Intrapartum balloon placement ameliorates repetitive variable decelerations of fetal heart rate Variable decelerations (VDs) of the fetal heart rate arise from transient interruption of umbilical blood flow due to compression or stretching of umbilical vessels during uterine contractions. Although sporadic VDs are considered harmless, repetitive VDs, if left untreated, can lead to fetal acidosis [1,2]. In the presence of oligohydramnios, repetitive VDs are likely attributable to umbilical vessel compression, which could be released by amnioinfusion . On the other hand, in the absence of oligohydramnios, repetitive VDs could be attributable to umbilical vessel stretching that is often associated with short or entangled umbilical cord.
Case Report: Vulvodynia Treated with Erbium:YAG Laser Vulvodynia is a quite common disorder that has a negative impact on quality of life. It is defined as a burning pain without relevant visible findings or a specific, clinically identifiable, neurologic disorder. It typically persists for a duration of at least 3 months (1). In the etiology of those women with normal skin, genetic factors, hypersensitivity, pelvic floor dysfunction and finally hormonal factors may play important roles (2). Various kinds of treatments modalities including surgery have thus far been recommended to reduce the pain.
New insight into glycation levels and pelvic organ prolapse - a combination of clinical and biochemical studies Pelvic Organ Prolapse (POP) is a multifactorial disease with ageing as a most notable risk factor. Advanced glycation end products (AGEs), biochemical markers of ageing are increased in prolapsed tissues. It is however unclear if AGEs are a cause or outcome of prolapse. By combining analysis of clinically relevant parameters in women with prolapse and POP tissues biochemically, this study aims to bridge the gap between existing clinical and biochemical research on the cause of POP.
Osteogenesis imperfecta type VIII: Association with increased nuchal translucency and prenatal diagnosis by targeted exome sequencing Osteogenesis imperfecta (OI) is a genetically heterogeneous skeletal dysplasia that affects approximately 1 in 10,000–20,000 births . Although most of the time prenatal diagnosis of OI can be confirmed by molecular testing, sonography is still the primary diagnostic modality. Criteria for the prenatal diagnosis of OI using second-trimester sonography include hypomineralization of the skull, early onset of bone shortening, and bowing due to multiple fractures involving long bones. However, the sonographic detection of OI at the first trimestr of pregnancy is challenging.
EBCOG Position Statement – Travelling when pregnant Pregnant women may want to travel to go on holiday, to visit friends or family or for work related purposes. For the majority of pregnant women, travelling long distances will be safe and a short flight may be a safer alternative to a long car, coach or train ride.With any type of travelling, seatbelts should be worn when directed to do so, with the upper belt above the uterus and the lower belt across the upper thighs, therefore ensuring that either belt avoids the pregnant uterus.
Vaginal birth after prior myomectomy The aim of this retrospective cohort study was to evaluate the obstetrical and perinatal outcomes of vaginal birth in case of pregnancies achieved after prior myomectomy. We also analyzed how operative characteristics at the time of surgery might influence the choice of obstetricians about mode of delivery.
Successful angioembolization treatment in a patient with a mechanical heart valve with hemorrhagic corpus luteum A 23 year-old nulliparous patient presented to our emergency department due to lower abdominal pain lasting for 3 weeks with aggravation two days prior to her admission after coitus. Her history was remarkable for prosthetic aortic valve replacement 4 years ago due to regurgitating congenital bicuspid aortic valve. She was recently switched from warfarin treatment to enoxaparin, a low molecular weight heparin, as the patient was trying to conceive. At presentation, the patient was in severe pain.
Compound heterozygous RYR1 mutations by whole exome sequencing in a family with three repeated affected fetuses with fetal akinesia Fetal akinesia deformation sequence (FADS) is characterized by intrauterine fetal immobility, hydrops, akinesia, growth restriction and arthrogryposis (OMIM#208150). Recent genetic analyses of a large panel of neuromuscular diseases-related genes using next-generation sequencing (NGS) have been performed, and a recent report suggests the association between KLHL40 mutations and FADS . In our present study, in a family with three repeated affected fetuses with fetal hydrops and akinesia, we performed whole exome analysis of 21,522 candidate genes by NGS using the fetal umbilical cord and the parents’ blood after the third conception.
Association between angiotensin-converting enzyme gene insertion/deletion polymorphism and susceptibility to preterm birth: A case-control study and meta-analysis Preterm birth is the largest contributor to newborn mortality, morbidity, and hospitalization in the first year of life worldwide. Previous studies have suggested the importance of genetic variation in the angiotensin-converting enzyme gene, including the angiotensin-converting enzyme gene insertion/deletion polymorphism, in association with preterm birth. The angiotensin-converting enzyme is a key component of the renin-angiotensin system that is involved in blood pressure homeostasis during pregnancy and also affects risk factors of preterm birth, including the regulation of fibrinolytic system, uteroplacental circulation, vascularization of the placenta, and inflammation.
Ovarian hemangioma with Meigs' syndrome Ovarian hemangiomas, are very rare benign tumors, exclusively detected anegdotally on histopathologic examinations. A 35-year-old nuligravida presented for abdominal pain and distention with regular menstrual cycles and appendectomy in childhood, and family history was inconspicuous. She did not undergo gynecologic examination regularly, the last one being six years before, with normal Pap test, somatogram and laboratory findings.
Plasmapheresis—A lifesaving treatment for life threatening HELLP syndrome Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome is a rare and serious complication of pregnancy characterized by microangiopathic hemolytic anemia, increased levels of liver enzymes, and thrombocytopenia. The optimal management approach of women with HELLP is highly controversial. We herein present a case of successful treatment of life threatening HELLP by plasmapheresis.
Maternal mortality after cesarean section in the Netherlands Maternal mortality is rare in high-resource settings. This hampers studies of the association between maternal mortality and mode of birth, although this topic remains of importance, given the changing patterns in mode of birth with increasing cesarean section rates in most countries. Purpose of this study was to examine incidence of cesarean section-related maternal mortality in the Netherlands and association of surgery with the chain of morbid events leading to death.
Editorial Breast cancer is the most frequent malignancy in women in Western countries. Because female gender is the strongest risk factor, women are extraordinarily sensitive to the issue. Age is another important breast cancer risk factor, so screening is only recommended from 45 to 50 years of age in most countries. Therefore, the young, pre-menopausal woman faces messages about the strength of the threat but lacks the support of a screening policy. This adds to some specific factors creating a feeling of uncertainty.
A rare case of refractory disseminated leiomyomatosisperitonealis complicated by cauda equina compression We wish to share our experience with a rare case of leiomyomatosis peritonealis disseminate LPD, which is a rare condition characterized by the presence of multiple benign smooth muscle nodules located on peritoneal surfaces . A 60 year postmenopausal woman had a 4 month history of abdominal bloating and postmenopausal bleeding, which required a total abdominal hysterectomy with bilateral salpingoopherectomy for a large benign uterine leiomyoma. She was para 3 with a BMI of 31 and medical history included type 2 diabetes mellitus, asthma, and rheumatoid arthritis.
Health care service in paediatric and adolescent gynaecology throughout Europe: a review of the literature Paediatric and adolescent gynaecology is a special field of interest within general gynaecology and obstetrics. The care for children and young people differs from adults. In gynaecology, children should not be treated like little adults. Within Europe, there is great variability in the provision of care, availability of clinical networks and lack of national standards within paediatric and adolescent gynaecology. Therefore, this review aims to summarize the current evidence regarding best clinical practice within Europe.
Shedding light on the fertility preservation debate in women with endometriosis: a swot analysis Endometriosis, a hormone-dependant condition affecting around 10% of women in their reproductive years, has frequent consequences on fertility. Indeed, a proportion of women will require assisted reproductive techniques or surgery in order to achieve pregnancy. Recent refining of stimulation protocols and vitrification techniques has created new possibilities in the field of fertility preservation. As a consequence, oocyte vitrification is now discussed not only in oncologic situations, but also in other conditions at risk of altered ovarian reserve and poor fertility outcome.
The Future of Paediatric and Adolescent Gynaecology in Europe Paediatric and Adolescent Gynaecology (PAG) is a subspecialty under the umbrella of Obstetrics and Gynaecology but linked to other branches of medicine including Paediatrics, Surgery, Endocrinology and Urology. Therefore future developments in clinical care and education requires a multidisciplinary approach combining aspects of all the above medical specialties, and also with inputs from Public Health, Genetics, Radiology and Psychology. A multidisciplinary collaboration among different specialists is as important as the establishment and adoption of standards in education, training and management.
Q fever first presenting as a septic shock resulting in intrauterine fetal death Q fever is a highly contagious zoonosis caused by the bacteria Coxiella burnetii . The occurrence of Q fever during pregnancy may lead to severe maternal and fetal consequences. There is paucity of literature regarding this issue and most data are based on scattered case reports and small case series. Available data suggest an increased risk for spontaneous abortion, growth impairment, intrauterine fetal demise and preterm labor [2–4]. Herein we present an unusual case of 2nd trimester pregnant patient presenting with septic shock due to Q fever,
Post cesarean candida peritonitis Post-caesarean section peritonitis is rare and a leading cause of maternal morbidity. The classical presentation is similar to other acute abdominal inflammatory conditions and, consequently, current management often involves an exploratory laparotomy .
The role of epidermal growth factor receptor (EGFR) common gene mutations in Iranian women with uterine fibroids Uterine myomas are benign uterine tumors that originate from smooth muscle cells of the myometrium. This common complication can be associated with irreversible complications, including infertility and malignancy. Better understanding of the genetic characteristics of myoma may effect on treatment. Epidermal growth factor receptor gene (EGFR) is one of the most important genes that has the major role in the pathogenesis of myoma, cell growth, differentiation, proliferation and mutagenesis. The aim of this study was to investigate EGFR common gene mutations in Iranian women with uterine fibroids.
Shoulder dystocia and range of head-body delivery interval (HBDI): The association between prolonged HBDI and neonatal outcomes: Protocol for a systematic review Shoulder dystocia (SD) is an obstetric emergency which if not carefully diagnosed and managed, can contribute to lifelong neonatal morbidities. Despite current guidelines on the definition of SD (impaction of the fetal shoulder behind the maternal symphysis pubis and need for ancillary manoeuvres or head-body delivery interval (HBDI) >60 s) its accurate diagnosis requires clinical expertise as well as overall consideration of feto-maternal condition. Based on the literature available, our study aims to determine (1) the range of HBDI as an indicator of SD and (2) the neonatal complications occurring following prolonged HBDI in normal or SD-complicated births.
Assessment of oxidant-antioxidant status alterations with tumor biomarkers and reproductive system hormones in uterine MYOMAS Uterine myomas (UM) are responsible for significant morbidity and have adverse effects on quality of life in women. Reactive oxygen species (ROS) and antioxidant enzymes (AOE), as well as sex steroids play important roles in the reproductive physiology processes. Thus, we aimed to investigate the role of oxidant-antioxidant status in UM by measuring the AOE activities and lipid peroxidation (LPO) levels. This is the first study assessing these parameters together in UM based on also menopausal status and evaluating possible correlations between AOE activities, LPO markers, tumor biomarkers, female reproductive system hormone levels, comprehensively.
Admission cardiotocography: A hospital based validation study Admission CTG is a short fetal heart rate (FHR) tracing recorded immediately at hospital admission to avoid unnecessary delay in action among pregnancies complicated by pre-existent fetal distress. There are different opinions regarding the value of the admission CTG, especially in low risk pregnancies.
Reliability of colposcopy during pregnancy To investigate the reliability of colposcopy during pregnancy and to evaluate the concordance between colposcopic patterns and histopathological findings in these women.
Physical activity and body image dissatisfaction among pregnant women: A systematic review and meta-analysis of cohort studies Body image dissatisfaction has increased among pregnant women, affecting their mental and physical activities. Previous systematic reviews only found significant results existed in cross-sectional design instead of longitudinal designs. This meta-analytic review of cohort studies aimed to report the relationships and moderator variables about body image dissatisfaction and physical activity among pregnant women. We searched for studies in PubMed, EMBASE, Web of Science and the Cochrane library until December 2017.
Can manual lymph drainage be improved or not: That’s the question! A response letter We have read the comments on the recently published protocol of the EFforT-BCRL trial  with great interest. The aim of this multi-centre randomized controlled trial (RCT) was to determine the effectiveness of fluoroscopy-guided manual lymph drainage (MLD) in addition to the other components of decongestive lymphatic therapy and compared to traditional or placebo MLD, in the treatment of breast cancer-related lymphoedema. The protocol of this trial adheres to the recommended CONSORT guidelines and the work received substantial contributions from all stakeholders in order to meet the required quality standards.
The predictive value of sentinel node biopsy in early breast cancer after neo-adjuvant chemotherapy: A prospective study A sentinel Node (SN) has replaced axillary lymph node dissection (ALND) in patients with clinically node negative axilla (cN0). SN after Neo-adjuvant chemotherapy (NACT) is feasible but not accurate in clinically node positive (cN1-3) patients. The goal of this study is to determine the negative predictive value (NPV) of SN in cN0 breast cancer after NACT. A secondary endpoint is to determine if ALND can be avoided after NACT regardless of the pre-treatment clinical staging of the axilla, in case of a normalization of the 18F-fluoro-2-deoxy-glucose positron emission tomography scan (PET-CT scan).
The effects of hydrocortisone on tight junction genes in an in vitro model of the human fallopian epithelial cells The tight junction between epithelial cells helps making connections in the fallopian tube and contributes to successful fertilization. Breaking the tight junction complex induces various diseases such as the EP. Previous studies have shown that glucocorticoids are effective in repairing and maintaining intercellular tight junctions in epithelial cells of the fallopian tube, although their mechanism is still unknown. This research is a genomic study of hydrocortisone’s effect on epithelial cells of the fallopian tube.
Breast cancer screening in young women Breast cancer is the leading cause of death by cancer in women aged less than 40. However, organized screening of young healthy women has been recognized as inefficient and even deleterious by most experts , and should not been offered. Individualized screening, targeting only some young high-risk women, may be beneficial although no randomized trial has proven an impact on breast cancer mortality. All recommendations are based on expert’s opinions. This review offers a toned overview of these recommendations and underlines the need of careful information and shared decision with each patient.
Breast cancer in pregnant patients: A review of the literature Breast cancer diagnosed during pregnancy is a rare occurrence at present; however, in recent years a trend towards delayed childbirth is generating an increase in its incidence. This situation requires a multidisciplinary approach involving obstetricians, oncologists and surgeons.In this review we analyse diagnostic methods, different possible treatments and long-term patient prognosis. We conducted a search for articles published in PubMed, or in abstract form from the San Antonio Breast Cancer Symposium (SABCS), the European Society for Medical Oncology (ESMO), and the American Society of Clinical Oncology (ASCO) annual meeting, using the search terms:“Breast cancer and pregnancy”.
Breast reconstruction after mastectomy Reconstructive surgery aims to improve quality of life by recreating a natural-looking breast that is warm to the touch. To obtain symmetry and body contour alignment, restoration of volume within the skin envelope is mandatory. The chosen reconstruction technique depends on the characteristics of the diseased breast, the shape and volume of the contralateral breast, and the technical skills of the surgical team. Timing, type and different possibilities of breast reconstruction are discussed.
Hormonal contraceptives and breast cancer: Clinical data The endocrine background of breast cancer has raised questions about the increase in risk that might bear the use of hormonal contraceptives. This has been a particular issue in the case of young women, who constitute the population of contraceptive consumers. Observational studies have been the main source of evidence, which has mainly limited to the combined estrogen-progestogen preparations, the popular pill. Studies in the 80′s and 90′s of the past century found a small, around a 20%, increase in risk.
The action of estrogens and progestogens in the young female breast Evidence from different sources sustains a pro-oncogenic role of hormones, estrogens and progestogens, on the breast. The issue is of interest for young women, who are exposed to the hormonal changes imposed by the ovarian cycle and, often, take hormones with contraceptive purposes.Experimental and clinical studies show that both estrogens and progesterone are involved in mammary development during puberty and lactation, the changes being observed across mammalian species, including humans. Estrogen receptors, and more particularly the alpha isoform, participate in molecular processes of stem cells differentiation and epithelial proliferation through paracrine actions implicating growth factors.
Obesity and breast cancer in premenopausal women: Current evidence and future perspectives There is raising evidence reporting an increased incidence of breast cancer over the past decades. Every year approximately 1.4 million new cases of breast cancer are diagnosed worldwide, with a mortality rate of approximately 450,000/year. Out of these cases, 6.6% are diagnosed in premenopausal women with a median age at diagnosis of 40 years: in premenopausal women breast cancer seems to be more aggressive than in post-menopausal women. Obesity has been reported to increase the risk of developing breast cancer and to worsen the prognosis.
Breast reconstruction after breast conservation therapy for breast cancer Conservative breast surgery followed by irradiation, often referred to as Breast conserving therapy (BCT), has replaced modified radical mastectomy for the treatment of early stage invasive breast cancer and ductal carcinoma in situ (DCIS). About 10% to 40% of the patients treated with BCT have poor cosmetic outcome results. Small tumours in large breasts can be successfully treated by lumpectomy and radiotherapy, with good cosmetic outcome. However when the tumour breast ratio is higher, the cosmetic outcome can be very disappointing.
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