Objective. Intrauterine retention of fetal bones following a termination of a pregnancy is a rare complication. Among the few reported cases in literature, there has been no report describing the ...birth of a live fetus, despite the presence of an embryonic ossicle within the endometrial cavity. Case Report. A 28-year-old woman, with an obstetrical history of a miscarriage at the 19th week of gestation, underwent a diagnostic hysteroscopy for evaluation of pelvic pain and infertility, which revealed an intrauterine embryonic ossicle. The patient did not comply with our recommendations to undergo a surgical hysteroscopy. The patient’s next visit was during her 9th week of gestation. She was followed up regularly at our Obstetrics Department. Her gestation was uneventful, while an elective caesarean section at the 39th week of gestation was performed. Conclusion. The present clinical case has demonstrated that achieving childbearing is possible, despite the requirement of removing such bone fragments.
This meta‐analysis aims to compare serum uric acid levels among preeclamptic and healthy pregnant women across the various trimesters and provide a summary of the effect size of this biomarker in ...predicting adverse pregnancy outcomes. MEDLINE, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar databases were systematically searched from inception. Observational studies were held eligible if they reported serum uric acid among preeclamptic and healthy pregnant women. Meta‐analysis was conducted regarding uric acid concentration, diagnostic accuracy, and association with perinatal outcomes. The credibility of evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The analysis included 196 studies, comprising 39 540 women. Preeclampsia was associated with significantly elevated uric acid levels during the 1st (mean difference MD: 0.21 mg/dL, 95% confidence intervals CI: 0.06‐0.35) trimester, 2nd (MD: 1.41 mg/dL, 95% CI: 0.78‐2.05) trimester, and 3rd (MD: 2.26 mg/dL, 95% CI: 2.12‐2.40) trimester. Higher uric acid was estimated for severe preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelet syndrome. The sensitivity for adverse perinatal outcome prediction ranged from 67.3% to 82.7% and the specificity from 47.7% to 70.7%. In conclusion, it is suggested that serum uric acid levels are increased in preeclampsia and can be used to predict disease severity and pregnancy complications. Future prospective studies should verify these outcomes, assess the optimal cutoffs, and incorporate uric acid to combined predicting models.
Despite the great number of studies conducted to examine the impact of infertility on the psychological status of women undergoing infertility treatment, little is known about the psychological ...impact of infertility when it is due to male or female factors and its role in the cause of higher levels of anxiety and stress. The aim of this cross-sectional study was to assess the impact of infertility diagnosis on infertile women's levels of anxiety, depression and fertility-related stress. The study involved 404 women undergoing fertility treatment in a public clinic in Athens. The research instruments were three self-administrated questionnaires. State and trait anxiety, infertility-related stress (personal, social and marital domain) and depression were measured. Most of the women in this sample had low levels of infertility-related stress and a low score for depression, but higher scores of state and trait anxiety than the published normative scores. Women with male factor infertility had higher levels of state anxiety (p = 0.007) and social stress (p = 0.007) than women with female, mixed and unknown infertility. Women with idiopathic infertility also had higher levels of trait anxiety (p = 0.001). Thus, the psychological status of women is strongly related to the aetiology of the infertility problem, and as a result it is necessary for women undergoing treatment for infertility to have an individualised psychological support, based on their infertility problem.
Large cyst of the vaginal wall in pregnancy Papapanagiotou, Ioannis K.; Chatzipapas, Ioannis; Koutroumanis, Pelopidas ...
Clinical case reports,
September 2019, Letnik:
7, Številka:
9
Journal Article
Recenzirano
Odprti dostop
Large vaginal cysts during pregnancy are rare and can mislead Obstetricians to a false diagnosis, that of “Protruding membranes”. Aspiration of the cyst can be easily performed, resulting in ...the collapsing of the cyst and an uneventful vaginal delivery can be conducted.
Large vaginal cysts during pregnancy are rare and can mislead Obstetricians to a false diagnosis, that of “Protruding membranes”. Aspiration of the cyst can be easily performed, resulting in the collapsing of the cyst and an uneventful vaginal delivery can be conducted.
Primary retroperitoneal ectopic pregnancy represents an extremely unusual entity with a rather obscure pathogenesis. Implantation in the retroperitoneal space has been reported to occur both ...spontaneously and with use of assisted reproduction techniques. The pelvic and the upper retroperitoneum have both been involved, and implantation in the most unusual anatomic sites has been reported. The majority of retroperitoneal gestations are located close to large blood vessels, and laparotomy is performed because of the high risk of massive hemorrhage. Few cases have been treated with laparoscopy so far. We report the case of an early first-trimester retroperitoneal broad ligament live pregnancy occurring after spontaneous conception in a patient who had a history of an ipsilateral tubal ectopic pregnancy, previously treated with laparoscopic right salpingectomy. Current gestation had been missed during initial laparoscopy, and was located and removed during a repeat laparoscopic procedure under intraoperative ultrasonographic guidance.
This prospective study was conducted to assess the feasibility of laparoscopic cystectomy of an intact adnexal cyst performed inside a water proof endoscopic bag, aiming to avoid intraperitoneal ...spillage in case of cyst rupture. 102 patients were recruited. Two of them were pregnant. In 8 of the patients the lesions were bilateral, adding up to a total of 110 cysts involved in our study. The endoscopic sac did not rupture in any case. Mean diameter of the cysts was 5.7 cm (range: 2.3–10.5 cm). In 75/110 (68.2%) cases, cystectomy was completed without rupture, whereas in the remaining 35/110 (31.8%) cases the cyst ruptured. Minimal small spillage occurred despite every effort only in 8/110 (7.2%) cases with large (>8 cm) cystic teratomas. There were no intraoperative or postoperative complications. We concluded that laparoscopic cystectomy in-a-bag of an intact cyst is feasible and oncologically safe for cystic tumors with a diameter < 8 cm. Manipulation of larger tumors with the adnexa into the sac may be more difficult, and in such cases previous puncture and evacuation of the cyst contents should be considered.
The role of vasopressin in preeclampsia pathogenesis has been recently supported by experimental studies. This meta-analysis aims to accumulate literature evidence and evaluate whether serum copeptin ...levels differ among preeclamptic and healthy pregnant women. Medline, Scopus, CENTRAL, Web of Science and Google Scholar databases were systematically searched from inception. All observational studies reporting serum copeptin values among preeclamptic and healthy pregnant women were deemed eligible. Sixteen studies were included, comprising 2105 women. Preeclampsia was linked to significantly higher copeptin levels during the 1st (Standardized Mean Difference-SMD: 2.25, 95% Confidence Intervals-CI: 0.86–3.67), 2nd (SMD: 1.73, 95% CI: 0.31–3.14) and 3rd (SMD: 1.74, 95% CI: 0.96–2.53) trimester. This association was present for severe, non-severe, early and late-onset preeclampsia. Women with the severe form of the disease displayed significantly elevated copeptin levels (SMD: 1.47, 95% CI: 1.10–1.84) compared to those with the non-severe one, while no difference was evident between early and late-onset preeclampsia (SMD: −0.30, 95% CI: −0.91 to 0.31). In conclusion, the present meta-analysis suggests that preeclampsia is associated with significantly increased serum copeptin levels in all pregnancy trimesters, irrespective of disease severity and onset. Future large-scale cohort studies should confirm these findings and introduce cut-off values in order to clarify the exact accuracy of copeptin for the prediction of preeclampsia early in the course of pregnancy.
Several articles investigated the impact of prolonged second stage of labor on maternal and neonatal outcomes; however, strict consensus is still lacking. The purpose of the present meta-analysis is ...to investigate risk factors that contribute to the pathophysiology of prolonged labor as well as effect sizes of maternal and neonatal morbidity. We searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar database. Observational studies (prospective and retrospective) were considered eligible for inclusion in the present meta-analysis. To minimize the possibility of article losses we avoided language, country and date restrictions. Meta-analysis was performed with the RevMan 5.3 and secondary analysis with Rstudio. Overall, 13 studies were included in the present systematic review that comprised 337.845 parturient. Prolonged second stage was associated with higher odds of postpartum hemorrhage, chorioamnionitis, endometritis, postpartum fever and obstetric anal sphincter injury. Persistent occiput posterior position and shoulder dystocia were also more prevalent compared to women with normal duration of the second stage. The need for admission to the neonatal intensive care unit was higher as well as the risk of developing neonatal sepsis. On the other hand, the odds of perinatal death were comparable among cases with prolonged and normal duration of the second stage. The results of the present meta-analysis clearly indicate that deliveries following a prolonged second stage of labor are at increased risk of maternal and neonatal complications. The presented effect estimates can be used in current clinical practice during patient counseling.
Introduction
Several studies acknowledge that the presence of amniotic fluid sludge (AFS) is an independent predictive factor for preterm birth. In the present systematic review, we summarize ...research that focuses on the comparison of pregnancy outcomes among women with and without AFS.
Material and methods
Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases were systematically searched from inception. Both observational and randomized controlled studies were considered eligible provided that they reported data on pregnancy outcomes among women with and without AFS. Outcomes were not meta‐analyzed because of the high heterogeneity in terms of selected population and outcome reporting.
Results
Seventeen studies of 2432 women were included in this review. Six studies evaluated women at high risk for preterm birth. Pregnancies complicated by AFS had a lower gestational age at delivery and increased incidence of preterm delivery at <37 weeks. Neonatal death rates and admission to the Neonatal Intensive Care Unit were also increased. Evidence in low‐risk women, those with signs of preterm labor, in those carrying twins, and in women with cervical cerclage or Arabin pessary was extremely limited.
Conclusions
Women with AFS seem to deliver at an earlier gestational age, and preterm birth rates are also increased. Limited data seem to point to neonatal morbidity and mortality being increased. However, the presence of a direct association should not be assumed because the evidence is not adjusted for the presence of confounders.
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