Gynecologic and Obstetric Investigation

Odendaal, Hein J.; Steyn, D. Wilhelm; Elliott, Amy; Burd, Larry

doi: 10.1159/000150597pmid: 18685256

Background: An increase in various congenital abnormalities associated with cigarette smoking and the use of alcohol during pregnancy has been reported in many studies. These exposures also increase the risk of pregnancy complications such as abruptio placentae, unexplained stillbirth, preterm labor and intrauterine growth restriction. However, very few studies have addressed the combined effect of smoking and drinking on pregnancy outcomes. Methods: In this review, the adverse effects of smoking or drinking on pregnancy were obtained from publications in which both substances were addressed in the same study population. A special effort was made to find studies in which the combined effect of these substances was investigated. Results: Preterm labor occurred more frequently in women who drank and smoked during pregnancy. This increased odds ratio was more than the sum of the effects of either smoking or drinking, indicating that the use of both substances by the same woman has a synergistic effect that increases the risk of preterm labor. This synergistic effect was also found for low birth weight and growth restriction. Conclusions: As most of the women who drink during pregnancy also smoke cigarettes, attention should be given to the prevention or reduced use of both substances during pregnancy.

Devlieger, R.; Verhaeghe, J.; Coopmans, W.; Deprest, J.A.

doi: 10.1159/000150598pmid: 18685257

Background: To evaluate the levels of insulin-like growth factor-binding protein-1 (IGFBP-1) in cervicovaginal secretions before and after midtrimester amniocentesis and relate to clinical outcome. Methods: 100 consecutive amniocentesis procedures were studied. We measured the IGFBP-1 concentration by radioimmunoassay in a cervicovaginal specimen before and after mid-trimester amniocentesis. The post-amniocentesis occurrence of vaginal loss of fluid or blood and abdominal pain was assessed by questionnaire. Results: In 6 cases there was a 100-fold increase in IGFBP-1 levels after amniocentesis. Loss of fluid per vaginam occurred in 4 (67%) of these pregnancies, compared to 3.2% of pregnancies without significant surge (p < 0.0001). In addition, post-procedural abdominal pain was more common among women with increased IGFBP-1 levels after amniocentesis (50 vs. 14%, p = 0.05). Two (33%) of the 6 patients with increased IGFBP-1 after amniocentesis delivered prior to 37 weeks as a result of spontaneous preterm labor and/or preterm ruptured membranes, compared to 7 (7%) in the group without surge in IGFBP-1 (p = 0.09). Conclusion: Increased post-procedure IGFBP-1 levels are after mid-trimester amniocenteses are related to procedure-related complications like abdominal pain and subsequent amniotic fluid leakage.

Machorro-Lazo, Maria-Victoria; Sanchez-Corona, Jose; Martínez-Abundis, Esperanza; González-Ortiz, Manuel; Galaviz-Hernandez, Carlos; Perea, Francisco-Javier; Garcia-Zapien, Alejandra-Guadalupe; Cruz-Quevedo, Edhit-Guadalupe; Salgado-Goytia, Lorenzo; Moran-Moguel, Maria-Cristina; Flores-Martínez, Silvia-Esperanza

Mahajan, Niraj N.; Thomas, Anita; Soni, Rajani N.; Gaikwad, Nilima L.; Jain, Suchi M.

doi: 10.1159/000158647pmid: 18824861

Aims: To determine the recurrent convulsion rate using low-dose magnesium sulphate regime in eclampsia and to identify toxicity and complications with clinical parameters. Methods: Prospective study with two different magnesium sulphate regimes in two slightly clinically different subgroups. Group A that came directly to our hospital and group B who had already received an injection of diazepam or Phenergan at the referring hospital. Group A received 10 g and group B 6 g loading dose of magnesium sulphate. Both groups received 4 g maintenance dose every 4 h. Results: Out of 95 eclamptic patients, only one woman in group B had recurrent convulsion. All women maintained normal respiratory rates. 39 (41.1%) women had absent knee jerks on at least one occasion when the maintenance dose was omitted. Urinary output was more than 30 ml/h in 92 (96.8%) women. In 5 women, maintenance dose had to be augmented to 5 g as reflexes were exaggerated. Conclusion: The low-dose regime appears to control and prevent convulsions effectively in Indian women. Clinical monitoring appears to be sufficient. We hope to be able to reassure health professionals at primary and secondary level hospitals about the safety of magnesium.

Kollenz, C.; Phleps, W.; Kaehler, S.T.

doi: 10.1159/000158648pmid: 18824862

Background: Primary dysmenorrhea is estimated to affect 40–50% of menstruating young women. Methods: Randomized, double-blind, 3-cycle crossover, active-controlled clinical trial conducted in 102 outpatients. Results: 102 patients entered the study and 77 were eligible for analyses. The mean (SD) age was 31.1 (7.0) years, and the mean cycle duration was 28.1 days (1.89) with a mean menstrual phase of 5.3 days (1.28). 40.26% of patients reported moderate pain from dysmenorrhea, and the remaining 59.74% reported severe pain. Compared to ibuprofen 400 mg, both dexibuprofen doses (200 and 300 mg) showed a trend towards superiority for sum of pain intensity difference (sum of PID), PID and total pain relief. Furthermore, dexibuprofen 200 mg had a faster onset of action compared to the double dose of ibuprofen (p = 0.035). A dose-effect relationship could be demonstrated for dexibuprofen in this visceral pain model. Tolerability was similar across all treatments. Conclusions: In patients experiencing acute visceral pain as a result of primary dysmenorrhea, dexibuprofen was associated with a dose-dependent effective analgesia; this effect was at least equivalent to that of the double dose of ibuprofen. With its lower body-loading dose, dexibuprofen expands the alternatives available to treat this condition.

Ragni, Guido; Scarduelli, Claudia; Calanna, Graziella; Santi, Giulia; Benaglia, Laura; Somigliana, Edgardo

doi: 10.1159/000158649pmid: 18827490

Background/Aims: Limited information is available regarding the quantity of blood loss associated with uncomplicated transvaginal oocyte retrieval. The aim of the present study was evaluating the quantity of such a loss. Methods: One hundred and fifty consecutive women undergoing oocyte retrieval were recruited. They underwent blood test assessment and ultrasonographic transvaginal evaluation at three different times: (1) immediately before initiating oocyte retrieval, (2) 4–6 h later, and (3) 72 h later. Results: At 4–6 h after oocyte retrieval, the red blood cell count and the hemoglobin concentration were significantly reduced, whereas pelvic free fluid had significantly increased. The estimated median (Interquartile range) blood loss was 72 (–8/162) ml. None of the recruited women was found to have a hemoglobin reduction >2 g/day or an increase in the pelvic free fluid >200 ml or a calculated blood loss >500 ml (0.0%, 95% CI: 0.0–2.4%). No significant worsening from baseline was observed at the 72 h evaluation. Conclusions: The quantity of blood loss following oocyte retrieval is clinically unremarkable in the vast majority of women.

To, William W.K.; Wong, Margaret W.N.

doi: 10.1159/000158650pmid: 18827491

Objective: To evaluate whether back pain symptoms in pregnancy are associated with bone mineral density (BMD) changes as measured by quantitative ultrasound at the os calcis. Methods: Consecutive patients were recruited from a general obstetric clinic over 1 year. Quantitative ultrasonographic measurements of BMD were performed at the os calcis between weeks 14–20 and 36–38. They were then surveyed for back pain symptoms experienced during pregnancy in the early postpartum period, and these were subsequently correlated with BMD changes. Results: Of a total of 463 patients, 231 (49.8%) reported one or more episodes of significant back pain during pregnancy. A mean fall in BMD of 0.0395 g/cm² was demonstrable from early to late gestation. Those with back pain symptoms have higher mean BMD loss at the os calcis during pregnancy compared to those without back pain (0.038 vs. 0.029 g/cm²; p = 0.012). A logistic regression model showed that weight gain and BMD loss in pregnancy were significantly associated with back pain symptoms. Conclusion: Back pain symptoms in pregnancy were associated with a greater fall in BMD at the os calcis, supporting the hypothesis that BMD changes could have an etiological role in back pain during pregnancy.

Hampl, Monika; Kueppers, Volkmar; Bender, Hans Georg

doi: 10.1159/000159178pmid: 18832852

The incidence of human papillomavirus (HPV)-induced vulvar cancer in young women is increasing and often presents as microinvasive or early invasive tumors in a grade 3 vulvar intraepithelial neoplasia. So far, the risk of lymph node metastases in early invasive vulvar carcinoma (depth of invasion 1.1–2.0 mm) is reported to be less than 8%. We present 2 cases of young women with early invasive vulvar cancers (depth of invasion 1.5 and 2.0 mm) induced by HPV 16 and 42. In both cases, the cancers are located between the clitoris and urethra and are each accompanied by one groin macro-metastatic lymph node. This case report highlights the necessity for complete inguinofemoral lymphadenectomy and/or adequate radiation therapy of the groin in early invasive tumors in young women to prevent cancer recurrence in the groin. Additionally, the indication for a sentinel node procedure in these specific cases requires particular caution.

Vandenput, I.; Vanden Bempt, I.; Leunen, K.; Neven, P.; Berteloot, P.; Moerman, P.; Vergote, I.; Amant, F.

doi: 10.1159/000161568pmid: 18843183

Background: It is hypothesized that the HER-2/neu receptor could be used for targeted therapy in recurrent endometrial cancer. Cases: A patient with type II endometrial cancer (serous), showing strong HER-2/neu overexpression and gene amplification in both primary and recurrent tumor, received single-agent trastuzumab (3× weekly, 8 mg/kg loading, 6 mg/kg maintenance dose). Because of progression after 4 cycles, weekly paclitaxel-trastuzumab (80 mg/m² paclitaxel; trastuzumab 4 mg/kg loading, 2 mg/kg maintenance dose) was initiated. However, progressive disease was also noted after 11 weeks of combined treatment. A second patient, with recurrent type II endometrial cancer (grade III endometrioid), had HER-2/neu gene amplification in the primary tumor. However, biopsy from a lung metastasis 3 years later appeared to be HER-2/neu-negative. Conclusion: Based on lack of response and changes in tumor biology, trastuzumab was of little clinical value in 2 cases of recurrent type II endometrial cancer. This report underscores the importance of reassessment of a recurrent tumor before initiating targeted treatment.

Andersgaard, Alice Beathe; Herbst, Andreas; Johansen, Marianne; Borgström, Anna; Bille, Anna Gry; Øian, Pål

doi: 10.1159/000161569pmid: 18843184

Background/Aims: The aim of the study was to assess the prevalence of persisting symptoms 6 months or more after eclampsia. Methods: During a 2-year period (mid-1998 to mid-2000), 210 patients with eclampsia were included in a prospective cohort study of eclampsia in Denmark, Norway and Sweden. One hundred and twenty-three women (59%) were followed up with a structured telephone interview, 6–24 months (median 11) after their eclamptic fit. Results: At the time of follow-up, 63 women (51%) had at least one persistent symptom; 2 patients had severe neurological sequels (hemiparesis and dysarthria), 11% had visual disturbances, 22% had problems concentrating or recalling phone numbers and messages, 18% reported frequent headaches and 10% had vertigo or balance problems. Conclusion: Although few women suffered from severe sequels, many women had persisting symptoms following eclampsia indicating a need for follow-up of these patients. A case-control study comparing the health and symptoms between women having suffered from eclampsia and women without this complication may therefore be justified.