Background: Erythrocyte alloantibodies often occur, especially in the case of polytransfusion and in pregnant women. Fast diagnosis and a compatible transfusion of the blood component are important ...to prevent an early or delayed post transfusion haemolytic reaction. We have analysed our efficiency to provide red cell units for these patients in our hospital and in the general hospitals of Ptuj and Murska Sobota. Methods: We analysed retrospectively which examinations had been done in sensitized patients, how successful we have been in finding appropriate blood for erythrocyte transfusion. We also analysed the proposed algorithm of the immunohaematological testing in our Centre. Results: At the Centre for transfusion medicine-CTM Maribor, we have provided compatible transfusions to 67 patients in the last year, for which we made 6215 tests to provide appropriate blood components. We were looking for compatibility between the serum of the patient and erythrocytes of the blood donor by a technique in which the antibodies showed the highest reactivity. In patients with antibodies of the Rh-system (D, E, e, C, c), Kell, Kidd, Duffy and MNS, we always provided antigen negative component, and in others a compatible component (negative result of cross match). Sometimes the appropriate blood was found based on already defined antigens in blood donors by means of the information system. If the appropriate component was found at the Unit for Transfusion Medicine in Ptuj or Murska Sobota the crossmatch was done there and the interpretation was done at the CTM by means of the teleconsultation system. Conclusions: In most cases we provided blood components successfully and relatively quickly, while in some cases, other transfusion centres were helping us out, especially the Blood Transfusion Centre Ljubljana and the Transfusion centre Celje.
Previous studies have found evidence for a genetic basis for pelvic organ prolapse (POP), but no genetic studies have differentiated between types of POP. This study investigated whether genetic ...variants in six previously suggested candidate loci for POP modify the risk of uterine prolapse (UP).
One hundred patients, aged 30–55 years, who had undergone surgery due to total UP and 105 healthy controls were included in this study. After extracting the genomic DNA from peripheral blood, six single nucleotide polymorphisms (SNPs) previously identified for POP were genotyped, and association analysis was performed for contributing risk factors. RNA expression was determined from sacrouterine ligaments of patients and controls using quantitative reverse transcription polymerase chain reaction.
The dominant genotype model for the T allele for SNP rs6051098 at the chromosome 20p13 locus was significant, and this remained significant with the risk factor regression model (p=0.046; odds ratio 1.93, 95 % confidence interval 1.01–3.66). The isocitrate dehydrogenase 3 beta (IDH3B) gene was the only potential candidate gene in the 20p13 locus that was significantly upregulated in sacrouterine biopsies in women with UP compared with controls (p = 0.034).
To the best of the authors’ knowledge, this is the first study to show that genetic risk factors contribute to UP, and suggested rs6051098 as the best candidate risk factor associated with UP. According to expression data in sacrouterine tissue, this study suggests that the IDH3B gene plays a role in the pathogenesis of UP.
Caring for victims of sexual assault demands of the physician a precise physical examination, provision of evidence, psychological support and appropriate treatment. Because the majority of victims ...of sexual violence are women, we usually encounter these patients in gynecological clinics. If the evidence is collected and stored properly, with special forensic methods we can distinguish between any two persons in the world, except identical twins. Therefore, patient’s history and taking evidence is of utmost importance. In the case of sexual assault, infection with sexually transmitted diseases is possible, so they should be diagnosed and treated in time. The victim should be offered the use of emergency contraception, which is only effective in the first days after sexual assault. To make sure that each step of the examination is completed and all samplings are done in the correct order, it is useful to have a written questionnaire or a routine protocol. We describe stepby- step management procedures for victims of sexual assault, taking into consideration the victim’s history, physical examination, different samplings, and different emergency treatments.
Izhodišče:V preteklih raziskavah je že bila ugotovljena povezava med dednostjo in zdrsom medeničnih organov (ZMO), vendar pa do sedaj še nobena raziskava ni ciljano preučevala pomena dednosti pri ...izoliranem zdrsu maternice (ZM). V naši raziskavi kandidatnih genov smo skušali ugotoviti, ali genetske različice v šestih predhodno predlaganih lokusih kandidatov za ZMO, ki so bili pri ženskah evropskega porekla identificirani z asociacijsko študijo celotnega genoma, prav tako spremenijo tveganje pri naši skupini bolnic z ZM. Preiskovanke in metode dela:V raziskavo smo vključili 100 bolnic, ki so imele operacijo zaradi izoliranega popolnega ZM, in 105 zdravih žensk. Vse udeleženke so bile stare med 30 in 55 let. Po izolaciji genomske DNA iz periferne krvi smo genotipizirali šest polimorfizmov posameznega nukleotida (SNP), ki so bili predhodno povezani z ZMO. Opravili smo tudi analizo dejavnikov tveganja. Ekspresijo RNA smo določili na RNA in proteinih, ki smo jih izolirali iz sakrouterinih ligamentov pacientk in zdravih žensk s qPCR.Rezultati:Eden od šestih analiziranih SNP-jev je bil statistično povezan z ZM. Na lokusu kromosoma 20p13 smo ugotovili statistično pomembnost za model regresije faktorja tveganja za dominantni model alela T v SNP-ju rs6051098 (p = 0,046; OR: 1,93, CI: 1,01-3,66). Gen IDH3B je bil edini gen v lokusu 20p13, ki je bil v biopsijah sakrouterinega ligamenta pri ženskah z ZM statistično višje izražen v primerjavi s kontrolno skupino (p = 0,034). Analiza proteinov je pokazala trend k povišanemu izražanju proteina IDH3B pri bolnicah z ZM.Zaključek:Po našem najboljšem vedenju, smo kot prvi dokazali, da genetski dejavniki tveganja prispevajo k ZM in predlagali rs6051098 kot najboljši dejavnik tveganja, ki je povezan z ZM. Glede na pridobljene rezultate o ekspresiji predpostavljamo, da gen IDH3B igra vlogo pri patogenezi ZM.
Is preterm delivery an infertility treatment-related adverse outcome in infertile women who conceived after reproductive surgery?
Compared with matched fertile women, preterm delivery appears to be a ...modest infertility treatment-related adverse outcome in infertile women who have reproductive surgery then conceived naturally or after IVF/ICSI.
Most observational studies have shown that women who receive any infertility treatment are more likely to deliver preterm than do fertile women. However, studies on the outcome of pregnancies in infertile women who conceive naturally after reproductive surgery are scarce.
This was a single-centre historical two-part study: cohort and matched cohort study. Anonymized data of 761 infertile women who conceived after reproductive surgery and 758 fertile women were obtained by linking three computerized databases from 1 July 2012 to 31 December 2015.
In the cohort study, we evaluated the association between the mode of conception and preterm delivery <37 and <32 gestational weeks in 703 infertile women, with a singleton pregnancy who conceived after reproductive surgery, using logistic regression adjusted for relevant co-variates to calculate the adjusted odds ratio with a 95% CI. In the matched cohort study, we evaluated preterm delivery as infertility treatment-related adverse outcome using the propensity score (PS) method. The matched cohort comprised 758 infertile women and 758 fertile women with a twin or singleton pregnancy. Infertile women conceived after reproductive surgery either naturally or through IVF/ICSI. Infertile and fertile women were matched using PS matching. Infertile and fertile women were matched for pre-defined risk factors for preterm delivery. Three infertile women out of an original 761 were not included in the analysis because they lacked all required matching variables. We performed a 1:1 matching with an optimal matching algorithm with a caliper width of the linear predictor of 0.1 standard deviations. The effect of reproductive surgery on preterm delivery was evaluated in the PS-matched sample using Pearson's χ2 test and presented as the odds ratio (OR) with 95% CI. All women delivered at the Department of Perinatology, University Medical Centre Ljubljana, Slovenia.
Among 761 infertile women who conceived after reproductive surgery, 428 (56.2%) women conceived naturally and 333 (43.8%) conceived after IVF/ICSI. The incidence of twin pregnancies was significantly lower after natural conception (2.6% vs 14.1%). Among the 703 infertile women with a singleton pregnancy, 417 (59.3%) conceived naturally and 286 (40.7%) conceived after IVF/ICSI. Adjusted for maternal age and parity in infertile women with singleton pregnancies, IVF/ICSI showed a moderate association with preterm delivery <32 weeks. Compared with natural conception after reproductive surgery, the odds for preterm delivery after IVF/ICSI was 1.07 (95% CI 0.63-1.81) <37 weeks and 2.25 (95% CI 0.80-6.34) <32 weeks. Preterm delivery appears to be a modest infertility treatment-related adverse outcome. Compared with fertile women in the PS-matched sample, infertile women who conceived after reproductive surgery either naturally or after IVF/ICSI the odds of preterm delivery <37 weeks were 1.31 (95% CI 0.97-1.78) and odds of preterm delivery <32 weeks were 1.57 (95% CI 0.78-3.18). However, none of the estimations were statistically significant.
The main limitations of the study were the retrospective design, the heterogeneity of the types of reproductive surgery performed and underlying reproductive pathologies. The low number of preterm deliveries in the present study might influence the precision of estimations.
The present study aims to alter the prevailing opinion that reproductive surgery should only be considered preceding IVF to increase implantation and pregnancy rates after IVF. It implies that in selected infertile women who have had reproductive surgery, a high rate of natural conception, a low rate of multiple pregnancies, and a modest infertility treatment-related effect on preterm delivery should be the reasons to encourage natural conception after reproductive surgery. Furthermore, by allowing for natural conception, we can avoid a high-cost invasive medical procedure.
The study received no funding. We have no competing interest to declare.
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BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of ovulation stimulation. Modest vulvar edema is frequently seen in a severe form of OHSS; however, cases of ...massive bilateral vulvar edema are rare and pathogenesis is uncertain. CASE REPORT We report a 31-year-old patient with massive vulvar edema and severe OHSS after IVF treatment with GnRH antagonist and gonadotropins. Five days after embryo transfer, she was hospitalized because of severe clinical manifestation of OHSS and on the fifth day after admission she developed a massive bilateral vulvar edema. After conventional medical therapy of OHSS, vulvar edema spontaneously resolved. CONCLUSIONS Hypoproteinemia with low oncotic pressure and certain personal tissue characteristics may play the main role in the pathogenesis of massive vulvar edema in OHSS.
Venous thromboembolism (deep vein thrombosis, pulmonary embolism) are serious, but highly preventable complications associated with gynecologic surgery. Risk of thromboembolic complications depends ...on patient characteristics, type and duration of surgery. Beside adequate hydration, according to the risk stratification we recommend thromboprophlaxis with mechanical methods and antithrombotic drugs (usually low molecular weight heparins). In this article current guidelines for effective and safe thromboprophlaxis for gynecological surgery are presented.
Venous thromboembolism (deep vein thrombosis, pulmonary embolism) are serious, but highly preventable complications associated with gynecologic surgery. Risk of thromboembolic complications depends ...on patient characteristics, type and duration of surgery. Beside adequate hydration, according to the risk stratification we recommend thromboprophlaxis with mechanical methods and antithrombotic drugs (usually low molecular weight heparins). In this article current guidelines for effective and safe thromboprophl axis for gynecological surgery are presented .
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