ISRN obstetrics and gynecology最新文献

Endometriosis, a gynecologic pathology, is defined by the presence of a tissue similar to uterine endometrium, which is located in places other than physiologically appropriate. These endometrial heterotopic islets contain glands and stroma and are functionally capable of responding to exogenous, endogenous, or local hormonal stimuli. Endometriosis affects 8%-10% of women of reproductive age; in 30% of the women, the condition is associated with primary or secondary infertility. In several instances, endometriosis persists as a minimal or mild disease, or it can resolve on its own. Other cases of endometriosis show severe symptomatology that ends when menopause occurs. Endometriosis can, however, reactivate in several postmenopausal women when iatrogenic or endogenous hormones are present. Endometriosis is occasionally accompanied by malignant ovarian tumors, especially endometrioid and clear cell carcinomas. Its pathogenesis is widely debated, and its variable morphology appears to represent a continuum of individual presentations and progressions. Endometriosis has no pathognomonic signs or symptoms; it is therefore difficult to diagnose. Because of its enigmatic etiopathogenesis, there is currently no satisfactory therapy for all patients with endometriosis. Treatments include medications, surgery, or combined therapies; currently, the only procedures that seem to cure endometriosis are hysterectomy and bilateral salpingo-oophorectomy. In this paper, we review the most controversial and enigmatic aspects of this disease.

Objective. The purpose of this study is to identify menstruation characteristics of the women and the effects of menorrhagia on women's quality of life. Methods. The study was designed as a descriptive, case-control one. Results. Of the women in the case group, 10.9% stated that their menstrual bleeding was severe and very severe before complaints while 73.2% described bleeding as severe or very severe after complaints. Among those who complained about menorrhagia, 46.7% pointed that they used hygienic products that are more protective than regular sanitary pads. Women also stated that their clothes, bed linens, and furniture got dirty parallel to the severity of the bleeding. In all subscales of SF-36 scale, quality of life of the women in the menorrhagia group was significantly lower than the ones in the control group (P < 0.05). Conclusion. Menorrhagia has negative effects on women's quality of life. Therefore, quality of life of the women consulting the clinics with menorrhagia complaint should be investigated and effective approaches should be designed.

Objective. To evaluate the clinical applicability of the rapid biophysical profile (rBPP), comparing results of the rBPP to umbilical cord pH values and Apgar scores. Methods. A cross-sectional study was conducted with 37 pregnant women from our high-risk service. All of them gave birth at our institution. rBPP was conducted up to 24 h prior to delivery and pH values were obtained from the umbilical vein immediately after birth. The mean and standard deviations for maternal age, gestational age at birth, pH values, and Apgar score in the 1st and 5th minutes after birth were calculated. An unpaired Student's t-test was applied to evaluate the correlation between these variables and rBPP scores of 2 and 4. Results. rBPP score of 2 was observed in 8 patients (21.6%) and score 4 was observed in 29 cases (78.4%). No patients received score zero. The difference between the Apgar scores of the rBPP score 2 and 4 was statistically significant (P < 0.01) while the same was not true with the umbilical cord pH (P = 0.08), even though the values tended to be lower in the rBPP 2 group. Conclusion. The rBPP is a fast and practical method of assessment of antepartum fetal well-being. Further studies, with a larger number of patients, are necessary to evaluate the applicability of the method.

Objectives. Our aim is to explore the clinical outcome of patients with acute fatty liver of pregnancy (AFLP), and evaluate the effect of early diagnosis and treatment. Methods. Seven patients who were diagnosed with AFLP were retrospectively analyzed from February 2005 to January 2013. The clinical records of the patients with AFLP were reviewed for clinical features, laboratory examinations, and maternal and perinatal prognosis. Routine laboratory evaluation revealed hyperbilirubinemia, moderately elevated liver transaminase, but negative serum hepatitis virus in each patient. For additional evidence, 126 cases of AFLP were reviewed retrospectively from original articles researched in A Medline-based English and Chinese Knowledge Infrastructure between the same periods. Results. The initial symptoms of all the 7 cases with AFLP were gastrointestinal symptoms; anorexia, nausea, vomiting, and progressive jaundice. Complications revealed with renal insufficiency in all 7 patients. Hepatic failure, MODS, hypoglycemia and DIC were seen in 4 patients (57.1%). Hemorrhagic shock, ARDS, and hepatic encephalopathy were seen in 3 patients (42.8%). There was only one case of maternal death (14.2%), three cases of perinatal death (30%) and one postnatal death (10%). Conclusion. AFLP occurs in late pregnancy is a rare clinical syndrome occurs at about 36 weeks of gestation. Early diagnosis and prompt termination of pregnancy is the key of management with multidisciplinary collaboration, comprehensive treatment and effective prevention are helpful to improve prognosis of the cases with AFLP and perinatal death.

Objective. To determine the effects of Mullerian inhibiting substance (MIS) treatment on endometriosis cells through study of apoptosis and autophagy. Design. Experimental in vitro study. Setting. University research laboratory. Cell Line. CRL-7566 endometriosis cell line. This line was established from a benign ovarian cyst taken from a patient with endometriosis. Interventions. In vitro treatment with MIS. Main Outcome Measures. The main outcome measures were cellular viability, proliferation, cell-cycle arrest, and induction of apoptosis and autophagy in endometriotic cells. Results. MIS treatment inhibited proliferation of endometriosis cells and induced apoptosis, as indicated by Annexin V staining, and induced caspase-9 cleavage and cell-cycle arrest, as evidenced by increased expression of p27 CDK-inhibitor. MIS treatment also induced autophagy in endometriosis cells as demonstrated by a significant increase in LC3-II induction, a hallmark of autophagy. Conclusions. MIS inhibits cell growth and induces autophagy, as well as apoptosis, in ectopic endometrial cell lines. Our results suggest that MIS may have a potential as a novel approach for medical treatment of endometriosis. Further studies may be needed to test the efficacy of MIS treatment in animal models and to develop MIS treatment specifically targeted to the endometriosis.

Objective. We examined which specific factors contributed to the increase in Cesarean delivery rate at our hospital over a 10-year period. Methods. From January 2002 to December 2012, data on the Japanese singleton deliveries at ≥22-week gestation managed at Japanese Red Cross Katsushika Maternity Hospital were collected. Potential factors associated with the increasing Cesarean delivery rate were selected according to previous studies. In this study, the incidences of intrauterine fetal demise, umbilical artery pH <7.1, and severe perineal laceration were calculated for each year. Results. The Cesarean delivery rate at our institution increased significantly during the study period (17.3% in 2002 versus 23.4% in 2012, P < 0.01). During the study period, the Cesarean delivery rates in the cases of nulliparity, preterm delivery, low birth weight (<2,500 g), previous Cesarean deliveries and breech presentation were increased significantly. The incidence of intrauterine fetal demise and low umbilical artery pH was significantly decreased, and a negative correlation was found between the Cesarean delivery rate and the incidence of low umbilical artery pH for each year (r = -0.92, P < 0.01). Conclusion. At our institute, the neonatal outcomes seemed to be improved associated with the increased Cesarean delivery rate between 2002 and 2012.

Physical exercise during postpartum period is beneficial to mothers, and the health gains are abundantly reported. This study characterises the postpartum exercise profile of a group of Nigerian women and reports how their exercise self-efficacies are influenced by sociodemographic characteristics. Participants were women attending the two largest postnatal clinics in Ibadan, south-western Nigeria. A self-developed questionnaire assessed the socio-demographic and exercise profile of participants, while the Exercise Self-Efficacy Scale assessed their exercise self-efficacy. About two-third (61.0%) of the participants were not aware that they could undertake physical exercise to enhance postpartum health, and 109 (47.8%) were not engaged in any exercise. Those who exercised did so for less than three days/week, and 89% of the women did not belong to any exercise support group. Exercise self-efficacy was significantly (P < 0.05) associated with being in an exercise programme, age, employment, work hours/week, monthly income, and number of pregnancies. Most of the women were not aware they could engage in postpartum exercise, and about half were not undertaking it. More women with high compared to moderate exercise self-efficacy undertook the exercise. Efforts at increasing awareness, improving exercise self-efficacy and adoption of postpartum exercise are desirable among the Nigerian women.

PLAC1 (Placenta-Specific 1) is a recently described, trophoblast-expressed gene essential for normal placental development. The protein localizes to the microvillus membrane surface of the syncytiotrophoblast in direct proximity to the maternal compartment. Although its role has not been defined, increased circulating levels of human PLAC1 mRNA in maternal blood are associated with preeclampsia. Furthermore, PLAC1-null mice exhibit decreased viability in the peripartum period suggesting a role in pregnancy maintenance late in gestation. We examined PLAC1 gene expression in the human placenta during normal pregnancy and pregnancies associated with maternal diabetes and preeclampsia using quantitative, real time PCR (q-RT-PCR). Although there was no apparent difference in PLAC1 gene expression among human pregnancies complicated by diabetes or preeclampsia, an unexpected effect of labor was noted at term. PLAC1 expression in placentae delivered vaginally following induced or spontaneous labor was significantly reduced compared to placentae not exposed to labor making it one of only a few placental genes influenced by labor. The significance of this finding is unknown. Viewed in the context of its importance in placental development, however, these findings are consistent with a role for PLAC1 in the maintenance of the maternal-fetal interface.

The aim of this study was to assess the prevalence and risk factors of anal incontinence in an unselected pregnant population at second trimester. A survey of pregnant women attending a routine ultrasound examination was conducted in a university hospital in Oslo, Norway. A questionnaire consisting of 105 items concerning anal incontinence (including St. Mark's score), urinary incontinence, medication use, and comorbidity was posted to women when invited to the ultrasound examination. Results. Prevalence of self-reported anal incontinence (St. Mark's score ≥ 3) was the lowest in the group of women with a previous cesarean section only (6.4%) and the highest among women with a previous delivery complicated by obstetric anal sphincter injury (24.4%). Among nulliparous women the prevalence of anal incontinence was 7.7% and was associated to low educational level and comorbidity. Prevalence of anal incontinence increased with increasing parity. Urinary incontinence was associated with anal incontinence in all parity groups. Conclusions. Anal incontinence was most frequent among women with a history of obstetric anal sphincter injury. Other obstetrical events had a minor effect on prevalence of anal incontinence among parous women. Prevention of obstetrical sphincter injury is likely the most important factor for reducing bothersome anal incontinence among fertile women.

Preeclampsia, a relatively common pregnancy disorder, is one of the major causes of maternal and fetal morbidity and mortality. Despite numerous research, the etiology of this syndrome remains not well understood as the pathogenesis of preeclampsia is complex, involving interaction between genetic, immunologic, and environmental factors. Preeclampsia, originating in placenta abnormalities, is induced by the circulating factors derived from the abnormal placenta. Recent work has identified various molecular mechanisms related to placenta development, including renin-angiotensin system, 1, 25-dihydroxyvitamin D, and lipoxin A4. Interestingly, advances suggest that vacuolar ATPase, a key molecule in placentation, is closely associated with them. Therefore, this intriguing molecule may represent an important link between various causes of preeclampsia. Here, we review that vacuolar ATPase works as a key link between multiple causes of preeclampsia and discuss the potential molecular mechanisms. The novel findings outlined in this review may provide promising explanations for the causation of preeclampsia and a rationale for future therapeutic interventions for this condition.