Phthalate Exposure from Drugs during Pregnancy and Possible Risk of Preterm Birth and Small for Gestational Age Phthalates are chemical compounds present in a wide range of consumer products and are thought to be endocrine disruptors. Though not commonly known, phthalates are present in some medication with previous studies finding up to 50-fold higher urinary metabolite concentrations among exposed compared to the general population. Previous studies on environmental phthalate exposure and pregnancy outcomes have been contradictory and inconclusive and all previous studies have assessed phthalate exposure using biomarkers despite a known rapid metabolism of phthalates.
Placental mesenchymal dysplasia, a rare pathology We report a case of a 16 year old primigravida referred to our center with a previous diagnosis of molar pregnancy and a 160/100 mmHg blood pressure at 28 weeks of gestation. On examination, she was noted to have 41 centimeters symphysis-fundal height, abdominal tenderness, diffuse bilateral edema in her lower extremities and hyperreflexia.
Non-clinical interventions to prevent postpartum haemorrhage and improve its management: a systematic review Postpartum haemorrhages (PPHs) account for around 200 deaths per year in the developed regions of the world. However, the efficacy of pharmacological and clinical interventions to prevent or manage PPHs is well established.Our objective was to determine the effectiveness of non-clinical interventions targeting healthcare professionals, organisations or facilities in preventing PPH or improving its management.We conducted a systematic review using the PRISMA four-step model. The MEDLINE and Cochrane databases were searched up to March 2019.
Review of Migraine Incidence and Management in Obstetrics and Gynaecology Migraines are the third most prevalent disorder, and seventh-highest specific cause of disability worldwide. Migraines have a multitude of underlying aetiologies; the pathology may come as a result of hormonal treatment or as a sole symptom during menstrual cycle or pregnancy, with variable intensity and duration. In addition, clinicians should be fully aware of the potential complications and well-versed in management options.
Radiofrequency ablation of retained placenta accreta after conservative management We herein report, to our knowledge, the first case of attempt to treat placenta accreta leaved in situ in human after delivery using RF ablation. The patient was a 35-year-old (gravida two para one) with history of cesarean delivery. Ultrasonography at 32 weeks of gestation showed an anterior placenta not low-lying. Labor was induced at 39 weeks and a female neonate weighing 3 400 g was delivered by vacuum extraction. Placenta delivery was incomplete and attempts for manual removal and uterine revision failed leading to suspicion of partial placenta accreta.
Kisspeptin as a potential biomarker throughout pregnancy Kisspeptins are a family of neuropeptides that are critical for the puberty initiation and female fertility. Plasma or serum kisspeptin is mainly derived from the placenta during pregnancy and plasma kisspeptin levels significantly increase across pregnancy. Plasma kisspeptin levels could be used as a potential biomarker for the detection of miscarriage, pre-eclampsia, gestational trophoblastic neoplasia (GTN), and fetal development. Kisspeptin may also be involved in the process of parturition by stimulating oxytocin secretion during term pregnancy.
The Association of ToRCH Infection and Congenital Malformations: A Prospective Study in China ToRCH infections (toxoplasmosis, rubella, cytomegalovirus and Herpes simplex virus) have long been known to be associated with bad obstetric outcomes. Little information is available about the impact of ToRCH infection on reproduction in china nearly for ten years. We designed a prospective study among 1863 pregnant women to investigate the association of ToRCH infection and congenital malformations.
Chlamydia trachomatis screening in preterm labor: A systematic review and meta-analysis Spontaneous preterm labor (PTL) is responsible for approximately half of all preterm births with intrauterine infection being an important risk factor for PTL. Chlamydia trachomatis infections have been associated with preterm prelabor rupture of membranes (PROM) and preterm birth, but its impact on PTL has not previously been specified. The aim of this study was to evaluate the overall prevalence of Chlamydia trachomatis infections in pregnant women with threatened PTL compared to those not in threatened PTL.
Re: Vaginal birth after prior myomectomy We read with interest the article “Vaginal birth after prior myomectomy” by Gambacorti-Passerini, a retrospective review of patients with previous myomectomy via laparoscopy or laparotomy who subsequently became pregnant . The study contacted patients with previous myomectomies to query their later pregnancy outcomes. The conclusion of the article was “A successful vaginal delivery was accomplished by 90.4% of women who had TOLAM (trial of labor after myomectomy), without any case of UR (uterine rupture) or severe maternal and perinatal complications.”
Autoantibodies common in patients with gastrointestinal diseases are not found in patients with endometriosis: A cross-sectional study Gastrointestinal symptoms are common in endometriosis, but the mechanisms behind these symptoms are yet poorly understood. Associations between endometriosis and irritable bowel syndrome (IBS), celiac disease, and various autoimmune diseases have been reported. These diseases express characteristic autoantibodies. The aim of the current study was to investigate autoantibodies against gonadotropin-releasing hormone 1 (GnRH1) and luteinizing hormone (LH) and their receptors, tenascin-C, matrix metalloproteinase-9, deamidated gliadin peptide, and tissue transglutaminase in a cohort of women with endometriosis, compared to controls and women with IBS or enteric dysmotility.
Late postpartum haemorrhage caused by placenta accreta accompanied by acquired uterine arteriovenous malformation A 32-year-old female, gravida 3 para 2 (two caesarean sections), presented to our hospital due to vaginal bleeding. She had undergone caesarean section 12 days previously. Preoperative ultrasound imaging showed a posterior placenta, whose inferior margin was 1.8 cm away from the cervical internal orifice (Fig. 1A). Intraoperative findings indicated that, most of the placenta was attached to the posterior wall of the uterus, with a wafer-thin lower margin fully covering the cervical internal orifice and reaching the lower segment of anterior uterine wall.
Elective induction of labour in low risk nulliparous women at term: Caution is needed The recently published ARRIVE trial demonstrated that “policies aimed at the avoidance of elective labour induction among low-risk nulliparous women at 39 weeks of gestation are unlikely to reduce the rate of caesarean delivery on a population level”. In this commentary we discuss some controversial aspects of the study that in our opinion may undermine its validity at wide population level.
Sigmoido-uterine fistula: An uncommon communication! Colouterine fistulas are extremely rare which may be attributed to the thick muscular structure of the uterus acting as a protective barrier. Though colonic diverticular disease is implicated as a common cause of such fistulae, neoplasia of the uterus/colon and iatrogenic trauma could be other etiological factors . Most of these patients do have significant lower gastrointestinal symptoms, but also could be asymptomatic only to present with feculent discharge per vaginum (PV) that compromises patients’ quality of life.
Analgesia, anaesthesia and obstetric outcome in women with inherited bleeding disorders Vertebral canal haematoma (VCH) complicates 1 in 168,000 obstetric epidurals (Ruppen et al., 2006). This risk is increased in women with inherited bleeding disorders (IBD). The impact of a contraindication to regional anaesthesia on pain management and obstetric outcome in these women is unknown. The purpose of this study was to determine anaesthetic use and obstetric outcomes in a cohort of women with IBD.
Considerations and variations in cesarean delivery techniques: A surgeon’s view Caesarean section is a common operation in obstetric practice. Techniques vary depending on the clinical situation and the preferences of the operator. I am here reporting 3 important considerations in the surgical technique. First i will discuss peritoneal closure then the role of uterine Exteriorization and finally uterine incision and closure techniques.
Predictors of patient preference for mode of delivery following an obstetric anal sphincter injury Patients who sustain an Obstetric Anal Sphincter Injury (OASI) have the opportunity to select an elective caesarean section over a vaginal delivery in subsequent pregnancies. It remains unclear whether there are identifiable factors which predict expectant mothers’ choices. The primary aim of our study was to explore this issue further in a consecutive group of patients who had suffered OASI.
Nocturnal blood pressure alterations in patients with preeclampsia – Do they really matter? A systematic review of the literature The significance of blood pressure alterations during night-time has been already recorded in essential hypertension and several studies have been conducted to guide current clinical practice. To date, however, there is no consensus regarding the need for screening patients with preeclampsia for nocturnal hypertension as evidence in this field remain scarce. The purpose of this study is to accumulate current data in this field and serve as a pilot for the conduct of future studies. The present systematic review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Letter to the Editor We read this article with great interest  and we agree that there is a need for an evidence based and validated algorithm for advising women who have sustained Obstetric Anal Sphincter Injuries (OASIS) on the mode of delivery in subsequent pregnancies. We were hoping that this paper (that criticises previous publications) will provide a definitive protocol but unfortunately it served only to create more confusion.
Laparoscopic lateral hysterosuspension with mesh using a special device via retroperitoneal tunneling Because of the changes in sexuality and fertility concerns over the last decade, there is a growing demand for uterine-sparing surgery to treat uterine prolapse . Both laparoscopic sacral hysteropexy and lateral hysterosuspension were identified as effective treatment options for uterine prolapse. However, these procedures required long operation time and expert laparoscopic skills [2,3]. Therefore, there is a need for a short-time, minimally invasive procedure. For this purpose, a new procedure has been designed and presented.
Efficacy and safety of the Calistar and Elevate anterior vaginal mesh procedures The pelvic organ prolapse (POP) surgery with implantation of anterior transvaginal mesh (e.g. Elevate or Calistar) may provide objective and subjective improvement as compared to traditional POP repair without mesh. Given differences between the Elevate and the Calistar mesh and their different placement methods, some variation inlong-term clinical outcomes of these anterior vaginal mesh procedures can be expected.
THE PERCEIVED EFFECT OF SERIOUS ADVERSE PERINATAL EVENTS ON CLINICAL PRACTICE. CAN IT BE OBJECTIVELY MEASURED? Obstetrics involves a high degree of clinical risk. While serious adverse events resulting in substantial maternal or neonatal morbidity or mortality are relatively rare it has been shown that exposure to a such an event can have a predominantly negative personal and professional impact on the healthcare professionals who are involved. There is little in the published literature to show an objective change in clinical practice as a result of an adverse event.The aim of this study was to identify if it was feasible to design a study that could objectively demonstrate if a change in labour ward clinical activity occurred in the 28 days following a serious adverse perinatal event.
Fetal monitoring in term breech labor – A review There has been considerable debate about the mode of delivery in breech presentation at term in response to a large randomized study (the Term Breech Trial) finding that mortality and short-term morbidity were increased among those selected for vaginal delivery . Inadequate fetal surveillance in breech labor has been reported as a contributing factor to adverse outcomes [2,3]. However, elective cesarean delivery is not necessarily advantageous to the long-term outcome , and several recent observational studies recommend vaginal delivery after careful selection and close monitoring during labor [5–20].
EBCOG position statement: Vaccination in pregnancy Maternal immunization has the potential to reduce morbidity and mortality from infectious diseases worldwide. EBCOG promotes this public health intervention supporting international recommendations about the use of vaccines during pregnancy.
Effects of exercise on pregnant women’s quality of life: A systematic review Exercise is a promising approach to improve the health of pregnant women. However, data from studies investigating exercise and the quality of life of pregnant women are inconsistent and, to date, no systematic review on this topic has been published. The aim of this review was to comprehensively assess the effects of exercise on pregnant women’s quality of life, and to determine whether exercise positively affects quality of life in this population.
Short report: Post-operative wound infections after the gentle caesarean section Worldwide, the caesarean section (CS) is the most performed type of surgery and numbers are still rising. The gentle CS has become a more common procedure as it allows the parents to experience birth. Early and continuous skin-to-skin contact between the mother and her newborn is pursued. Parents are not separated from their newborns and stay with their child in the operation theatre and recovery room. However, data are limited on the incidence of surgical site infections (SSI) after gentle CS. The aim of our study was to examine the risk of postoperative wound infections after gentle CS.
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