Proceedings in Obstetrics and Gynecology
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Gonadotropin-releasing hormone agonist and depot medroxyprogesterone acetate following uterine artery embolization in the management of uterine arteriovenous malformation
Get PDFA young woman presenting with recurrent episodes of uterine bleeding due to an extensive uterine arteriovenous malformation was treated with two sessions of uterine artery embolization. Further bleeding was managed with a combination of gonadotropin-releasing hormone and depot medroxyprogesterone acetate. The patient remains asymptomatic with a significant decrease in uterine and pelvic vascularity at one year follow-up.These drugs may decrease the need for repeat embolization
The effects of pregnancy on the sexual life of Turkish women
Get PDFAim: To investigate the effects of pregnancy on the sexual life of Turkish womenMaterials and Methods: One thousand twenty six pregnant women were included in the study. The Libido Scoring System, which is a questionnaire consisting of four questions about the frequency of intercourse, the partner initiating the intercourse, orgasm and masturbation status of the pregnant women, was completed by all patients. Both pre-pregnancy and pregnancy sexuality was evaluated independently using this scale.Results: The frequency of sexual intercourse during pregnancy significantly decreased from 3.07/week to 2.40/week (p<0.05). The masturbation rate during pregnancy was significantly lower than the pre-pregnancy period (3.6% vs 4.9 %, p<0.001). The percentage of pregnant women who never had an orgasm was significantly higher compared to the pre-pregnant period (21.7 % vs 10.8 %, p<0.01). The rates of initiation of sexual intercourse in the pre-pregnancy period by men and by women were 94.5% (970/1026) and 5.3% (54/1026) respectively. In pregnancy period the rates of initiation of sexual intercourse by man and woman were 93.4% (904/968) and 6.6% (64/968) respectively (p=0.0001). The mean libido scores during pregnancy were statistically lower than the pre-pregnancy period (6.38±0.04 vs 7.31±0.04, p<0.001).Conclusion: Pregnancy has a negative effect on the sexual life of women, but more prospective studies are required to clarify the mechanisms
Large doses of intravenous Rh (D) immunoglobulin lead to sustained elevations in Rh antibody titers
Get PDFRhesus (Rh) alloimmunization is potentially devastating for reproductive health. Rarely, RhD mismatched blood may be transfused accidentally, increasing the risks of RhD sensitization. Prevention of Rh sensitization is important especially in women of reproductive age group. Treatment with intravenous RhIg is potentially safe and also the effective means of preventing Rh alloimmunization in cases of Rh-mismatched blood transfusion. We report a case that illustrates the significantly high RhD antibody titers following treatment with intravenous Rh immunoglobulin for prevention of alloimmunization. An 18yo Rh-negative G0 had mistakenly received four units of Rh-positive blood. To avoid future pregnancy related complications, she received monotherapy with 13,200 μg total of intravenous Rh immunoglobulin (RhIg). The treatment was well tolerated; however the RhD antibody titers reached a peak of 1:512. The high levels of RhD antibody titers can have grave implications if the patient is pregnant
Retroperitoneal hematoma following hysteroscopic removal of levonorgestrel intrauterine system: a case report
Get PDFLong acting reversible contraceptive (LARC) devices such as the levonorgestrel intrauterine system (LNG-IUS) have increased in use. Care should be taken with insertion and removal of the device as, although rare, serious complications can occur. We present a case of retroperitoneal hematoma following hysteroscopic removal of LNG-IUS
Influence of infertility diagnosis on pregnancy outcome in ART
Get PDFObjective: To determine the influence of the infertility diagnosis on gestational age (GA) and birth weight (BW) of children conceived using assisted reproductive technology (ART).Design: Retrospective cohort.Setting: University-affiliated infertility clinic.Patients: Women with a singleton live birth following their first fresh ART cycle with autologous oocytes.Interventions: Patients were stratified into groups based on infertility diagnosis. GA and BW of their infants were compared.Main Outcome Measures: GA and BW of children conceived using ART.Results: 397 women were included. Average GA in the cohort was 38.7±2.3 weeks and average BW was 3301.5±633.8 grams. Maternal age, BMI, and parity were significantly different between groups. After controlling for these factors and stratifying by infertility diagnosis, there was no difference in GA or BW in infants conceived with ART.Conclusions: Contrary to previously reported data, there was no difference in GA or BW in infants conceived with ART when stratified by infertility diagnosis. Our results were not different from the national population; however GA was one week longer in our cohort than in the national ART database. These data suggest a difference exists between our cohort and the ART population at large. We propose that the main difference is our institution’s focus on single embryo transfer
Angiosarcoma of the vulva
Get PDFObjective: Angiosarcoma is a rare neoplasm typically presenting in the skin and superficial soft tissues, with an equal female-to-male ratio. We present a woman with recurrent vulvar lesions and a history of melanoma found to have angiosarcoma.Case: A 67-year-old woman presented with a seven month history of recurrent vulvar lesions with symptoms of discomfort and bleeding. The histopathological diagnosis revealed high-grade angiosarcoma. Computed tomographic imaging with contrast and positron emission tomography revealed disseminated disease. She underwent chemotherapy and radiation but died within one year of diagnosis.Conclusions: The prognosis for patients with angiosarcoma is generally poor, especially with disseminated disease. Early detection remains the key element in maximizing patient outcomes
The impact of LEEP margin status on subsequent abnormal cervical cytology
Get PDFObjective: To evaluate the relationship between Loop Electrosurgical Excision Procedure (LEEP) margin status and subsequent cytology results to determine the significance of margin status as a predictor for recurrent cervical disease.Methods: A retrospective cohort of women who underwent LEEP for treatment of cervical dysplasia from 1995 to 2006 with subsequent follow-up to 2009 at a single academic institution. Data extracted consisted of information routinely collected during clinic visits including demographic information, LEEP histology results, and cytology results.Results: The analysis was limited to 144 women with documented LEEP margin status and subsequent cytologic follow-up. The women were predominantly white, non-Hispanic, with a mean age of 27 years (range 14 – 62 years). Of the 144 LEEP specimens, 77 had negative margins, and 67 had positive margins (44 ecto-cervical, 16 endo-cervical, 7 both ecto-cervical and endo-cervical margins involved). Twenty-three women required subsequent colposcopy during the follow-up period: 7 with negative margin status and 16 with positive margin status on their initial LEEP. There was no association between LEEP margin status, grade of dysplasia, or depth of excision, and subsequent abnormal cytology (P>0.05 for each). There was no association between positive ecto-cervical or endo-cervical margin status and subsequent abnormal cytology (P>0.05 for each).Conclusion: We were unable to identify factors related to LEEP margin status to predict recurrent abnormal cytology. Thus, we recommend surveillance of all women following LEEP for cervical dysplasia regardless of margin status
Ruptured heterotopic pregnancy presenting as hemorrhagic shock
Get PDFBackground: Heterotopic pregnancy is a rare event consisting of simultaneous intrauterine and extrauterine pregnancies. If undiagnosed, it is probable the patient will present to an Emergency Department and require emergent care.Case Report: A 25 year-old woman arrived at the Emergency Department at 14 weeks gestation reporting sharp abdominal cramping and pelvic pain with a history of current tobacco use. Trans-abdominal ultrasound revealed a viable intrauterine pregnancy consistent with 14 weeks, closed cervix with free fluid noted in pelvis, and no evidence of ovarian torsion. Over the next three hours, the patient’s condition deteriorated and hemoglobin levels dropped. The surgeon on call was consulted and suspected ruptured hepatic adenoma versus hepatic hemangioma versus visceral aneurysm. A laparotomy was emergently performed with supraceliac control of aorta to permit resuscitation, and the right and left upper quadrants of the abdominal cavity were investigated without discovery of bleeding source. Further investigation revealed ruptured left tubal ectopic pregnancy and a partial salpingectomy was performed.Conclusions: This case serves as a clinical reminder that while heterotopic pregnancy is thought to be rare, when a patient presents with known intrauterine pregnancy and abdominal pain, heterotopic pregnancy should be included in the differential diagnosis. More common use of assisted reproductive technology may increase the incidence of heterotopic pregnancies, making familiarity with the signs, symptoms, and risk factors for this condition important
Novel mutation in COL1A1 associated with Osteogenesis imperfecta not compatible with life
Get PDFOsteogenesis imperfecta (OI) is a skeletal dyscrasia characterized by decreased bone strength and associated fractures. Over 95% of autosomal dominant forms of this disease are associated with defects in the genes for collagen COL1A1 and COL1A2.1 The lethal type II disease has been identified antenatally by symmetrically shortened long bones and micromelia. Many reports have indicated that a femur length to abdominal circumference ratio (FL:AC) of less than 0.16 is predictive of lethality associated with OI.2,3 We report a case that presented at 20 weeks’ gestation with shortening of the lower limbs, specifically a lagging femur length and FL:AC of < 0.16. On subsequent ultrasound examinations, progressive shortening of the femur as well as shortening of the long bones of the upper extremities was documented. The thorax appeared normal until 31 weeks. The FL:AC remained below 0.16 throughout pregnancy. Workup in the neonatal period identified a novel mutation in COL1A1. The neonate was able to breathe spontaneously at birth requiring minimal respiratory support for the initial 2 weeks and lived for 26 days
Pain control options for first trimester surgical abortions: a review
Get PDFPain control is a significant issue for women undergoing gynecological procedures including first trimester surgical abortion. Pain perception is a complex phenomenon which impacts the selection of analgesia. We present a review on the efficacy of various pain control modalities for first trimester surgical abortion in the clinical setting