Gynecologic and Obstetric Investigation

van den Veyver, Ignatia B.; Yankowitz, Jerome; Subramanian, Stephanie B.; Dorman, Karen F.; Moise Jr., Kenneth J.

doi: 10.1159/000010188pmid: 10592422

Polymerase chain reaction (PCR)-based genotyping on amniotic fluid in an RhD-negative alloimmunized woman predicted an RhD-negative fetal blood type. The neonate was RhD-positive and developed hemolytic disease. Discrepant results were also observed on paternal testing. PCR analysis with a different set of primers correctly predicted the RhD-positive fetal and paternal blood type. Use of more than one set of primers and parental testing can avoid some of the problems associated with use of PCR genotyping.

Ditto, A.; Morgante, G.; la Marca, A.; De Leo, V.

doi: 10.1159/000010189pmid: 10592423

Objective: Hyperemesis gravidarum is a relatively unknown disease, and is generally self-limiting. In some women the symptoms are so severe as to threaten the health of the mother and fetus. Therapies proposed for hyperemesis gravidarum are therefore rather empirical. Medical treatment includes parenteral fluid replacement and nutrition, electrolytes, antiemetics, vitamins, sedation and psychological counseling. Diazepam and benzodiazepins have been widely studied in pregnancy but the results are contradictory. The aim of the present study was to investigate the efficacy of parenteral fluids with vitamins, with or without diazepam sedation. Methods: Fifty women with hyperemesis gravidarum were enrolled in the study. They were treated with infusions of normal saline, glucose, vitamins and randomly with diazepam. Results: The results show that the mean stay in the hospital was shorter in the diazepam group: 4.5 ± 1.9 vs. 6 ± 1.6 days (p < 0.05) and readmission to the hospital was 4% in the diazepam group versus 27% in other group (p < 0.05). There was a significant reduction in nausea in the diazepam group (p < 0.05). A significant reduction in vomiting was observed in both groups. No side effects or congenital neonatal malformations were found in the diazepam group. Conclusions: Intravenous administration of fluids and vitamins is the standard treatment for women hospitalized for hyperemesis gravidarum. The addition of diazepam to the treatment is effective in reducing nausea and does not have teratogenic effects.

Suzuki, Shunji; Sawa, Rintaro; Yoneyama, Yoshio; Otsubo, Yasuo; Araki, Tsutomu

doi: 10.1159/000010190pmid: 10592424

The aim of this study was to compare the fetal middle cerebral artery (MCA) Doppler waveforms in growth-retarded twin fetuses with (n = 11) and without (n = 24) twin–twin transfusion syndrome (TTTS). Umbilical artery (UA) and fetal MCA Doppler velocity waveforms were recorded on admission. The mean values of the UA pulsatility index (PI) of smaller twin fetuses with and without TTTS were significantly higher than those of normal singleton pregnancies. The mean values of the MCA PI of smaller twin fetuses in the TTTS group (+0.7 ± 1 SD) were significantly higher than those of normal singleton pregnancies on admission, and these levels did not markedly change following amniocentesis. On the other hand, the values of the MCA of the growth-retarded fetuses without TTTS (–0.9 ± 1 SD) were significantly lower than those of normal singleton pregnancies. Our findings suggest that measurement of fetal MCA PI is a useful method to assess growth-retarded fetuses in monochorionic twin pregnancies.

Nisell, Henry; Erikssen, Catharina; Persson, Bengt; Carlström, Kjell

doi: 10.1159/000010191pmid: 10592425

Objective: To compare women after a preeclamptic pregnancy with women after a normal pregnancy with respect to androgenic-anabolic status and carbohydrate and lipid profiles. Method: Twenty-one patients and 22 controls were followed up to 26–119 weeks after delivery. Blood was sampled for analyses of insulin, glucose, insulin growth factor-1, lipids, androgens, sex hormone-binding globulin (SHBG) and uric acid. Anthropometric data and blood pressure were recorded. Data are presented as median and ranges (within parentheses) or mean ± SEM where appropriate. Comparisons were made by unpaired t test or Mann-Whitney U test, respectively. Results: Significantly higher values were found in the preeclampsia than in the control group for fasting insulin, fasting glucose, fasting insulin resistance index (FIRI, fasting glucose × fasting insulin/25), serum triglycerides, uric acid and blood pressure. There were no differences in androgen status and IGF-1 levels. Conclusion: Patients with a recent history of preeclampsia demonstrate signs of relative insulin resistance, hypertriglyceridemia and hyperuricemia as well as increased blood pressure as compared with women who had a normal pregnancy. However, in contrast to other women with insulin resistance, they have a normal androgen status.

Mutlu-Türkoglu, Ü.; Aykaç-Toker, G.; Ibrahimoglu, L.; Ademoglu, E.; Uysal, M.

doi: 10.1159/000010192pmid: 10592426

It has been suggested that oxidative stress may cause endothelial dysfunction and that endothelial dysfunction may lead to hypertension by reduced release of vasodilating agents such as nitric oxide (NO). In this study, we investigated the relationship between serum NO and lipid peroxides in preeclamptic and normal pregnant women before and after delivery. Plasma from women with preeclampsia had significantly lower nitrate/nitrite concentrations and significantly higher lipid peroxide levels than normal pregnant women before the delivery. Lipid peroxide levels were significantly elevated in preeclamptic placenta. After delivery in the preeclamptic group the plasma concentration of nitrate/nitrite was increased and plasma thiobarbituric acid reactive substance levels decreased, while these parameters remained unchanged in the normal pregnants women. These results indicate that high levels of lipid peroxides in the circulation may be the cause of lowered NO synthesis and hypertension observed in preeclamptic women.

Young, Ronald L.; Sangi-Haghpeykar, Haleh; Thomakos, Nikolaos; Miller, Harold J.

doi: 10.1159/000010193pmid: 10592427

Objective: To assess the practice habits and recommendations of members of American Society of Gynecologic Oncologists (ASGO) dealing with follow-up management of molar pregnancy. Materials and Methods: A questionnaire was mailed to ASGO members requesting their recommended waiting period for subsequent pregnancy following treatment of molar pregnancy. Year of Fellowship completion was determined for each respondent. Results: Only 36.8% still recommended the traditionally accepted 12-month waiting period, and 31.3% recommended 6 months. The trend was toward shorter waiting periods among younger, more recently trained oncologists, although differences were not statistically significant. Conclusion: It appears time to review the recommendation of a 12-month waiting period. A reduction of at least down to 6 months may be appropriate, but needs further investigation.

Wolman, Igal; Groutz, Asnat; Gordon, David; Kupferminc, Michael J.; Lessing, Joseph B.; Jaffa, Arial J.

doi: 10.1159/000010194pmid: 10592428

A prospective, blind study was carried out on 44 patients to evaluate the most suitable time to perform transvaginal sonohysterography. On the day of arrival at our unit, regardless of their cycle day, the women underwent sonohysterographic evaluation, which was repeated during the first 10 days of the next cycle. Patients with sonohysterographic findings underwent hysteroscopy. According to the timing of the first examination, they were divided into two groups, i.e. group 1 for the first 10 days of the cycle, and group 2 for days 16 through 28. At the end of the study the groups were compared. The results showed a false-positive rate of 27% in group 2, while no false-positive was found in group 1. We concluded that the best time for sonohysterography in patients who still have their menstrual period is during the first 10 days of the cycle.

Furuta, Itsuko; Yamada, Hideto; Sakuragi, Noriaki; Fujimoto, Seiichiro

doi: 10.1159/000010195pmid: 10592429

Apoptosis is often characterized by internucleosomal DNA fragmentation, which is classically visualized in standard agarose gel electrophoresis. However, this technique is not sufficiently sensitive for the detection of a modest apoptotic level in intact tissues. We developed a sensitive, nonradioactive method for the qualitative and quantitative analyses of apoptotic DNA fragmentation in intact tissues. An ultrasensitive chemiluminescent substrate, CDP-Star, was used for the visualization of digoxigenin (DIG)-labeled DNA fragments, and banding patterns were densitometrically quantified. Serially diluted DNA samples from rat ovaries were labeled with DIG. As a result, only 1.56 ng of DNA could be analyzed for the presence of apoptotic DNA cleavage. The sum intensity of these bands increased almost linearly by increasing the amount of labeled DNA. In human placental tissues, clear apoptotic DNA ladders were visualized by this method, and the quantification of apoptotic DNA fragmentation was also possible. This new method provides a nonradioactive, highly sensitive and semiquantitative analysis of apoptotic DNA fragmentation and may be highly useful for the study of a low, physiological level of apoptosis.

Matányi, S.; Ács, N.; Fontányi, Z.; Paulin, F.

doi: 10.1159/000010196pmid: 10592430

Anterior colporrhaphy (Kelly-Stoeckel suture) was performed on 22 women suffering from grade-I or grade-II genuine stress incontinence. Urodynamic investigation was performed on every patient before surgery and 6 months postoperatively. 21 patients were cured and 1 patient improved. After operation the functional urethral length was increased by 28.8%, and urethrovesical pressure transmission was improved by 22.9%. Maximum urethral closure pressure decreased postoperatively by 21.1%. Pressure transmission was clearly improved by the surgical intervention and urinary continence was restored in spite of the fact that maximal urethral closure pressure decreased. Based on these results it is suggested to consider performing anterior colporrhaphy in cases of weak urethral closure pressure, because of the increased risk of worsening the complaints of these patients.

Olsson, I.; Kroon, U.-B.

doi: 10.1159/000010197pmid: 10592431

The aim of this study was to evaluate the outcome of tension-free vaginal tape (TVT) 3 years after surgery. Fifty-one women (mean age 52.9) with a genuine stress incontinence underwent the TVT operation. In 10 patients, a prolapse repair was also done simultaneously. The majority of the patients were operated under local anesthesia. All patients were evaluated 3 years after the procedure using a protocol for objective and subjective assessment of the outcome including an evaluation of quality of life related to urinary incontinence. According to the protocol, 46 women (90%) were successfully cured, another 3 patients (6%) were improved, whereas 2 patients (4%) were classified as failures. Few complications occurred. We conclude that TVT is a simple and well-accepted minimal invasive surgery for treatment of female urinary stress incontinence. The outcome 3 years after the operation showed no signs of deterioration compared to the results shortly after surgery. The cure rate of 90% is comparable with the best results of other surgical treatments for female urinary incontinence.