Gynecologic and Obstetric Investigation

doi: 10.1159/000178769pmid: N/A

Verhaeghe, Johan

doi: 10.1159/000147167pmid: 18645254

Pregnancy is accompanied by notable changes in the secretion of growth hormone (GH) and the insulin-like growth factors (IGFs). A GH variant produced by the placenta is discernible in maternal plasma from early pregnancy, rising exponentially until 37 weeks. Meanwhile, pituitary GH gradually drops to near-undetectable levels. While there might be a modest reduction in circulating IGF-I in early pregnancy, IGF-I increases 2- to 3-fold in the second half, again with a peak at around 37 weeks. Thus, placental GH is believed to replace pituitary GH as the primary stimulus for IGF-I secretion in pregnancy. Several IGF-binding proteins (IGFBPs) including IGFBP-3 are proteolyzed, leading to an elevated free (bioavailable) IGF-I fraction. IGF-II concentrations also appear to show a modest (20–25%) increase in the course of pregnancy. The possible clinical manifestations include edema of face and forearms and carpal tunnel symptoms, reminiscent of the symptoms of acromegaly and the side effects of GH/IGF-I treatment. Neither placental GH nor the maternal IGFs cross the placental barrier, yet evidence from preclinical models is accumulating that they promote trophoblast invasion, placenta growth and maturation, transplacental nutrient transport and, ultimately, fetal growth. The ensemble data strongly suggest that ‘gestational acromegaly’ develops in order to foster fetoplacental growth.

Adama van Scheltema, P.N.; In’t Anker, P.S.; Vereecken, A.; Vandenbussche, F.P.H.A.; Deprest, J.A.; Devlieger, R.

doi: 10.1159/000147168pmid: 18645255

Objective: To evaluate which of the commercially available solutions is best suited for amnioinfusion during fetoscopy, based on resemblance with the biochemical properties of amniotic fluid. Materials and Methods: Amniotic fluid samples from 10 pregnancies were studied. Specimens were obtained from 5 pathologic pregnancies (of which 3 were complicated by polyhydramnios) and 5 uncomplicated pregnancies. The concentrations of sodium, potassium, chloride, bicarbonate, calcium, glucose, osmolality, pH, total protein content and albumin were determined in each sample. A literature search (PubMed, Embase) was performed to identify commercially available fluids used for amnioinfusion in clinical practice. The composition of these infusion solutions was compared to the amniotic fluid samples mentioned above. Results: We identified two different electrolyte solutions used in clinical practice for amnioinfusion. We identified four additional commercially available solutions that could potentially be used for amnioinfusion. Most of these infusion solutions differ considerably from midtrimester amniotic fluid samples both in electrolyte composition and pH, with the most striking difference in the latter. Conclusion: Lactated Ringer’s solution approximates amniotic fluid the closest for both electrolyte composition and pH. This infusion solution seems to be the most suitable choice for amnioinfusion during fetoscopy.

Orcy, Rafael Bueno; Schroeder, Sabrina; Hofmeister Martins-Costa, Sérgio; Lopes Ramos, José Geraldo; Schechinger, Wolfgang; Klein, Harald; Simoni Brum, Ilma; von Eye Corleta, Helena; Capp, Edison

doi: 10.1159/000147169pmid: 18645256

Meza-Espinoza, Juan Pablo; Ortiz Anguiano, Lilia; Rivera, Horacio

doi: 10.1159/000147170pmid: 18645257

Aim: To determine the prevalence of chromosomal abnormalities in couples with reproductive disorders. Methods: A retrospective study was performed in 939 Mexican couples with reproductive disorders (542 with recurrent fetal loss, 356 with malformed/stillborn children, and 41 with sterility) whose karyotype was established on GTG-banded metaphases. Results: A chromosomal aberration was detected in one partner of 52 couples, including a double translocation carrier; therefore, the prevalence of chromosomally abnormal couples was 5.5%; 31 couples with recurrent fetal loss (31/542, 5.7%), 15 with malformed/stillborn children (15/356, 4.2%), and 6 with sterility (6/41, 14.6%). There were 43 couples with structural rearrangements (29 reciprocal translocations, 10 robertsonian translocations, 2 inversions, 1 insertion, and 1 ring) and 9 with gonosomal aneuploidies. The affected partner was female in 28 (53.8%) and male in 24 (46.2%) couples. In addition, 17 couples (1.8%) with the structural variant inversion 9qh were detected. Conclusion: The prevalence of chromosomal abnormalities found in our sample is consistent with figures described in several populations around the world.

Machida, Shizuo; Matsubara, Shigeki; Ohwada, Michitaka; Ogoyama, Manabu; Kuwata, Tomoyuki; Watanabe, Takashi; Izumi, Akio; Suzuki, Mitsuaki

doi: 10.1159/000147171pmid: 18645258

Background: Intracystic papillary excrescence is a characteristic morphological feature of ovarian malignancy. A few recent reports have demonstrated that ovarian endometriotic cysts, undergoing decidualization during pregnancy, occasionally show excrescence, necessitating surgery during pregnancy; however, this phenomenon is not well recognized among clinicians. Cases: Three pregnant women with decidualized ovarian endometriosis showed excrescence. Both ultrasound and magnetic resonance imaging (MRI) preoperatively suggested the presence of underlying ovarian endometriotic cysts in 2 women, but not in the other. Intracystic papillary excrescence prompted us to perform laparotomy at 14, 14, and 19 weeks of pregnancy, respectively, with 1 woman aborting in the 21st week, and with 2 delivering healthy term infants. Histological examination confirmed the diagnosis of decidualized ovarian endometriotic cysts in all 3 patients. Conclusions: We provide the first report of pregnant women in whom excrescence occurred from ovarian endometriotic cysts without preoperative evidence. Decidualized ovarian endometriosis, even without preoperative morphological features of endometriosis, should be added to the differential diagnosis of ovarian malignancy during pregnancy.

Jung, Eui; Huh, Chu Yeop; Choe, Bong-Keun

doi: 10.1159/000148655pmid: 18667835

Aims: To investigate the incidence and risk factors for anal incontinence after childbirth in Korea. Methods: We retrospectively examined the records of 1,123 unselected women who delivered live infants at the KyungHee University Hospital between January 2006 and December 2006. Symptoms of anal incontinence were assessed by telephone interview using standard questionnaires. Results: A total of 966 women (86%) responded to the survey, and the overall incidence of anal incontinence was 6.1% (9 fecal and flatal incontinence, 50 flatal incontinence). Of the study population, 562 (58.2%) had vaginal deliveries and 404 (41.8%) had cesarean sections. Vacuum extraction was used in 160 (28.5%) cases, and sphincter tears occurred in 16 (2.8%). Multivariate analysis showed that anal incontinence was associated with multiparity [2.75 (1.17–6.47)], maternal weight increase ≧15 kg [2.11 (1.03–4.31)], vaginal delivery with vacuum extraction [2.74 (1.23–6.14)], sphincter laceration [14.74 (4.69–46.27)], and cesarean section after second-stage labor [16.82 (4.61–61.40)]. Conclusion: Koreans had a lower incidence of post-birth anal incontinence than Westerners (6.1 and 29.3%, respectively), even though the risk factors were similar. These findings suggest that further studies examining differences in the incidence of anal incontinence based on ethnicity are warranted as such information may provide clues in terms of prevention and management of this disorder.

Shen, O.; Ben Chetrit, A.; Margalioth, E.J.; Lavie, O.; Rabinowitz, R.R.

doi: 10.1159/000148656pmid: 18667836

Aim: To determine the effect of a copper-medicated intrauterine device (IUD) on ovarian, uterine, arcuate, radial and subendometrial Doppler-derived indices of blood flow. Method: 23 regularly menstruating patients requested insertion of an IUD. All patients had a copper T (Nova T) IUD inserted between days 8 and 11 of the menstrual cycle. Ovarian, uterine, arcuate, radial and subendometrial artery pulsatility indices (PIs) were assessed by transvaginal color Doppler prior to insertion between days 8 and 11 of the menstrual cycle, and after 2 months in the same period of the cycle. Ovarian, uterine, arcuate, radial and subendometrial artery PIs were considered prior to and following IUD insertion. Results: No differences were recorded in any of the blood vessels sampled between pre- and post-insertion PIs. Conclusion: No significant change in ovarian or in uterine system vascular impedance is associated with the presence of a copper-medicated IUD.

Christiansen, Ole B.; Steffensen, Rudi; Nielsen, Henriette S.; Varming, Kim

doi: 10.1159/000149575pmid: 18679035

A considerable proportion of recurrent miscarriage (RM) cases are caused by recurrent chromosomally abnormal conceptions. However, in younger patients and patients with multiple miscarriages, maternal causes seem to dominate. No single biomarker with a high predictive value of maternally caused RM has been identified. Non-genetic biomarkers in RM may not reflect conditions in the pregnant uterus and we rarely know whether they are causes or consequences of miscarriage. Studies of genetic biomarkers are probably the best way to reveal the pathophysiological mechanisms behind RM. Epidemiological and genetic studies suggest that RM due to maternal causes has a multifactorial background. The risk of RM in each patient is probably determined by the interaction of many genetic variants and environmental factors but only few of these have so far been identified. The genetic biomarkers for RM can probably be classified into three groups: (1) variants associated with excessive inflammatory responses and autoimmunity; (2) variants of importance for insulin and androgen sensitivity and turn-over, and (3) variants associated with thrombophilia. Identification of these markers will require whole genome association studies comprising thousands of individuals. Acknowledgement of the multifactorial background for RM has important implications for the management of patients in clinical practice.

Jeon, Myung Jae; Chung, Sue Min; Jung, Hyun Joo; Kim, Sei Kwang; Bai, Sang Wook

doi: 10.1159/000149851pmid: 18685255

Background/Aims: To investigate the risk factors for the recurrence of prolapse after traditional pelvic reconstructive surgery. Methods: The medical records of 212 patients who received traditional restorative reconstructive surgeries for symptomatic pelvic organ prolapse from March 1999 to April 2006 were retrospectively analyzed. Recurrence was defined as any prolapse of stage II or greater according to the Pelvic Organ Prolapse Quantification system. The log-rank test and Cox regression of the Kaplan-Meier survival analysis were used in univariate analysis, and the Cox proportional hazard model was used in multivariate analysis. Results: The median follow-up period was 24 (range 1–84) months and the number of patients suffering from recurrence was 36 (17.0%). Age, parity, repetitive heavy lifting/chronic constipation, family history, hormone replacement therapy status, and preoperative stage all had an influence on the outcome, although preoperative stage IV was the only independent risk factor (hazard ratio (HR) 5.6, 95% CI 1.1–29.3, p = 0.044). Analyzing by compartments, preoperative stage IV (HR 18.6, 95% CI 2.1–162.3, p = 0.018) was an independent risk factor for the recurrence in anterior compartment, not for posterior or apical. Conclusions: Patients with a far advanced preoperative stage (stage IV), especially in cases of anterior prolapse, are more likely to experience a recurrence after traditional reconstructive surgery.