery of vision is unpredictable, occurring over several weeks and months.CASE: A 38-year-old woman presented at 34 weeks' gestation with contractions and heavy bleeding. Placental abruption was confirmed after a repeat cesarean was performed. Hours after delivery, she complained of central vision loss despite normal blood pressure and preeclamptic laboratory results. The diagnosis of Purtscher-like retinopathy was made, presumably from multiple infarcts to the retina caused by the placental abruption.CONCLUSION: Recovery from Purtscher-like retinopathy may result in permanent visual impairment.

BACKGROUND: The cesarean delivery rate continues to rise in the United States. The majority of cesarean deliveries are performed secondary to a previous cesarean delivery. Bladder injury at the time of a repeat cesarean delivery is a known risk.CASE: A 28-year-old woman sustained an incidental cystotomy during her second cesarean delivery, which was repaired at that time. During her third cesarean delivery she was noted to have a 6x5-cm calculus in her bladder. This large bladder calculus was removed through a cystotomy and her bladder was repaired without incident.CONCLUSION: Women with a previous bladder injury undergoing repeat cesarean delivery should have their bladder carefully inspected for any further urologic complications.

BACKGROUND: Pyogenic granuloma (PG) is a common vascular lesion of the skin and subcutaneous tissue and is usually found on the face, trunk, and limbs. It is well known by general surgeons.CASE: A 42-year-old woman attended our clinic due to a rapidly growing, glistening, ulcerative, pedunculated vulvar mass. The mass was excised and subsequent histopathology revealed it as PG, which was completely unexpected. We reviewed the previous reported cases to investigate its clinical behavior, incidence, and management.CONCLUSION: PG of the vulva is a common clinical misdiagnosis. It is the third most common vulvar vascular lesion, but all the reported cases were diagnosed after histopathological examination. Gynecologists should include PG among the differential diagnoses of vulvar polypoid mass.

OBJECTIVE: To examine whether postpartum contraceptive rates are higher in the CenteringPregnancy population as compared to patients who choose to participate in traditional prenatal care. Centering Pregnancy is a model of obstetrical care that allows for enhanced contraceptive education.STUDY DESIGN: All patients who were delivered within the Florida State University College of Medicine Obstetrics and Gynecology residency from October 31, 2010, to October 31, 2011, were included in the study. A retrospective chart review was undertaken to compare the postpartum contraceptive use of patients in traditional obstetric care versus patients in CenteringPregnancy.RESULTS: A total of 472 obstetrical charts were reviewed, with 350 women participating in traditional care and 122 women in CenteringPregnancy. Using Fisher's exact test, the 2 groups' postpartum contraceptive use was compared. Analysis revealed that 57.4% of CenteringPregnancy patients returned for postpartum contraception, vs. 37.7% of traditional prenatal care patients. Furthermore, 24.5% of CenteringPregnancy patients chose long-acting reversible contraception as compared to only 8.28% of traditional patients.CONCLUSION: Centering Pregnancy leads to an increase in use of postpartum contraception when compared to traditional prenatal care. Long-acting reversible contraceptive usage rates were also significantly higher among CenteringPregnancy patients and were the most frequently chosen method of family planning.

OBJECTIVE: To investigate the relationship between ovarian volume-related parameters and in vitro fertilization (IVF) outcomes in order to establish an accurate and reliable method of determining ovarian response or IVF outcomes.STUDY DESIGN: A total of 142 women undergoing controlled ovarian stimulation with gonadotropin-releasing hormone agonist were retrospectively analyzed. In each ovary, diameters in 2 perpendicular planes were measured and calculated by applying the formula for an ellipsoid: (D1xD2x(D1+D2/2)xπ/6). The total basal ovarian volume (BOV) was calculated as the sum of the bilateral ovarian volume. Total follicular volume (TFV) was defined as sum of bilateral follicular volume. The study subjects were grouped by TFV/BOV and by TFV/BOV/stimulation days.RESULTS: A significantly higher number of oocytes was retrieved in the participants with a higher TFV/BOV (p=0.002). The patients with higher TFV/BOV/stimulation days also demonstrated a significantly higher serum estradiol level on the hCG day and a higher number of retrieved oocytes (p=0.04 and 0.02, respectively). In a multivariate analysis, the TFV/BOV/stimulation days had a significant independent effect on the number of transferred embryos (p=0.01).CONCLUSION: Ovarian volume-related dynamic parameters play an important role in predicting ovarian response and IVF outcomes.

BACKGROUND: Complications of operative laparoscopy and laparoscopic hysterectomy were once repaired by laparotomy. Their laparoscopic repair still offers challenges, most especially in the presence of inflammation, scarring, and tissue distortion. This report presents a new application, under high-risk conditions, of a simple and effective method for repair of inadvertent cystotomy.CASE: A 29-year-old woman undergoing laparoscopic hysterectomy for a vaginal mass experienced an incidental bladder injury in the context of a retained foreign body, extensive inflammatory changes, and scarring. A novel use of a standard laparoscopic tool produced a rapid, effective bladder repair.CONCLUSION: Simple and effective cystotomy repair is possible even under extremely complex conditions.

OBJECTIVE: To examine the potential use of hyperglycosylated human gonadotropin (hCG-H) in identifying ectopic pregnancies in pregnancies of unknown location (PULs) on ultrasound scan.STUDY DESIGN: This was a prospective observational study. An additional blood sample was taken from women whose initial transvaginal ultrasound scan showed none of the following: intact intrauterine pregnancy, retained placental tissue, or ectopic pregnancy. Parallel sandwich ELISAs were performed using sheep monoclonal antibodies to the 12F6 epitope for detection of total hCG and to the 4D8 epitope for hCG-H detection, and an automated immunoassay technique was used for progesterone and serum β-hCG measurements. Patients were managed accord-ing to our standard clinical protocol.RESULTS: hCG-H was significantly higher in ectopic pregnancies (85.6 ng/mL) than in viable intrauterine pregnancies (26.8 ng/mL) and spontaneously resolving pregnancies (23.2 ng/mL). The ability to distinguish ectopic pregnancies from nonectopic pregnancies, expressed as area under the curve, was 0.816 for hCG-H and 0.824 for total hCG.CONCLUSION: Women with an underlying ectopic pregnancy tended to have higher hCGs, whichever assay was used. However, the current study does not support a role for a single measurement of hCG-H in the diagnosis of ectopic pregnancy within the PUL population.

OBJECTIVE: To examine the prevalence and the effect of intimate partner violence (IPV) during pregnancy on maternal and neonatal health outcomes among Hispanics.STUDY DESIGN: A cross-sectional survey was conducted among Hispanic women who delivered at a Houston hospital between January 2011 and October 2012; 613 women completed self-administered questionnaires in the postpartum window prior to discharge. Indices of maternal and neonatal health were compared between women with and without reports of IPV during the most recent pregnancy.RESULTS: Approximately 11% of the surveyed population reported having experienced IPV during the most recent pregnancy. Among non-U.S. born participants, women who experienced IPV reported longer U.S. stay (11.4±7.3 years) as compared to women who did not (9.2±6.3 years). They were more likely to be unhappy about their pregnancy and to have evidence of depres-sion. Reported IPV was also associated with later initiation of prenatal care, a greater likelihood of delivery before 34 weeks' gestational age, lower infant birth weight, and lower likelihood of planning to breastfeed beyond 12 months (aOR 0.43, CI 0.21-0.83; p=0.02).CONCLUSION: IPV during pregnancy is associated with adverse maternal and neonatal health outcomes. Prenatal programs should assess Hispanic women for IPV during pregnancy with the goal of mitigating its long-term health consequences.

OBJECTIVE: To examine the expressions of thioredoxin-1 (TRX-1) and thioredoxin-1 binding protein-2 (TBP-2) in placentas affected by preeclampsia.STUDY DESIGN: We examined the mRNA levels of TRX-1, TBP-2, cyclooxygenase-2 (COX-2), and tumor necrosis factor-α (TNF-α) in preeclamptic (n=20) and normal placentas (n=18) by quantitative reverse transcriptase-polymerase chain reaction.RESULTS: We found the mRNA level of TRX-1 was significantly decreased (p<0.005), while the mRNA levels of TBP-2, COX-2, and TNF-α were significantly increased in the placentas in preeclampsia when compared to the normal group (p<0.005).CONCLUSION: These data suggest that TBP-2 may play roles in the pathophysiology of preeclampsia, probably by contributing to oxidative stress and inflammation. Thus, TBP-2 may be a potential therapeutic target for preeclampsia.