Markers of maternal cardiac dysfunction in pre-eclampsia and superimposed pre-eclampsia Women who experience hypertensive disorders of pregnancy have an increased risk of developing cardiovascular diseases including hypertension, stroke, and ischaemic heart disease later in life.1–3 This risk is evident shortly after an affected pregnancy and persists for decades.4 The mechanism underlying this association is not known, particularly whether women who develop hypertensive disorders are at higher risk pre-pregnancy and pregnancy unmasks their cardiovascular risk, or whether hypertensive disorders of pregnancy are an index event causing cardiovascular damage.
Maternal cardiac arrest in the Netherlands: a nationwide surveillance study Maternal cardiac arrest is a complex and demanding clinical situation requiring a well-attuned team effort of healthcare workers of multiple disciplines. A recent report on maternal cardiac arrest in the United Kingdom reported a rise in incidence over a span of 10 years, while maternal mortality increased in the United States between 2000 and 2014. However, reported causes of maternal cardiac arrest differed between both countries.
Delivery in Patients with Dyspareunia – A Prospective Study Despite the high prevalence of dyspareunia, published data focused on childbirth is scarce. This study aimed to evaluate the prevalence of dyspareunia in a random primiparae parturient population, characterize their features, and describe associated perinatal outcomes.
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.
Efficiency of Using a Vaginal Drain after Hysterectomy: A Systematic Review Hysterectomy is the second most frequently performed surgical procedure for women of reproductive age topped only by caesarean section. Hysterectomies may be associated with a significant risk of ultrasonographically detected vault haematomas in up to 59% with consequent postoperative morbidity. The aim of this systematic review was to compare women who had a vaginal drain placed intraoperatively after a hysterectomy and the impact on peri and postoperative outcomes related to vault haematomas.
SKA2 Gene - A Novel Biomarker for Latent Anxiety and Preterm Birth Prediction There is a relationship between preterm birth (PTB) and anxiety. Spindle and Kinetochore Associated Complex Subunit 2 (SKA2) gene polymorphism (NC_000017.11: g.59110368 G > A) has also been associated with the development of anxiety. The current study was designed to evaluate the relationship between SKA2 gene SNP (NC_000017.11: g.59110368 G > A) with the occurrence of anxiety and PTB which might be considered a predictive biomarker for the prediction of preterm delivery.
An intrapartum coccygeal fracture: An easily missed buttock pain We found an unusual and severe complication intrapartum coccygeal fracture we will report. Low-back and buttock pain is a common complaint during pregnancy and the postpartum period, and it may be due to a variety of conditions. However, intrapartum coccygeal fracture is a very rare condition presenting with non-specific symptoms and clinical signs. To date, only two cases have been published in the literature [1,2], thus, there is very limited information on coccygeal fracture during pregnancy or the immediate postpartum period.
Cutaneous non-tubercular mycobacterial infection in pregnancy and treatment consideration We present a unique case of non-tubercular mycobacterial infection during pregnancy. A 36-year-old pregnant woman (gravida 2, para 1) presented at 24+ weeks of gestation to the dermatology outpatient with an ulcerated lesion on the abdomen. It had been present for 1 month. There was minimal non-foul-smelling seropurulent discharge from the lesion. She was a known diabetic, and there was a history of multiple injections on the site in the past. She had received amoxicillin 500 mg four times per day for 3 weeks without any response.
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.
Risk of Unexpected Uterine Cancer in Women Undergoing Myomectomy: A Population-Based Study Up to 70% of American women develop uterine fibroids (benign smooth muscle tumors) by age 49 . Myomectomy, surgical removal of fibroids while preserving the uterus, offers a treatment option for women who desire future fertility . Although a common gynecologic procedure, myomectomy is not appropriate for patients with suspected or known cancer. Yet fibroids may present with similar symptoms as uterine sarcomas, and there is heightened concern about unrecognized uterine cancer since the U.S.
Allergy-like reactions to methylene blue following laparoscopic chromopertubation: A systematic review of the literature Methylene blue is commonly used as a tracer in sentinel lymph node mapping for many malignant diseases or chromopertubation during gynecologic laparoscopy. In contrast with other blue dyes such as patent blue V or isosulfan blue, methylene blue rarely causes an allergy-like reaction in patients undergoing sentinel lymph node mapping. However, in chromopertubation, some cases of allergy-like reaction to methylene blue have been reported; these comprise two types: an allergic reaction and methemoglobinemia.
Fetal phenotypes of congenital disorder of glycosylation: A case presentation Congenital disorders of glycosylation (CDG) are a rapidly growing and genetically and clinically heterogeneous family caused by impaired synthesis of glycoconjugates . Affected individuals have multi-systemic manifestations, mainly profound neurological deficiencies, growth failure, facial dysmorphisms, and a wide range of multiorgan symptoms. Currently, all reported CDG cases are child patients. We here first present a prenatal case of CDG due to a de novo variant in the X-linked gene SLC35A2.
Imaging findings of ovarian leiomyosarcoma with histopathologic correlations Leiomyosarcoma (LMS) is a malignant mesenchymal tumor deriving from smooth muscle. Ovarian LMS is exceedingly rare and only few reports have been reported in literature. The article illustrates a case of ovarian leiomyosarcoma in a 61-year-old woman, describing CT and MRI features correlated to histopathologic findings. LMS should be included in the differential diagnosis of solid and multiloculated ovarian lesions, in particular in post-menopausal women.
Growth Hormone Adjuvant trial for poor responders undergoing IVF We were pleased to note that the registered randomised control trial from Cairo  showed some similar outcomes as our retrospective Australian trials, which were cited by the authors. In particular growth hormone (GH) adjuvant therapy 7.5 IU daily from Day 21 to Trigger (˜20 days) for poor responders in IVF, generated significantly more usable embryos; meaning embryos which were transferred in the fresh cycle plus embryos deemed suitable for cryopreservation; some of which were later transferred in a frozen embryo transfer (FET) cycle.
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.
Antagonists of TNFα for recurrent miscarriages: 2 Illustrative cases Approximately 1 to 3% of women have recurrent early miscarriages, defined as ≥3 pregnancy losses before 14 weeks of gestation. The immune deregulation and tolerance rupture could be the origin of these miscarriages in at least 30% of these women. Chronic intervillositis of unknown etiology (CIUE) is a rare placental lesion characterized by intrauterine deaths, growth restriction and high recurrence rate. In cases with recurrent obstetrical adverse events and intrauterine deaths, we previously reported the benefit of hydroxychloroquine combination to prednisone.
Apparent germline mosaicism for a 15q11-q13 deletion causing recurrent Angelman syndrome in a Chinese family Angelman syndrome (AS) is a genetic and neurological disorder characterized by severe developmental delay and learning disabilities, speech impairment, ataxia, tremulousness with jerky movements of limbs and a happy, sociable disposition. This disorder affects males and females in equal numbers with a prevalence of approximately 1 in 12,000–20,000 live births. The etiology is the loss of function of the imprinted UBE3A gene in 15q11-q13. The four known mechanisms include chromosome deletions, genetic imprinting errors, mutations in the UBE3A gene, and paternal uniparental disomy (UPD) .
Some anatomical explanations for mesh complications Managing pain after synthetic mesh implants in pelvic surgery. Toozs-Hobson P, Cardozo L, Hillard T. Eur J Obstet Gynecol Reprod Biol. 2019 Jan 9;234:49-52. doi: 10.1016/j.ejogrb.2018.12.037. [Epub ahead of print] Review.
A case of gastric-type mucinous endocervical adenocarcinoma in presence of nabothian cysts A group of benign and malignant endocervical glandular lesions unrelated to human papillomavirus (HPV) and showing gastric differentiation, has been described in the last years . Minimal deviation adenocarcinoma (MDA) and lobular endocervical glandular hyperplasia (LEGH) exhibit a gastric phenotype and immunophenotype . Gastric-type adenocarcinoma (GAS) has been recently described as a subtype of cervical adenocarcinoma .These neoplasms have aggressive clinical behavior. There is a likely LEGH-GAS sequence, and an absence of HPV in cases of LEGH, and MDA suggested that this sequence represents an HPV-independent pathway of carcinogenesis .
A case of 20-week abortion in a rare communicating rudimentary horn of a misinterpreted unicornuate uterus, incorrectly diagnosed as bicornuate: A serious hazard! Female genital malformations, as the unicornuate uterus, are deviations from normal anatomy that could impair the reproductive potential of a woman or her health. We present a rare case of a 20-week spontaneous abortion in a 24 years old patient affected by a misunderstood unicornuate uterus with communicating rudimentary horn, previously diagnosed as bicornuate, and for this reason subjected to induction of abortive labor, using mifepristone and gemeprost. Following the ultrasound exam and MRI, performed due to the failure of the abortive procedure, revealed the diagnosis of unicornuate uterus with (not clear) communicating accessory horn pregnancy, then treated with laparotomy.
Letter to the editor- familial differentiated vulval carcinoma We found that while vulval carcinoma is a rare condition, accounting for less than 1% of all new cancer cases in females , we recently had three cases of multi-focal differentiated vulval carcinoma in three women with one degree of familial separation with similar histological characteristics, in the absence of a known genetic mutation. Their characteristics are described in Table 1.
Prolapse mesh complication: large stone on vaginal mesh extruded in the bladder We found an unusual and severe complication of mesh prolapse surgery we will to report. Synthetic meshes augmentation for pelvic organ prolapse repair by vaginal route has been associated with better anatomical outcomes without improvements in terms of symptoms and quality of life. However their widespread use raised a growing awareness of mesh-related complications which lead in 2011 to FDA warning. These complications include infection, fibrosis, shrinkage and exposure [1,2]. In particular mesh extrusion inside the urinary tract is uncommon and has been mainly related to incorrect suburethral tape positioning (bladder/urethra perforation or submucosal placement) .
Seminal exosomes induce interleukin-6 and interleukin-8 secretion by human endometrial stromal cells Exosomes are extracellular microvesicles that participate in intercellular communication. Seminal plasma (SP) contains very large amounts of exosomes which are deposited in female genital tract after insemination. Although the response of vaginal cells to seminal exosomes (SE) is recently being elucidated, the interaction of uterine cells with SE is still unknown. Here, we aimed to evaluate the effect of SE on cytokine secretion by human endometrial stromal cells (eSC).
Human urogenital myiasis: A systematic review of reported cases from 1975 to 2017 The public health importance of myiasis [infestation with dipterous (fly) larvae] remains unknown. This disease is spread worldwide in animals and humans, but baseline data on its prevalence are limited. In particular, knowledge on human urogenital myiasis (UGM) is scattered. As such, a systematic search was undertaken of five English and five Persian databases for publications describing UGM cases in English or Persian published between 1975 and 2017. In total, 45 papers reporting 59 UGM cases from various regions of the world are included in this review.
Development of a novel bedside index for the early identification of severe maternal infection International consensus reports have recently recommended that the Systemic Inflammatory Response Syndrome (SIRS) criteria for the diagnosis of sepsis should cease and that new bedside criteria need to be developed to improve prevention, early diagnosis and treatment.The aim of this retrospective audit was to evaluate a suite of four bedside clinical criteria, called the Early Maternal Infection Prompts (EMIP), in helping to identify women with a suspected severe infection who were admitted to a High Dependency Unit (HDU) in a large tertiary referral stand-alone maternity hospital.
Association between delivery mode and pelvic organ prolapse: A meta-analysis of observational studies Pelvic organ prolapse (POP) is a common disease in aged women with negative physical and psychological influences. The long-term impact of delivery mode on POP remains uncertain. To evaluate the relationship between delivery mode and POP, a meta-analysis was carried out in this study. PubMed, Web of Science and CENTRAL were combined to search for relevant studies. Data were extracted by two investigators independently. Odd ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by a random-effects model.
Risk factors for pelvic and distant recurrence in locally advanced cervical cancer Despite the benefits of concomitant radiotherapy and cisplatin for locally advanced cervical cancer, recurrence rates remain high. New treatment strategies such as consolidation chemotherapy and different concomitant chemotherapy combinations have been tested in recent years. Identification of the best candidates for each treatment strategy could optimize results.
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.
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.
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.
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.
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.
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