Proceedings in Obstetrics and Gynecology
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The effect of gonadotropin-releasing hormone analogues on the preservation of ovarian function against cyclophosphamide-induced damage in adult mice
Full text linkObjective: To assess the effect of gonadotropin-releasing hormone analogue (GnRHa) on the preservation of ovarian function against cyclophosphamide-induced gonadal toxicity.Materials and Methods: In a controlled, experimental study, 64 female mice were divided into four groups: control (C), triptorelin acetate (T), cyclophosphamide (CY), and triptorelin plus cyclophosphamide (T+CY) groups. Mice in the group (T) were subcutaneously injected with GnRHa (triptorelin acetate) in a dose of 0.5 mg/kg daily for 21 days. In contrast, mice in the (CY) group and (T+CY) group were injected intraperitoneally with 75 mg/kg of CY on day 15. After 21 days, half of the mice in each group were sacrificed, and their ovaries were removed. The rest of the mice in each group were left without any intervention for an additional 21 days, and the same procedures were repeated to assess the ovarian follicles. Results: There was significant depletion of ovarian follicles in the CY group compared to the control group (p<0.05). There were significant decreases in the number of secondary and antral follicles at late stage as compared to early stage in the CY group (p<0.05). There was also a significant increase in the number of primordial and primary follicles in the T+CY group as compared with the CY group early post-treatment, while the increase was significant in all follicles after 42 days (p<0.05).Conclusion: Cyclophosphamide destroys primordial and primary follicles at an early stage while damage in secondary and antral follicles was prominent after 42 days. Triptorelin acetate reduces the toxic effect of CY; it has early and late protective effects and preserves ovarian function in mice
Can Bandl’s ring be recurrent?
Full text linkBackground: Bandl’s ring is a pathologic contraction ring of the uterus that is associated with obstructed labor.Case: A 35-year-old with an uncomplicated past medical history was found to have a Bandl’s ring in her first pregnancy during a cesarean section for failure to progress. During her subsequent pregnancy, what appeared to be a Bandl’s ring was again found during repeat cesarean section after spontaneous labor
Undiagnosed endometrial abnormalities in women with normal hysterosalpingography scheduled for IVF: prospective evaluation of three-dimensional transvaginal ultrasound versus office hysteroscopy
Full text linkObjectives: To compare the diagnostic accuracy of three-dimensional transvaginal ultrasound (3D-US) to office hysteroscopy (OH) in the screening of uterine cavity with normal hysterosalpingography (HSG) findings for subtle endometrial abnormalities before in vitro-fertilization (IVF). Methods: A prospective cohort cost-modeling study was carried out in a University hospital. We included 120 infertile women with a normal uterine cavity on HSG scheduled for IVF. All cases were evaluated by 3D-US, and the results were compared with OH findings.Results: OH revealed cavitary endometrial lesions (CLs) in thirty-four women (28.3%). Endometrial polyps were the most common detected lesions (16, 47.1%). 3D-US had 88.2% sensitivity, 96.5% specificity, 90.9% positive predictive value, 95.4% negative predictive value, and 94.2% overall accuracy for CLs. The overall agreement between 3D-US and OH was near-perfect (κ=0.86, 95% CI=0.75-0.96). Irregular menstrual bleeds and prior endometrial procedures were significant predictors for CLs (aOR=24.96, 95% CI=2.71–230.04, P=0.005, aOR=9.16, 95% CI=2.13–39.3, P=0.002, respectively). A selective screening strategy discerning OH to women with these predictors and/or women with abnormal 2D-US would have an NPV of 92.8 % with substantial cost benefits. Conclusions: In the pre-IVF work up, 3D-US, a non-invasive imaging modality, seems to be nearly comparable to OH. Office hysteroscopy screening prioritizing women with abnormal 2D-US, irregular menstrual periods and/or prior endometrial traumatization could yield a satisfactory cost-effective approach for identifying endometrial lesions
Primary radiation as initial management in endometrial cancer: investigating EBRT, IMRT and HDR brachytherapy
Full text linkFor patients with endometrial cancer at increased risk of perioperative morbidity, primary radiation therapy is an effective alternative treatment option. However, there has been no consensus on radiation technique and little data on outcomes. Our aim was to identify factors which determine patient selection for primary radiation, investigate treatment efficacy of radiation compared to surgical management of endometrial cancer and to evaluate different radiation modalities including external beam radiation therapy alone or with a boost of either high dose rate brachytherapy or intensity-modulated radiation therapy for differences in toxicities, recurrence-free interval, cancer-specific survival and overall survival
Quality of Care and Patient Safety
Full text linkThis issue of Proceedings in Obstetrics and Gynecology (POG) is devoted to exploring issues related to the quality of care provided to patients and to patient safety
Vaginal misoprostol before elective cesarean section for preventing neonatal respiratory distress: a randomized controlled trial
Full text linkObjective: The current study aims to evaluate the efficacy of vaginal misoprostol before elective cesarean section (ECS) for preventing the occurrence of neonatal respiratory distress (RD).Materials and Methods: A randomized controlled trial (NCT03239327) was carried out in a tertiary-care university-affiliated hospital between June 2016 and August 2017. All eligible pregnant women scheduled for ECS were randomly allocated in a 1:1 ratio to two groups. One group, the Misoprostol group, received a misoprostol 50 mcg vaginal tablet 60 minutes before ECS while the other, the Control group, received no drugs before ECS. The primary outcome was the rate of neonatal RD among the study groups.Results: The study included 146 women in each arm, with no significant difference between the baseline characteristics of members in each group. Primary outcomes resulted in 22 (15.1%) newborns in the misoprostol group having RD at birth versus 44 (30.1%) newborns with RD in the control (P =0.02). No differences were found between the groups regarding the need for neonatal intensive care unit (NICU) admission (P =0.61), duration of NICU stay (P =0.08) and neonatal mortality rate (P =0.73).Conclusion: Prophylactic vaginal misoprostol at a dose of 50 mcg administered 60 minutes before ECS could reduce the rate of neonatal RD and improve the neonatal respiratory outcomes
Marygrace Elson, MD, MME, FACOG, President of the Iowa Medical Society
Full text linkDr. Marygrace Elson was installed as the President of the Iowa Medical Society on April 5, 2019. The following is excerpted from Dr. Elson’s inauguration remarks
Developing a program for residents to support training in research
Full text linkPhysicians are expected to be life-long learners and to assimilate and evaluate new knowledge gained from research. Many residencies also require completion of a scholarly project during their residency. However, the majority of residency training is dedicated to enhancing clinical knowledge base and skills.Because residents are quite busy clinically in residency, the research curriculum is designed to help divide the projects into manageable pieces to be accomplished each year. Research-centered education sessions and frequent feedback about their scholarly project progress help to bolster their research training. Overall, we find that a structured research curriculum results in generally positive perceptions of research and increases the ability of residents to successfully complete projects that are worthy of presentation at conferences as well as of publication
Opportunistic salpingectomy during hysterectomy for benign indications in women at low and high risk for ovarian cancer: a cross-sectional study
Full text linkObjectiveOur study aims to evaluate the role of pathology evaluation of fallopian tubesduring hysterectomy for benign indications for the purpose ofearly detection of serous tubal intraepithelial carcinoma (STIC) in women at high and low risk for ovarian cancer.Material and methodsThis cross-sectional study was conducted at Minia Maternity University Hospital, Egypt, between June 2015 and December 2017. Our study included all women undergoing hysterectomy for benign conditions in the genital tract. Appropriate histories were taken, as well as physical exams, and laboratory and ultrasound evaluations were done prior to scheduling surgery. Abdominal hysterectomies including opportunistic salpingectomies were performed and the whole specimens including the tubal fimbria were sent to the pathology lab for histo-pathological examination. ResultsA total of 526 patients met inclusion criteria for this study. The mean age of the study participants was 49.75±8.95 years, the mean parity was 3.91±1.62 and the mean BMI was 24.21±2.38 Kg/m2. The most common surgical indications for hysterectomy were postmenopausal bleeding (34.6%), a clinically benign adnexal/pelvic mass (31.7%), and menorrhagia (24.7%). The fallopian tubes were found to have either no pathology or benign conditions in 500 out of the 526 patients. Among these patients, 56% had no pathologic abnormality. The most common benign conditions were paratubal cysts (25%), endometriosis (9%), torsion (2%) and hydrosalpinx (1%). STIC was identified in the fallopian tubes of 8 out of 526 patients.ConclusionsMicroscopic examination of the entire fimbriae from all patients regardless of the clinical context represents a novel method of early detection of sporadic tubal carcinoma, a putative precursor to advanced-stage pelvic cancer
Post ablation bacteremia syndrome: an emerging clinical entity
Full text linkGlobal endometrial ablation continues to be a frequent therapeutic option for abnormal uterine bleeding. Post ablation bacteremia, a rare clinical occurrence, provides diagnostic and treatment challenges for clinicians. We report a case of post ablation bacteremia from the vaginal flora bacterium Streptococcus anginosus. A definition of post ablation bacteremia syndrome (PABS) and its clinical implications are presented