生殖医学杂志最新文献

Background: Autoimmune hepatitis (AIH) is a progressive chronic hepatitis of unknown cause that occurs in children and adults, with a paucity of informa- tion of this disorder existing -__ in pregnancy.

Case: A primigravid pa- tient presented at 30 weeks with altered mental status, abdominal pain, vomiting, and epistaxis. Her history was significant for por- tal hypertension, encepha- lopathy, ascites, coagulopathy, hyperammonemia, and end-stage liver disease secondary to AIH. Ultrasound revealed cirrhosis, ascites, splenomegaly, and an appro- priately grown singleton gestation. She received 2 intra- muscular doses of betamethasone over 24 hours, subcuta- neous vitamin K, and oral prednisone. A lower extremity venous Doppler study was negative for thrombosis. She received ceftriaxone 1 g daily x 5 days to treat sponta- neous bacterial peritonitis. A unit of packed red blood cells and 1 unit of platelets were transfused prior to a primary cesarean 2 weeks after the initial presentation. Postoperative agitation was managed with risperidone, and wound infection was treated with vancomycinl metronidazole. She discharged herself against medical advice on postoperative day 15, and the infant was dis- charged to foster care on day 15 of life.

Conclusion: Multiple management challenges usu- ally arise in pregnancies com- plicated by end-stage - liver disease. However, with com- prehensive multidisciplin- ary care a successful perina- tal outcome can be accom- - plished.

Objective: To investigate the effects of the anti- β2-glycoprotein I (anti-β2-GPI) antibody on the tro- phoblast by evaluating the effects of the anti-β2-GPI antibody on the expression of toll-like receptor (TLR) mRNA in choriocarcinoma cells and primary trophoblast cells.

Study design: We cul- tured the choriocarcinoma cells (BeWo) and the pri- mary first trimester tropho- blast with the IgGs taken from anti-β2-GPI antibody-positive and -negative sera. Four hours later we purified the RNAs from those cells. We measured the expressions of TLR mRNA in cells using real-time. PCR.

Results: The expression of TLR mRNA increased in BeWo cells and primary trophoblast cells cultured with the IgGs taken from anti-β2-GPI antibody-positive women. Specifically, the expression of TLR1, 2, and 4 in BeWo cells -and TLRI, 3, 4, and 9 in first trimester trophoblast cells increased significantly.

Conclusion: The anti-β2-GPI antibody-positive IgG increased the TElR mRNA expression in choriocarcino- ma cells and primary trophoblast cells. We suggest that anti-β2-GPI antibodies may bind to trophoblast and increase the expression of TLR mRNA.

Background: Sex reversal syndrome is a genetic anomaly caused by the disorder of sex development (DSD) with the characteristics of inconsistent phenotype normal penile size but small testes and infertility re- stulting from azoospermia.

Case: A male patient was diagnosed with the karyo- type of 45,XO/47,XXX/46,XX male sex reversal syn- drome with normal pubic hair and normal penile size, high levels of follicle-stimulating hormone and luteiniz- ing hormone, but small testes and infertility resulting from azoospermia.

Conclusion: Sex reversal syndrome is a genetic con- dition caused by DSD. Many factors can lead to DSD, but the accurate mechanism has not been completely discovered. between gonadal sexuality and chromosome sexuality, including 46,XX male and 46,XY female for the most part, but the rare type 45,XO male also can be found. Approximately 80% of males with 46,XX present' with normal pubic hair and.

Objective: To evaluate outcomes of patients with unexplained infertility who underwent letrozole (LET)- stimulated controlled ovarian stimulation (COS) with timed sexual intercourse (IC) as compared to patients treated with clomiphene citrate (CC) and intrauterine insemination (IUI).

Study design: A non- randomized, retrospective study where unexplained in- fertility patients (n=7,764). underwent a COS cycle with both LET and timed IC or with CC and IUI from January 2010-June 2014. One group consisted of patients who completed a COS cycle with LET and were instructed to have sexual IC. The other included patients were treated with CC and underwent IUI. Pregnancy rates (PRs) were compared between groups.

Results: No statistical difference was observed in each group's age or serum follicule-stimulating hor- mone levels. A statistical significance in LET versus CC-stimulated groups was observed for mean endome- trial thickness (8.3 ± 1.7 vs. 7.9 ± 1.8 mm) and follicular response (2.0 ± 1.0 vs. 2.3 ± 1.3), respectively. Clinical PRs after timed IC were significantly higher in the LET versus CC-stimulated group (15.0% vs 11.8%). Clinical PRs after timed IUI were also significantly higher in the LET versus CC-stimulated group (12.3% vs. 11.5%). Moreover, clinical PRs in LET with IC were significant- ly higher than CC with IUI (15.0% vs. 11.5%).

Conclusion: Unexplained infertility patients who underwent LET stimulation with IC werefound to have better pregnancy out- comes as compared to those who underwent timed IC.or IUI with CC stimulation.

Objective: To assess the relationship between uterine myomas, urinary symptoms, and urodynamic findings.

Study design: A total of 49 women hospitalized for uterine myoma were eval- uated in this prospective study. Patients underwent- a detailed clinical evaluation and ukodynamic study. Uri- nary symptoms were as- sessed using 3-day micturi- tion diary and Patient Perception of Intensity of Urgency scale questionnaire. The dimensions of fibroma- tous uterus and single large myomas were evaluated by both transabdominal and transvaginal ultrasound. Urodynamic parameters and urinary symptoms were assessed before and 4 months after surgery.

Results: A total of 44 patients were evaluable at the end of the study: 32 out of 44 (72.8%) had urinary symptoms; 26 women underwent hysterectomy, and 18 had abdominal myomectomy. After surgery 87.5% of women were asymptomatic or showed improvement in urinary symptoms. Improvements were also seen in urodynamic parameters.

Conclusion: Uterine myomas often result in uri- nary symptoms. Surgical therapy can result in signifi- cant improvements in symptoms as well as urodynamic findings.

Objective: To analyze the benefits of saline infusion sonography (SIS).due to its endometrial injury effect on outcomes of subsequent intracytoplasmic sperm injection (ICSI) cycles.

Study design: This study is a retrospective anal- ysis of 398 patients under- going ICSI cycles. The bio- chemical and clinical preg- nancy rates of 45 patients who underwent SIS prior to starting an ICSI cycle were compared to those of controls.

Results: Endometrial thickness was significantly higher in patients who underwent SIS (p=0.016). The biochemical pregnancy rate was statistically significant- ly higher in the SIS group than in the control group (p=0.040). The clinical pregnancy rate was 55.56% in patients who underwent SIS, while it was only 39.09% in the control group. The difference was statistically sig- nificant (p=0.037).

Conclusion: .SIS can be used to assess the endome- trial cavity prior to ICSI cycle; moreover, SIS might be associated with improved outcomes when no intrauterine pathology is detected. Confirmation of this finding via future robust randomized trials is needed and would be useful to further guide clinical practice.

Objective: To evaluate histological uterine fibroid incidence among reproductive age women and to deter- mine correlations between fibroid histological type, patient age, and number and size offibroids.

Study design: The study cohort consisted of 103 women desiring preg- nancy who underwent myo- mectomy for symptomatic uterine fibroids. The primary endpoints were histological type of fibroid, myomectomy incidence among 2 age groups (18-34 vs. 35-40), solitary or multiple fibroids, and <5 cm vs. >5 cm fibroid diameter. Secondary anal- ysis endpoints evaluated correlations between uterine fibroid histological type, 2 age groups of women,.and uterine fibroid number and size.

Results: Following myomectomy, 84.5% exhibited benign histology, and myomatosis malignancy was not detected. Of the 103 women, 50.5% were aged <34 and 49.5% were aged 35-40; 71.8% had a solitary fibroid and 28.2% had α 2 fibroids; 58.3% had a fibroid of <5 cm. and 41.7% had a fibroid >5 cm in diameter. Cellular fibroid incidence was higher (10.3%) in cases of multiple myomatosis in comparison to the solitary fibroid group (n=0) (p=0.021). Among women with multiple myomatosis (n=29), almost all (n=28, 96.6%) had only 1 histological type.

Conclusion: Among women of. child-bearing age having myomectomy, most have benign histology with no significant differences in histological type with regard to patient age and fibroid size. A higher incidence of cellular fibroids was observed only in multiple myomatosis cases.

Objective: To evaluate the relationship between the 936C/T polymorphism of VEGF and the occurrence of gestational trophoblastic neoplasia (GTN).

Study design: A retro- spective study that included 8 patients with complete hydatidiform -mole (CHM) that evolved into spontane- ous remission (SR), 12 pa- tients with CHM that prog- ressed to GTN, and 20 control (C) patients without obstetric complications. Polymorphisms were detected by polymerase chain reaction-amplified technique of patients' DNA, and genotype frequencies were compared between the groups.

Results: . The genotype frequencies of the VEGF 936C/T polymorphism were as follows: SR group, 100% CC genotype; GTN group, 50.0% CC, 41.7% CT, and 8.3% TT; C group, 30.0% CC, 65.0% CT, and 5.0% TT. Genotype frequencies did not differ significantly be- tween the SR and GTN groups, although a trend was observed (p=0.06). Genotype frequencies did differ sig- nificantly between the combined group of all patients with CHM (SR+GTN) and the C group (p=0.03).

Conclusion: This study did not identify a different VEGF 936CT genotype profile for patients with CHM who undergo SR versus those who progress to GTN. However, the, results do suggest that this polymor- phism may affect susceptibil- ity to CHM. Larger groups may improve the results of assessments of the predictive parameters of GTN.

Objective: To determine the impact of a new cur- riculum based on the "flipped classroom" model on the gynecologic oncology (gyn onc) section of the annual in-service examination for residents in obstetrics and gynecology.

Study design: We intro- duced a curriculum focused on a weekly topic for teach- ing the residents on the gyn onc service in January of 2009. We compared the over- all mean gyn onc-specific percent-correct scores on the in-service examination be- fore (1999-2009) and after (2010-2011) the implemen- tation of the curriculum using linear regression to estimate the mean percentage point change and 95% confidence interval, adjusting for clustering by residents.

Results: Our analysis included 90 residents (73 females and 17 males), which yielded 295 scores for analysis. We found a significant increase of 6.5 per- centage points (95% CI 3.5-9.6) in the gyn .onc mean percent correct for all postgraduate year levels combined after initiation of our curriculum. During that same period the overall in-service examination percent-correct scores did not significantly change.

Conclusion: Our curriculum,focusing on a weekly topic, resulted in improve- ment in in-service exam- ination scores. This type of curriculum could be applied to other areas of resident edu- cation within obstetrics and gynecology.

Objective: To evaluate the effect of a "hard stop" on elective induction prior to 39 weeks at a large volume obstetrics hospital.

Study design: From July 1, 2011, to June 30, 2013, there were 27,435 deliveries at our institution. We performed a retrospective chart review of all elective inductions I year before and after the implementation of a 39 week "hard stop" .policy. All women (n=2,574) who underwent elective induction of labor were analyzed.

Results: The rate of cesarean delivery was not sta- tistically different between the group evaluated before the "hard stop" and those after (20.6% vs 18%). The rate of postpartum hemorrhage decreased significantly following the policy change (6.2% vs 3.2%, respectively). There were no other clinically important differences in maternal or neonatal outcomes.

Conclusion: The implementation of a "hard stop" policy aimed at eliminating elective inductions before 39 weeks did not affect the rate of cesarean birth.