The long-term effects of endometrioma surgery on ovarian reserve: a prospective case–control study

The objective of this study was to evaluate the long-term effects of endometrioma excision on ovarian reserve. This study evaluated the long-term effects of endometrioma excision on ovarian reserve. A total of 63 women were enrolled in this prospective case–control study; 21 women had histories of endometrioma surgery (study group), 21 women had diagnoses of endometrioma, and 21 healthy age-matched women served as controls. Participants were recruited from the Department of Obstetrics and Gynecology, Inonu University Faculty of Medicine, between January 2007 and January 2016. The mean follow-up duration after endometrioma surgery was 30.4?±?18.0?months for the study group. The mean follicle-stimulating hormone, luteinizing hormone and estradiol levels were similar among groups, but the anti-Müllerian hormone (AMH) level was significantly lower in the surgery group than in the control group (p?p?=?.080 and p?=?.160, respectively). Endometrioma has a detrimental effect on ovarian reserve, and decreased ovarian reserve compared with that in healthy fertile subjects without endometrioma is evident shortly after endometrioma excision. However, the endometrioma excision procedure does not significantly decrease the ovarian reserve in the long term.     

Mild versus conventional antagonist ovarian stimulation protocols in expected normal responders undergoing IVF/ICSI: a case–control study

Mild controlled ovarian hyperstimulation (COH) protocols combining clomiphene citrate (CC) or letrozole with gonadotropins were introduced as an effective alternative of conventional COH in normal responders undergoing IVF/ICSI. In this case–control study, we compared 41 participants treated with a mild stimulation protocol receiving gonadotropins combined with either CC (n?=?24) or letrozole (n?=?17) with 71 subfertile participants with matching baseline characteristics, conforming with the same inclusion criteria and treated with a conventional antagonist protocol. Live birth was determined in reduced rates in the study group compared to the control group, reaching marginal statistical significance [4/41 versus 19/71, p?=?0.050], as also in the respective number of clinical pregnancies [6/41 versus 22/71, p?=?0.054], although the incidence of miscarriage was similar for both groups [2/41 versus 5/71, p?=?0.714]. Most of the secondary parameters examined, favored the conventional antagonist protocol. There was no difference in any of the outcomes reported between the three different stimulation groups in post-hoc analysis. Mild stimulation regimens with the aid of either CC or letrozole employing GnRH antagonists do not seem to constitute an equally effective method as compared to the conventional antagonist protocol to be offered in good prognosis subfertile women seeking an induced cycle toward IVF/ICSI.     

Perinatal outcomes of unplanned out-of-hospital deliveries: a case–control study

Purpose

To compare the pregnancy and perinatal outcomes of unplanned home or car births vs. in-hospital deliveries.

Methods

A retrospective, case–control study of women who underwent unplanned out-of-hospital deliveries vs. in-hospital deliveries from 2004 through 2014. Matching was based on gestational age and parity in a ratio of 2:1.

Results

There were no significant differences between the groups regarding demographic criteria, prenatal care and delivery complications. Women who delivered out of hospital (n = 90) had significantly fewer cesarean deliveries (1.1 vs. 10.6%; p = 0.05) and operative deliveries (2.2 vs. 13.3%; p = 0.004) in their obstetrical history than did the control group (n = 180). Significantly more newborns delivered out of the hospital had polycythemia (25.6 vs. 1.7%; p < 0.0001) and hypothermia (3.3 vs. 0%; p = 0.036) compared to the control group.

Conclusion

Women with unplanned out-of-hospital deliveries tend to have fewer complications in their previous deliveries. Higher rates of polycythemia and hypothermia require attention for neonates born out of the hospital.

     

Transitional cell carcinoma of the ovary: A case–control study

Objectives

The aim of this study is to compare response to chemotherapy and survival between patients with transitional call carcinoma of the ovary (TCCO) and papillary serous ovarian cancer (PSOC).

Methods

We identified women with both pure and mixed TCCO who were treated between 2000 and 2010. Each case was matched to two women with PSOC by age, grade, stage, and year of diagnosis. Correlation between categorical variables was assessed with chi square test. The Kaplan–Meier survival analysis was used to generate overall survival data (OS). Factors predictive of outcome were compared using the log-rank test and Cox proportional hazards model.

Results

Eighty-one women diagnosed with TCCO were selected as cases and compared to 162 controls. Women with TCCO had a lower rate of platinum resistance compared to controls (9% vs. 25%; p = 0.01). When multivariate logistic regression was used to control for other factors independently associated with platinum resistance, patients with TCCO had a significantly lower risk of platinum resistance compared to PSOC. Median progression-free survival was not significantly different (27 months vs. 22 months; p = 0.15) for women with TCCO and PSOC, respectively. Median OS, however, was significantly different at 83 months vs. 52 months for the TCCO and PSOC groups, respectively (p = 0.01). A Cox proportional hazards model identified optimal cytoreduction, transitional cell histology, age, stage, and platinum and paclitaxel chemotherapy as independent predictors of OS.

Conclusions

Patients with TCCO are less likely to demonstrate resistance to platinum chemotherapy and have improved overall survival when compared to patients with PSOC.     

Risk factors for preeclampsia: a case–control study

Objective: To explore the risk factors of preeclampsia and provide information for prevention of preeclampsia among obstetrical patients. Methods: A case–control study was designed to find the risk factors of preeclampsia among obstetrical patients by logistic regression analysis. Results: The risk factors for pregnant women were older gestational age, increasing body mass index, living in the countryside or small towns, fewer antenatal visits, and cold seasons. Conclusions: Health education should be emphasized to encourage women to have children at a relatively younger age and control weight during pregnancy. Special measures should be taken to improve the living condition and prenatal care in the countryside and small towns.     

Outcome of adolescent pregnancies in southwestern Nigeria: a case–control study

Background.?The most important health problems among adolescents in the developing countries are increased incidence of preterm labour and delivery, hypertensive disease, anaemia, more severe forms of malaria, obstructed labour, poor maternal nutrition and poor breastfeeding, low birth weight and increased neonatal mortality and morbidity.

Objectives.?To evaluate the risk factors of adolescent pregnancy, assess and explore the occurrence of specific complications and compare pregnancy complications among adolescent parturients to older controls in a tertiary health centre in order to design appropriate policies and interventions.

Method.?A retrospective study was conducted in a population of adolescents (age <18 years) delivered at the University College Hospital, Ibadan, Nigeria from January 2007 to November 2008. The birth register for the study-period was reviewed and socio-demographic data and labour records were extracted for both cases and controls.

Results.?The proportion of adolescent pregnancy between January 2007 and November, 2008 is between 1.5% and 2.2%. Overall, considering all the complications considered in the study 44.44% of adolescent pregnancies had one form of complication or the other. The corresponding figure among the control was 22.22%. The p-value?=?0.002 showing that adolescents had statistically more significant complication rates in pregnancy. Concerning the individual complications, the incidence of eclampsia and pre-eclampsia among adolescent was 20% which was only 3.33% among the controls. The p-value when this was compared was 0.001 showing statistical significance.

Conclusion.?Psychological, nutritional and social work services should be an integral part of obstetrical care in adolescent pregnancy especially in low resource country like Nigeria.     

The effects of gestational transient thyrotoxicosis on the perinatal outcomes: a case–control study

Purpose

To study the effects of gestational transient thyrotoxicosis (GTT) on pregnancy outcomes.

Methods

This case–control study retrospectively analyzed 7976 women with singleton pregnancies whose thyroid function was measured before 16 weeks of gestation and who delivered at ≥22 weeks of pregnancy. GTT was defined as hyperthyroidism (free thyroxine [FT4] level: ≥95th percentile) in the early pregnancy, which normalized in mid-pregnancy without thyroid-stimulating hormone receptor antibodies. Using data extracted from electronic records, we examined the association between GTT and the pregnancy outcomes (preterm delivery, gestational age at delivery, pregnancy induced hypertension (PIH), preeclampsia, placental abruption, caesarian section, birth weight, low birth weight, Apgar score, cord pH, stillbirth at gestational week ≥22, and neonatal death). We classified the cases into quartiles according to their FT4 values during the early pregnancy and investigated the association with the gestational age at delivery.

Results

Two hundred and eight cases of GTT and 6317 cases with normal thyroid assessments were reviewed. GTT was associated with hyperemesis gravidarum, but not with stillbirth, preterm delivery, PIH, preeclampsia, placental abruption, or low birth weight. The gestation period was shorter in patients with GTT than in those with a normal thyroid function (38.69 ± 1.79 vs. 39.07 ± 1.64 weeks, p < 0.01). Higher FT4 levels during the early pregnancy were associated with earlier delivery (p = 0.02).

Conclusions

GTT was associated with a lower gestational age at delivery but not with adverse pregnancy outcomes. There was a negative correlation between the FT4 values in the early pregnancy and the gestational period.

     

Association between fragile X premutation and premature ovarian failure: a case–control study and meta-analysis

Aim

The aim of the present study was to investigate the association between FMR1 premutation and premature ovarian failure (POF) patients in Indian population, and a meta-analysis of published results was undertaken to clarify whether FMR1 premutation consistently contributed to the susceptibility.

Methods

A total of 289 POF samples and 360 control samples were included in the study. Repeat variation was checked using GeneScan technique. Results were analyzed with GeneMapper software. Meta-analysis was performed using the Open Meta-Analyst and STATA 12.0 software. The crude odds ratio with 95 % confidence interval (CI) was computed to assess the strength of the associations.

Results

The assayed case and control population showed 29 different CGG repeat sizes (alleles), ranging from 7 to 40. Within this population, we found that the CGG repeat length polymorphisms were within the normal range of 6–55 in both patients as well as control samples. Eleven case–control studies were included in the meta-analysis with a total of 1,313 POF cases and 3,132 control subjects. Our meta-analysis revealed that there was a significant difference in the incidence of FMR1 premutation between POF cases and control subjects with p value <0.001 (OR 5.41; 95 % CI 2.53, 11.61).

Conclusions

We found no significant association between FMR1 CGG repeat premutation and POF in Indian population. However, the meta-analysis showed an increased risk of POF associated with a premutation, especially among populations from European descent. Further functional research should be performed to explain the inconsistent results in different ethnicities and POF susceptibility.     

Preeclampsia and depression: a case–control study in Tehran

Purpose

This study was conducted to determine the correlation between preeclampsia and depression.

Methods

Participants in this study included 156 cases with preeclampsia and 156 controls without any history of preeclampsia who were all newly admitted to antepartum wards, emergency room wards, and labor and delivery wards of the study hospitals (Valieasr, Shariatti, Mirza Koochak Khan, Shahid Akbar Abadi, Baharloo and Arash). They consented and completed a questionnaire on demographic characteristics, obstetric, delivery and infant information and Patient Health Questionnaire (PHQ-9) to assess their depression status. Data were analyzed through independent t test, Mann–Whitney U test, Chi-squared test, Fisher’s exact test and multiple regression by SPSS and STATA.

Results

Moderate to severe depression was found in 31.2% of the cases and 24.8% of the controls. Women with no depression in comparison with women with mild depression had a 1.81-fold (95% CI 1.05–3.14; P = 0.03) increased risk of preeclampsia, while moderate to severe depression correlated with a 2.52-fold increase (95% CI 1.05–6.02; P = 0.03) after adjustment of the probable confounding variables.

Discussion

With regard to the high prevalence of moderate to severe depression and its association with preeclampsia, our findings support and suggest efforts for screening depression among pregnant women and appropriate educational studies for mental and psychological problems during pregnancy.     

Hysteroscopic appearance of malignant and benign endometrial lesions: a case–control study

Objective To analyze hysteroscopic appearance of benign and malignant endometrial lesions in order to identify patterns to estimate the risk of malignance.Study design Matched case–control study; two controls per case. The cases were 21 women (age range 40–90 years, median 63) with histologically confirmed endometrial malignancy, and the control group 42 women submitted to diagnostic hysteroscopy for benign lesions (age range 37–81 years, median 57).Results Hysteroscopic findings associated with malignancy were papillary aspect (OR 26.0, 95%CI 6.4–105.3), size > 1/2 uterine cavity (OR 22.0, 95%CI 5.1–95.8), irregular surface (OR 8.0, 95%CI 2.7–23.2), mixed color (OR 10.0, 95%CI 3.6–28.0), diffuse vascular arrangement (OR 5.3, 95%CI 1.3–21.5), little branched vessels (OR 15.0, 95%CI 3.0–74.9), and discordance between the main vascular axe and the direction of the lesion growth (OR 37.0; 95% CI 10.7–128.3). Ulcerated surface and anarchic vascular aspect were present only in malignant cases.Conclusion The analyzes of general aspect, size, surface, color, vascular arrangement and vascular aspect allowed the estimation of the risk of malignancy, and the identification of points for targeted sampling.     

Efficacy and safety of late-start Corifollitropin-alfa administration for controlled ovarian hyperstimulation in IVF: a cohort,case–control study

ObjectiveTo investigate efficacy and safety of a controlled ovarian stimulation (COS) protocol in which a single dose of Corifollitropin-alfa (CFα) was administered on day 4 of a GnRH-antagonist cycle.DesignCohort case–control study.SettingUniversity Hospital.PatientsOne hundred twenty-two normally cycling women expected to be normal responders to COS.InterventionsIn 61 patients, CFα (100–150 μg) was injected subcutaneously on day 4 of a spontaneous menstrual cycle; a GnRH-antagonist was added from day 8 (fixed protocol; 0.25 mg/day). If needed to complete follicular maturation, recombinant FSH (rFSH) daily injections (150/200 IU/day) were given from day 11. A control group of 61 matched women was stimulated with daily subcutaneous injections of rFSH (100–150 U/day) from day 4 of the cycle, and received GnRH-antagonist (0.25 mg/day) from day 8. IVF or ICSI was performed according to the sperm characteristics, and 1–2 embryos were transferred in utero under US guidance on day 2.ResultsNo cycle was cancelled and the mean number of retrieved COCs was comparable in patients and controls. About 60 % of CF-alfa treated women had no need of daily rFSH addition, and the mean number of injections/cycle was significantly lower in the CF-alfa group than in controls (p < 0.05). The ongoing PR/transfer was 36.8 % in CF-alfa group and 37.5 % in controls. No patient developed severe OHSS, and the incidence of moderate OHSS was similar in cases and controls.ConclusionsCFα may be started on day 4 of the cycle obtaining results comparable to those of a COS using day 4-start daily rFSH, with significantly less injections and a similar risk of OHSS.     

Pathology findings in preterm placentas of women with autoantibodies: a case–control study

Objective: To evaluate the placental histopathology findings in women with systemic lupus erythematosus or antiphospholipid syndrome delivered preterm. Methods: We performed a case-control study comparing clinical outcomes and placental histopathology of 18 consecutive singleton pregnancies with systemic lupus erythematosus (n = 9) or antiphospholipid syndrome (n = 9) delivered between 24 and 37 weeks, and 54 controls matched for gestational age and type of preterm delivery (spontaneous or indicated). Placental examinations were performed by a single pathologist, and placental lesions were grouped into four categories: uteroplacental vascular pathology and related villous lesions; coagulation-related damage; chronic inflammation; and acute inflammatory lesions. Statistical analysis included the Mantel-Haenzsel or Fisher's exact test, and logistic regression, with a value of p < 0.05 or an odds ratio (OR) with 95% confidence intervals (CI) not inclusive of unity considered significant. Results: Lupus anticoagulant was positive in ten out of 18 cases and medium or high positive IgG anticardiolipin antibodies in seven out of 18. Antenatal treatment included corticosteroids (n = 9), low-dose aspirin (n = 15) and heparin (n = 8). Rates of necrotizing enterocolitis (33% vs. 0%, p < 0.001) and of perinatal mortality (33% vs. 9%, p = 0.02) were significantly different between cases and controls, and rates of birth weight < 10th centile approached statistical significance. Uteroplacental vascular lesions (OR 3.7, 95% CI 1.1, 11.7) and coagulation-related damage (OR 16.8, 95% CI 3.9, 72.6) were significantly more common among cases than controls, and rates of chronic inflammatory lesions approached significance. Conclusions: Cases of systemic lupus erythematosus and antiphospholipid syndrome delivered preterm are associated with a significant increase in placental vascular and coagulation-related lesions, which are reflected clinically by higher rates of perinatal mortality, necrotizing enterocolitis, and small-for-gestational age neonates.     

Acute post-partum urinary retention: analysis of risk factors,a case–control study

Purpose

The aim of this retrospective case–control study was to assess clinical factors that can predict the occurrence of post-partum urinary retention (PPUR) and evaluate their influence as independent risk factors.

Methods

Between January 2008 and December 2010, 11,108 vaginal deliveries were performed. 105 women who suffered from PPUR were detected by retrospective data analysis. PPUR was defined as the inability to have spontaneous micturition within 6 h after vaginal delivery.

Results

Data analysis detected six risk factors for PPUR on-set: primiparity, vacuum-assisted delivery, uterine fundal pressure during the second stage of labor (Kristeller’s maneuver), a longer second stage of labor, medio-lateral episiotomy, initial higher dose of epidural analgesia. Nevertheless, logistic regression showed that only vacuum-assisted delivery and Kristeller’s maneuver were significant independent risk factors (P = 0.001 and 0.009, respectively).

Conclusions

Our study identified these risk factors as the cause of mechanical and neurological damage, which can lead to post-partum urinary retention. By early diagnosis, a prompt and appropriate management of PPUR can be established in order to assure a rapid return to normal bladder function after vaginal delivery.

     

Periconceptional risk factors of spina bifida among Egyptian population: a case–control study

Objective: To study the preconceptual & early conceptional risk factors predisposing to the development of spina bifida (SB) among Egyptian population.

Study design: The study involved 197 pregnant women undergoing fetal anatomy scan; 97 women proved to have fetal SB and 100 women with normal fetuses as a control group. The control group was recruited randomly in the same period from patients undergoing anatomical scan. Risk factors that might lead to SB were investigated including maternal age, gravidity, parity, residence, history of diabetes mellitus or drug intake, smoking, infections, exposure to X-ray, history of congenital anomalies in other offspring, parental consanguinity, positive family history, and folate supplementations.

Results: SB affected the lumbo-sacral region in the majority of cases (89.7%). It was associated with hydrocephalus in 66 cases (68%), polyhydramnios in 12 cases (12.4%). The SB group showed significantly higher parity (p?=?0.005), more frequent history of drug intake (p?<?0.001), higher frequency of infection with CMV (p?=?0.004), and HSV (p?=?0.013) and less proportion of folate supplementation (p?<?0.001).

Conclusion: The rate of SB in the tested group was five per 1000. Risk factors were lack of folate supplementation and history of antiepileptic drugs intake.     

Coasting,embryo development and outcomes of blastocyst transfer: a case–control study

This study compared the effect on blastocyst development and clinical outcome of coasting in women at increased risk of moderate–severe ovarian hyperstimulation syndrome (OHSS; n = 389) with a control group matched for age and basal FSH that did not undergo coasting (n = 386) in IVF/intracytoplasmic sperm injection (ICSI) cycles. The main outcome measures were rate of blastocyst development and live birth. More cycles progressed to the blastocyst stage in the coasted group (n = 169) compared with the control group (n = 83; 43.4% versus 21.5%; P < 0.001). The biochemical pregnancy, clinical pregnancy and live birth rates were similar (46.5% versus 42.0%; 40.6% versus 37.8%; 31.6% versus 30.1%). The duration of coasting up to 4 days did not affect progression to blastocyst stage. The multivariate model showed that coasting (OR 1.73, P = 0.004) and the number of oocytes retrieved (OR 1.17, P = 0.001) were positively correlated with blastocyst formation. Coasting, a measure to reduce the risk of OHSS, does not impair blastocyst development or clinical outcome. Coasting should remain an effective measure to prevent OHSS.     

Maternal factors in the origin of isolated anorectal malformations – a population-based case–control study

Objective: In most patients affected by isolated anorectal malformation (IARM), the etiology is unknown. Thus, the aim of this study was to analyze the possible role of maternal risk factors in the origin of IARM.

Methods: The study samples included 231 cases with IARM, 361 matched and 38 151 population controls without any defect in the population-based large dataset of the Hungarian Case–Control Surveillance of Congenital Abnormalities, 1980–1996. Cases with IARM were evaluated in the function of maternal diseases and related drug use.

Results: The findings of this case–control study suggested that cases with IARM have an obvious male excess. The mothers of cases with IARM had a lower incidence of severe nausea and vomiting in pregnancy and a higher incidence of acute infectious diseases in the urinary tract.

Conclusions: Lack of nausea and vomiting in pregnancy and the higher incidence of urinary tract infections may have a role in the development of IARM.     

Association of interleukin-6 in women with persistence of DNA-HPV: a nested case–control study

Objective  

To identify the role of Interleukin-6, IL-10 and their epidemiological association in women with persistence of DNA-HPV.     

Obstetric and neonatal outcomes in a home-like birth centre: a case–control study

Purpose

To compare the intervention rates associated with labor in low-risk women who began their labor in the “home-like birth centre” (HLBC) and the traditional labor ward (TLW).

Methods

This retrospective study used data that were collected from January 2005 to June 2008, from women admitted to the HLBC (n = 316) and compared to a group of randomly selected low-risk women admitted to the TLW (n = 890) using the Baysian information criterion to select the best predictive model.

Results

Women in the HLBC had spontaneous vaginal deliveries more often (88.6 vs. 82.8 %, p value 0.034) and perineal lesions less often (60.1 vs. 62.5 %, p value 0.013). The frequency of adverse neonatal outcomes did not differ statistically between the two groups, although the mean clamped at birth umbilical arterial pH level was higher in the HLBC group. The transfer rate from HLBC to TLW was 31.3 % of which 75.8 % were nulliparae.

Conclusions

It appears that women could benefit from HLBC care in settings such as the one studied. Larger observational studies are warranted to validate these results.     

The neuro control of the ovarain cycle – a hypothesis

Since more than 100?years, it is known that pituitary function depends upon the function of higher centers in the brain. It was already assumed at this time that pituitary extracts could influence the gonads and postulated that their use could have practical applications. In 1926, the ‘gonadal principle’ was discovered revealing the regulation of ovarian function by the pituitary. The two pituitary hormones were called ‘Prolan A’ and ‘Prolan B’ which are responsible for ovarian function especially secretion of the hormones: ‘lutein’ and ‘foliculin’. If the names of Prolan A and B are changed to follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and the names of foliculin and lutein to estrogen and progesterone, it becomes obvious that the pituitary–gonadal relationship, as we know it today, was first described in 1930. Then, the next step was the isolation, sequence and synthesis of gonadotropin releasing hormone (GnRH) responsible for the secretion of gonadotropins (Gn). It could be shown that GnRH pulse frequency has differential effects on Gn secretion: low-frequency pulses of GnRH stimulate preferentially FSH and high frequency LH secretion. The pulse frequency control depends from a subpopulation of kisspeptin neurons within the infundibular region of the hypothalamus with coexpression of neurokinin B and dynorphin A – KNDy neurons showing a negative feedback to estrogen. A second group of kisspeptide neurons in the rostral periventricular area of the third ventricle is devoid of neurokinin-B and dynorphin, mediates positive feedback from estrogen and so induces the midcycle LH-surge. Therefore, the variability in the frequency and amplitude of GnRH pulsatility is central to the differential regulation of LH and FSH and thus ovarian follicle development, the correct selection of a single dominant follicle for ovulation, the LH surge and the luteal phase.