Pregnancy in a patient with autosomal-dominant polycystic kidney disease and congenital hepatic fibrosis.
Klinkert J. Koopman MG. Wolf H.
Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, Amsterdam, Netherlands.
This case report describes a pregnancy in a patient with autosomal-dominant adult polycystic kidney disease and congenital hepatic fibrosis, a very rare and problematic combination. In particular, hypertension and renal dysfunction caused problems during this pregnancy. Peritoneal dialysis became necessary.
Unusual case of severe cholestasis of pregnancy with early onset, improved by ursodeoxycholic acid administration.
Brites D. Rodrigues CM. Cardoso Mda C. Graca LM.
Centro de Patogenese Molecular, Faculdade de Farmacia da Universidade de Lisboa, Portugal.
An exceptional case of early onset and prolonged postpartum course of intrahepatic cholestasis of pregnancy is described. Contrary to other drugs tested, ursodeoxycholic acid administered after the 29th week of gestation improved pruritus and decreased bile acid levels both in serum and amniotic fluid. Labour was induced at 36 weeks, and a female weighing 2.050 g and with an Apgar score of nine was born. Ursodeoxycholic acid, by decreasing the passage of bile acids to the foetus, may have improved the outcome of the pregnancy.
Leiomyomatosis peritonealis disseminata associated with endometriosis: a case report and literature review.
Herrero J. Kamali P. Kirschbaum M.
Department of Obstetrics and Gynaecology, University of Giessen, Germany.
Leiomyomatosis peritonealis disseminata (LPD) is a rare disease characterised by the presence of multiple smooth muscle tumour nodules throughout the peritoneal cavity. Approximately 50 cases of LPD have been reported to date in the world literature. There is a very high association with excess exogenous and endogenous female gonadal steroids, specifically oestrogen and progesterone. LPD has been described almost only in premenopausal women and is mostly asymptomatic. Four cases of malignant transformation of this disease have been reported. We report a case of a patient with prolonged exposure to oral contraceptives, operated because of hypermenorrhea and 'myoma in statu nascendi'. A metastasing myomatous tumour was suspected during the operation. LPD was diagnosed by intraoperative histological examination. Abdominal hysterectomy was performed. Five months later a second laparotomy had to be done because of an ovarian endometriosis tumour of about 10 cm size. A bilateral salpingo-oophorectomy and omentectomy were performed.
Emergency cervical cerclage: a study between duration of cerclage in situ with gestation at cerclage, herniation of forewater, and cervical dilatation at presentation.
Yip SK. Fung HY. Fung TY.
Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin. firstname.lastname@example.org
OBJECTIVE: To investigate the effectiveness of emergency cerclage in prolonging pregnancy and its effect on pregnancy outcome in patients with cervical incompetence. STUDY DESIGN: Retrospective review of patients who had emergency cervical cerclage performed for cervical incompetence. 19 patients between 16 and 30 weeks' gestation with (1) cervical effacement, (2) cervical dilatation of at least 1 cm, (3) herniation of intact fetal membranes through the cervical os, (4) absence of established labor, and (5) absence of clinical evidence of infection were studied. The duration of cerclage in situ, gestation at delivery and birth weight were analyzed. RESULTS: The mean duration of cerclage in situ was 47.5+/-48.6 days. The mean gestation at delivery was 30.5+/-6.6 weeks and the mean birth weight was 1730+/-1105 grams. The duration of cerclage in situ was significantly longer when the procedure was performed at or before 20 weeks' gestation (Mann-Whitney U test, P
Ascending dose tolerance study of intramuscular carbetocin administered after normal vaginal birth.
van Dongen PW. Verbruggen MM. de Groot AN. van Roosmalen J. Sporken JM. Schulz M.
Department of Obstetrics and Gynaecology, University Hospital Nijmegen St Radboud, The Netherlands.
OBJECTIVE: To determine the maximum tolerated dose (MTD) of carbetocin (a long-acting synthetic analogue of oxytocin), when administered immediately after vaginal delivery at term. MATERIALS AND METHODS: Carbetocin was given as an intramuscular injection immediately after the birth of the infant in 45 healthy women with normal singleton pregnancies who delivered vaginally at term. Dosage groups of 15, 30, 50, 75, 100, 125, 150, 175 or 200 microg carbetocin were assigned to blocks of three women according to the continual reassessment method (CRM). RESULTS: All dosage groups consisted of three women, except those with 100 microg (n=6) and 200 microg (n=18). Recorded were dose-limiting adverse events: hyper- or hypotension (three), severe abdominal pain (0), vomiting (0) and retained placenta (four). Serious adverse events occurred in seven women: six cases with blood loss > or = 1000 ml, four cases of manual placenta removal, five cases of additional oxytocics administration and five cases of blood transfusion. Maximum blood loss was greatest at the upper and lower dose levels, and lowest in the 70-125 microg dose range. Four out of six cases with blood loss > or = 1000 ml occurred in the 200 microg group. The majority of additional administration of oxytocics (4/5) and blood transfusion (3/5) occurred in the dose groups of 200 microg. All retained placentae were found in the group of 200 microg. CONCLUSION: The MTD was calculated to be at 200 microg carbetocin.
Mapping of androgen, estrogen and progesterone receptors in the anal continence organ.
Oettling G. Franz HB.
Universitats-Frauenklinik, Ulm, Germany.
OBJECTIVE: To investigate the expression of androgen, estrogen and progesterone receptors (ARs, ERs, PRs) in the tissues of the anal continence organ using immunohistochemical techniques. STUDY DESIGN: Thirty-nine samples of anorectal tissue were obtained from 23 patients (seven men, seven premenopausal women and nine postmenopausal women). Immunostaining for ARs, ERs and PRs was performed by the ABC technique using 3,3'-diaminobenzidine tetrahydrochloride as the chromogen. RESULTS: Specific immunostaining for ARs, ERs and PRs was found exclusively over cell nuclei. ARs were found in the smooth muscle cells of the internal anal sphincter in all but one of the females (10/11) and all males (7/7), ERs were found in 12/12 females and 4/7 males, and PRs were found in 4/10 females and 1/7 males. The squamous epithelium exhibited a similar pattern of immunostaining. The nuclei of the striated muscle fibers expressed none of the sex steroid receptors investigated. CONCLUSION: The intense expression of ARs, ERs and, in some cases, PRs in the tissues of the anal continence organ at all ages and in both sexes indicates that this organ is a target for sex steroid hormones.
Short-term medical complications of 1500 oocyte retrievals for in vitro fertilization and embryo transfer.
Govaerts I. Devreker F. Delbaere A. Revelard P. Englert Y.
Fertility Clinic, Department of Obstetrics and Gynecology, CUB Erasme, Free University of Brussels, Belgium.
OBJECTIVE: To evaluate the different short-term complications after in vitro fertilization and embryo transfer. DESIGN: a retrospective study on 7 years in the fertility clinic of an university hospital. MATERIALS AND METHODS: Short-term medical complications were analysed after 1500 transvaginal ultrasonographically guided oocyte retrievals. RESULTS: Ovarian hyperstimulation syndrome (1.8%), pelvic infections (0.4%), intraperitoneal bleeding (0.2%) and adnexal torsions (0.13%) were observed. One case of adnexal torsion occurred during pregnancy (0.18%). Two unusual case of bowel endometriosis were encountered (0.13%). CONCLUSIONS: Short-term medical complications after in vitro fertilization and embryo transfer are rare (2.8%). This contrast with the high rate of multifetal pregnancies which increases maternal and perinatal morbidity and mortality and must be considered as the major complication of in vitro fertilization treatment.