Maternal serum insulin-like growth factor (IGF-I) and binding proteins IGFBP-1 and IGFBP-3 at 11-13 weeks' gestation in pregnancies delivering small for gestational age neonates

Objective

To investigate the possible value of maternal serum concentration of insulin-like growth factor-I (IGF-I), IGF binding protein-1 (IGFBP-1) and IGFBP-3 at 11–13 weeks’ gestation in the prediction of small-for-gestational age (SGA) neonates.

Study design

Maternal serum concentrations of IGF-I, IGFBP-1 and IGFBP-3 at 11–13 weeks were measured in 60 cases that subsequently delivered SGA neonates in the absence of pre-eclampsia, and compared to 120 non-SGA controls.

Results

In the SGA group, compared to the non-SGA group, there was significantly lower median IGF-I (61.8, IQR 43.4–93.4 ng/mL vs 94.9, IQR 56.7–131.2 ng/mL, p = 0.002) and IGFBP-1 (58.2, IGR 39.8–84.9 ng/mL vs 81.4, IGR 57.3–105.5 ng/mL, p = 0.002) but not IGFBP-3 (54.5, IGR 45.6–61.5 ng/mL vs 55.4, IGR 47.4–64.9 ng/mL, p = 0.402). However, after multiple regression analysis and adjustment for maternal characteristics, these biomarkers were not useful in predicting SGA.

Conclusion

Maternal serum IGF-I, IGFBP-1 and IGFBP-3 at 11–13 weeks are unlikely to be useful biochemical markers for early prediction of SGA.     

Effectiveness of local anaesthetics with and without vasoconstrictors for perineal repair during spontaneous delivery: double-blind randomised controlled trial

Objective

to investigate the use of local anaesthetics, in the presence or absence of vasoconstrictors, for perineal repair during spontaneous delivery.

Design

double-blind, randomised-controlled trial.

Setting

a birth centre, in the city of Sao Paulo, Brazil.

Participants

from June to December 2004, a total of 96 women were allocated into three groups (first-degree perineal lacerations, second-degree perineal lacerations or episiotomy), and treated with local anaesthesia (1% lidocaine or 1% lidocaine with epinephrine) (n=16 per treatment per group).

Interventions

an initial local infiltration of the anaesthetic solution was given so that episiotomy could be carried out (5 ml) and to suture spontaneous lacerations (1 ml), followed by repeated doses (1 ml) until pain was completely inhibited.

Measurements and findings

the main outcome measurement was the volume of anaesthetic used during episiotomy and perineal suture. Our data suggest that the concomitant use of the vasoconstrictor resulted in a significantly lower average volume used in the treatment of first-degree (1 ml, 95% confidence interval (CI) 0.4–1.6) and second-degree (3.7 ml, 95% CI 1.6–5.8) lacerations (p=0.002 and 0.001, respectively). A 0.3 ml (95% CI 1.5–2.1) average decrease in anaesthetic volume was observed with episiotomy (p=0.724). The maximum volume of anaesthetic used with and without vasoconstrictor was 1–2 ml in 95% and 3–4 ml in 50% of first-degree lacerations, respectively, and 1–6 ml in 88% and 7–15 ml in 81% of second-degree lacerations, respectively. For episiotomy, the maximum dose was 15 ml, regardless of anaesthetic solution used.

Key conclusions

our data confirm the hypothesis that the use of anaesthetics in conjunction with vasoconstrictors is more effective than anaesthetics alone in the repair of perineal lacerations, but not for episiotomy.     

Twin pregnancies in Cardiff and Vale of Glamorgan over four decades: natural twinning is on the increase

Objective

To assess trends in twinning over four decades using a population-based registry.

Design

Ecological study to conduct trend analysis of twin pregnancies in a geographically defined area over 40 years.

Setting

All pregnancies in the Cardiff and Vale of Glamorgan area of South Wales from 1965 to 2004, as recorded in the Cardiff Birth Survey (CBS) database.

Methods

Trends of the incidence of all twin pregnancies (≥18 weeks of gestation) were calculated in 5-year increments, beginning with 1965–1969 and ending in 2000–2004. Natural twinning rates could only be calculated for the terminal five time periods (i.e., 1980–1984, 1985–1989, 1990–1994, 1995–1999, and 2000–2004), when information regarding non-spontaneous (iatrogenic) twinning was first collected in the database. All results were adjusted for maternal age.

Results

The total twinning rate was 13.1 per 1000 pregnancies in the 1st time period (1965–1969). Subsequently, there was a gradual reduction in twinning, reaching a nadir of 10.3 per 1000 for the time period 1980–1985 (Z = 3.15, P value < 0.001). This was followed by a gradual increase in twinning, reaching a maximum of 15.7 per 1000 for both 1995–1999 and 2000–2004 (Z = −5.18, P value < 0.0001). After exclusion of the cases of iatrogenic pregnancies, the natural twinning rate showed a continuous and gradual increase from 10 per 1000 spontaneous pregnancies in 1980–1984 to 13.3 per 1000 in 2000–2004 (Z = −5.08, P value < 0.0001).

Conclusion

The data showed a gradual, continuous increase in natural twinning rates over the last two decades. Such an increase cannot be attributed to the rise in maternal age alone.     

Urbanization and the likelihood of a cesarean section

Objective

This study examines the association between the likelihood of cesarean section (CS) and the degree of urbanization in Taiwan, exploring possible explanations for the difference.

Study design

The database used in this study was the Taiwan 2004 National Health Insurance Research Database. A total of 200,207 singleton deliveries fulfilled our criteria and were included in our study. The urbanization level of cities/towns where parturients resided at the time of delivery was stratified into seven categories. A multilevel logistic regression model was applied to examine the relative likelihood of CS by urbanization level after adjusting for parturient, physician and hospital characteristics.

Results

There was an upward trend in the CS rate with advancing urbanization level; the CS rates for urbanization level 1 (most urbanized) through 7 (least urbanized) were 33.7, 32.3, 30.4, 30.2 29.7, 29.5, and 28.6%, respectively. Compared with participants living at the highest urbanization level, the adjusted odds of a CS were 0.91 (95% CI = 0.85–0.98, p = 0.014), 0.84 (95% CI = 0.78–0.91, p < 0.001), 0.83 (95% CI = 0.68–0.88, p < 0.001), 0.79 (95% CI = 0.72–0.86, p < 0.001), and 0.70 (95% CI = 0.62–0.80, p < 0.001) times, respectively, for those living in cities/towns ranked from the third highest to the lowest levels of urbanization.

Conclusions

We conclude that higher urbanization levels were associated with higher odds of CS. Highly urbanized communities could therefore be targeted for policy intervention aimed at reducing the unnecessary CS rate.     

Familial Mediterranean fever during pregnancy: an independent risk factor for preterm delivery

Objective

To investigate pregnancy outcome of patients with Familial Mediterranean fever (FMF).

Study design

A population-based study comparing all pregnancies of women with and without FMF between the years 1988 and 2006 was conducted. Stratified analyses, using the Mantel–Haenszel procedure and multiple logistic regression models, were performed to control for confounders.

Results

During the study period there were 175,572 deliveries, of which 239 occurred in patients with FMF. Using a multivariable analysis, the following conditions were significantly associated with FMF: preterm delivery (PTD, <37 weeks) (odds ratio (OR) = 1.5; 95% confidence interval (CI) 1.1–2.2), fertility treatments (OR = 2.5; 95% CI 1.4–4.4), recurrent abortions (OR = 2.2; 95% CI 1.5–3.2), labor induction (OR = 1.9; 95% CI 1.5–2.5) and malpresentations (OR = 1.8; 95% CI 1.2–2.8). Patients with FMF were more likely to deliver by cesarean delivery (CD) as compared to the comparison group (18.0% vs. 12.8%; P = 0.017). However, while controlling for possible confounders such as malpresentations, labor dystocia and failed induction, using multivariable analysis with CD as the outcome variable, FMF was not found as an independent risk factor for CD (adjusted OR = 1.2; 95% CI 0.8–1.8, P = 0.388). No significant differences were noted between the groups regarding perinatal outcomes such as low Apgar scores (<7) at 1 and 5 min (2.4% vs. 4.3%, P = 0.153 and 0.4% vs. 0.6%, P = 0.692; respectively), congenital malformations (5.2% vs. 4.9%, P = 0.838), or perinatal mortality (0.8% vs. 1.4%, P = 0.445). Stratified analysis, using the Mantel–Haenszel technique, was used to assess the association between FMF and PTD while controlling for possible confounders such as iatrogenic labor induction, fertility treatments, recurrent abortions and placental abruption. None of those variables explained the higher incidence of PTD in the group of patients with FMF.

Conclusion

Familial Mediterranean fever is an independent risk factor for preterm delivery. Nevertheless, perinatal outcome is comparable to the general population.     

Ultra-high dose of intra-amniotic or direct fetal intramuscular betamethasone for lung maturation in the preterm goat model

Objective

To evaluate the effects of intra-amniotic (IA) and fetal injections of a single ultra-high dose of betamethasone (BM) 48 h before preterm delivery on neonatal pulmonary function, using an experimental goat model.

Study design

Eighteen date-mated singleton pregnant Hair goats were randomized into four groups. At gestational day 118 (alveolar phase, term 150–155 days) after obtaining a sample of amniotic fluid, fetuses in group 1 (n = 5) received 8 mg/kg IA BM, and in group 2 (n = 5) 4 mg/kg fetal IM BM. In group 3 (n = 4) (0.3 mg/kg/day) maternal BM was administered at day 118 and 119 with a 24 h interval; control fetuses (n = 4) received 1 mL/kg of IA saline at day 118. At gestational day 120, after obtaining second sample of amniotic fluids 18 kids were delivered by preterm cesarean section, entubated, weighed, and mechanically ventilated for 15 min. Arterial blood gas samples and deflation/inflation lung pressure–volume measurements were obtained. After sacrifice, lungs were removed, weighed, gross examined and processed for further histological and immunohistochemical (IHC) evaluations. On hematoxylin and eosin (HE) stained slides, presence and severity of lung emphysema was evaluated; slides stained for surfactant proteins, and caspases were used for semi-quantitative evaluation of lung maturation. Kruskal–Wallis, Mann–Whitney, Wilcoxon signed rank, and chi-square tests were used for comparisons.

Results

IA BM was associated with increased number of stillbirths (60% vs. 0% in control) (p = 0.06) and emphysematous changes. Bodyweight-adjusted pressure–volume measurements were improved after maternal, but not IA or fetal, BM (p = 0.06). Following mechanical ventilation, arterial blood gas parameters did not significantly alter across maternal and fetal administrations. However, pH was significantly lower (p < 0.05) and carbon dioxide partial pressure was higher (p < 0.05) in the control group, indicating hypercapnic acidemia in non-treated pregnancies. None of the treatments induced measurable alterations in amniotic fluid lecithin/sphingomyelin (L/S) values. IA and fetal routes were associated with decreased surfactant protein expressions and increased apoptotic activity in alveolar and bronchio-alveolar epithelial cells.

Conclusion

Ultra-high dose IA and fetal IM BM is not superior to the standard dose and maternal way of administration in our experimental design.     

Classical and non-classical HLA molecules and p16(INK4a) expression in precursors lesions and invasive cervical cancer

Objectives

Viruses and tumour cells may regulate the expression of HLA molecules on the cell surface to escape immune system surveillance. Absence of classical HLA class I molecules may impair the action of specific cytotoxic cells, whereas non-classical HLA class I molecules may regulate innate and adaptive immune cells. We assess here the possible associations between classical/non-classical class I HLA and p16^INK4a molecule expression in cervical biopsies of women infected with HPV, stratified according to grade of the lesion and HPV type.

Study design

Cervical biopsies (N = 74) presenting cervical intraepithelial neoplasia grade 1 (CIN1) (n = 31), CIN2–3 (n = 19), and invasive cancer (n = 14) were evaluated alongside 10 normal cervical specimens.

Results

HLA-A/B/C/G staining was observed in the early stages of HPV infection. A significant association was detected between HLA-A/B/C staining and HPV16/18 infection (OR = 0.12, 95%CI: 0.0163–0.7899; p = 0.04). HLA-E expression increased with the progression of the lesion (χ²-test for trend = 4.01; p = 0.05), and a significant association was found between HLA-E staining and HPV16/18 infection (OR = 11.25, 95%CI: 2.324–54.465; p = 0.003). Irrespective of the grade of the lesion, HLA-A/B/C staining and p16^INK4a presented a good concordance (Kappa: 0.67).

Conclusions

HLA-E overexpression seemed to be associated with invasive cancer and HPV16/18 infection.     

Human papillomavirus (HPV) infections as risk factors for cytological and histological abnormalities in baseline PAP smear-negative women followed-up for 2 years in the LAMS study

Objective

To assess the role of HPV as determinant of the incident cytological abnormalities (SIL) and cervical lesions (CIN) during a 24-month follow-up of baseline PAP smear-negative subgroup of women included in the Latin American Screening study (LAMS).

Study design

A group of 365 women with normal Pap smear and negative or positive high-risk Hybrid Capture II test were prospectively followed-up for 24 months at Campinas and São Paulo (Brazil). The incidence rate (IR) and risk ratio (RR and 95% CI) of developing cytological or histological abnormality during the follow-up was calculated for HPV-negative and HPV-positive women.

Results

During the 12-month follow-up, women HPV-positive at baseline had developed a significantly higher rate of incident LSIL (IR = 3.5%, RR = 1.4; 95% CI 1.1–1.7) and HSIL (IR = 0.7%, RR = 1.5; 95% CI 1.4–1.7) abnormality. For HSIL, the IR increased to 2.1% and the RR increased to 1.7 (95% CI 1.5–1.9) among those followed for 24 months. Similarly, women with positive HPV tests were at a higher risk of developing CIN 2–3 (IR = 2.6%, RR = 1.5; 95% CI 1.4–1.6) during the first 12 months of follow-up, and for those followed for 24 months, this RR increased further to 1.7 (95% CI 1.5–1.9) although the IR was 0.7%.

Conclusions

Oncogenic HPV infections comprise a significant risk factor for incident cervical abnormalities, and HPV test is a useful adjunct to cytology in detecting the high-risk patients among baseline PAP smear-negative women.     

Fetal blood sampling in labour and the decision to delivery interval

Objective

To determine the time interval from decision to result for fetal blood sampling (FBS) and the time from an abnormal pH result to delivery of the neonate.

Study design

A prospective study of 107 consecutive attempts at FBS on 72 out of 1450 patients in labour from 1st April 2006 to 1st August 2006 at St James University Hospital in Leeds, England.Statistical analysis was performed by using nonparametric tests.

Results

107 attempts at FBS on 72 cases were reviewed. Overall the median time from decision to the result of FBS was 17 min (interquartile range: 11–22 min). 27% (19/70) of fetuses had abnormal results and the median time from result to delivery was 21 min (interquartile range: 16–25 min) in these cases. The median time from decision to perform FBS to delivery was 37 min in cases where acidaemia was present. Body mass index (BMI) cervical dilatation and grade of operator were the factors which affected median time from decision to the result of FBS.

Conclusion

The time from decision to the result of FBS should be considered in the delivery decision-making process in cases complicated by suspected fetal compromise.     

Combination of uterine artery Doppler velocimetry and maternal serum placental growth factor estimation in predicting occurrence of pre-eclampsia in early second trimester pregnancy: a prospective cohort study

Objective

To determine the effectiveness of the combined use of uterine artery Doppler velocimetry (UADV) and estimation of maternal serum placental growth factor (PlGF) levels in early second trimester (20–22 weeks of gestation) in identifying pregnant women at risk of developing pre-eclampsia.

Study design

Prospective cohort study on 1104 pregnant women with singleton pregnancies between May 2009 and December 2010. UADV and maternal serum PlGF estimation were done at 20–22 weeks’ gestation. Association between the two variables and the occurrence of pre-eclampsia was analyzed by logistic regression analysis and odds ratio was computed. The results were considered significant when p was <0.05.

Results

Logistic regression analysis showed that both abnormal UADV (odds ratio (OR) 4.1; 95% CI 2.3–7.2; p = 0.000) and serum PlGF < 188 pg/ml (OR 3.6; 95% CI 1.95–6.5; p = 0.000) are independent variables in the occurrence of pre-eclampsia, and the difference between the association of these two variables with pre-eclampsia was statistically insignificant as 95% CI values overlap. Multivariate logistic regression analysis showed that a combination of abnormal UADV and serum PlGF < 188 pg/ml at 20–22 weeks had a very poor association (OR 1.1; 95% CI 0.3–3.8; p = 0.938) with the occurrence of pre-eclampsia, as the 95% CI values encompass 1 and p is >0.05.

Conclusion

UADV and maternal serum PlGF estimation at 20–22 weeks of gestation are strong predictors of the occurrence of pre-eclampsia when used individually but in combination their association with pre-eclampsia is not significant.     

Relationship of serum adipocyte-derived proteins with insulin sensitivity and reproductive features in pre-pubertal and pubertal daughters of polycystic ovary syndrome women

Objective

To evaluate in a cross-sectional study adiponectin and leptin levels in prepubertal and pubertal daughters of women with PCOS and their relationship to insulin sensitivity and reproductive features.

Study design

We studied 92 daughters of PCOS women (PCOSd) and 76 daughters of control women (Cd) matched by age and body mass index SD scores and distributed according to breast Tanner stage: prepuberty (Tanner 1), early puberty (Tanner 2–3) or late puberty (Tanner 4–5). In all girls an oral glucose tolerance test was performed. Leptin, adiponectin, sex steroids, SHBG, glucose, insulin and lipid profile were determined. Leptin–adiponectin ratio, free androgen index and insulin sensitivity (HOMA-IR and ISI composite) were then calculated.

Results

Prepubertal PCOSd showed lower serum adiponectin compared to Cd (p = 0.028), whereas during puberty no differences were observed between the groups. Leptin concentrations were similar in both groups in all Tanner stages. In addition, in PCOSd during early puberty, adiponectin showed a negative correlation with testosterone and leptin showed a negative correlation with ISI composite, which were independent of BMI SDS (r = −0.39; p = 0.02 and r = −0.42; p = 0.01).

Conclusion

These observations suggest that during the prepubertal period PCOSd exhibit abnormal adiponectin levels, independently of BMI. Moreover, leptin and adiponectin may be related to metabolic and reproductive abnormalities observed in PCOSd during the early stages of sexual development.     

Association between TGF-β1-509C/T polymorphism and endometriosis: a systematic review and meta-analysis

Objective

To evaluate the association between the transforming growth factor β1 gene-509C/T (TGF-β1-509C/T) polymorphism and the risk of endometriosis.

Study design

Relevant studies published before October 2011 were identified by searching PubMed and Embase. Studies were selected using prior defined criteria. The strength of the relationship between the TGF-β1-509C/T polymorphism and endometriosis risk was assessed by Odds Ratios (ORs). Fixed- or random-effects model was calculated according to study heterogeneity. Stratification analysis and sensitivity analysis were also conducted. Possible publication bias was tested by funnel plots and Egger's test.

Results

Of 49 potentially relevant studies, six case–control studies were identified in this meta-analysis. The integrated result showed that the TGF-β1-509C/T polymorphism was not associated with the endometriosis risk for the allele contrast (T vs. C: OR = 1.57, 95%CI = 0.88–2.79), the additive genetic model (T/T vs. C/C: OR = 2.96, 95%CI = 0.97–9.10), the dominant genetic model (T/T + T/C vs. C/C: OR = 1.80, 95%CI = 0.80–4.07) and the recessive genetic model (T/T vs. C/C + T/C: OR = 1.91, 95%CI = 0.89–4.12). In the stratified analysis by ethnicity, genotyping method and source of control, no significantly association was found. Publication bias was not detected in the included studies.

Conclusions

Meta-analyses of the available data showed that the association between TGF-β1-509C/T polymorphism and susceptibility of endometriosis was not significant. More studies are needed to elucidate its role in endometriosis.     

Screening history of women in Malmö with invasive cervical cancer

Objectives

Cervical cancer is one of the most common forms of cancer among women. Cytological screening and follow-up are potentially effective procedures for preventing the development of – and mortality from – cervical cancer. The purpose of this study was to investigate the screening history of women diagnosed with cervical cancer with the aim of improving the screening programme.

Study design

All of the 187 women diagnosed with invasive cervical cancer in Malmö between 1991 and 2000 were identified, and those below 61 years of age (n = 130) were included in the analysis. The cytological and histological screening history of these women prior to their diagnosis was scrutinized. We analyzed shortcomings related to the cervical screening with special attention to participation defined as having had a cervical smear within 1 year of the scheduled time.

Results

Of the non-participants who developed cervical cancer (n = 70), roughly one-third “never participated,” half were “sub-optimal participants,” and one-sixth were “decliners,” i.e., women who declined the recommended measures. Among participants (n = 60), 80% were either “unexplained” (n = 35) or “misread as normal” (n = 13). The 9.5% subgroup of non-participants was at an 11-fold increased risk of being diagnosed with invasive cervical cancer.

Conclusion

The greatest reduction in cervical cancer would be realized if non-participants could be brought into the screening program.     

A prospective randomized study to compare four different mineral oils used to culture human embryos in IVF/ICSI treatments

Objective(s)

We aimed to evaluate and compare the embryo quality at early cleavage stages using different oils overlaying media to culture human embryos during IVF/ICSI treatments.

Study design

A total of 500 IVF/ICSI treatments from 500 women were analyzed in a prospective randomized study. Oocytes/embryos were treated into microdroplets of appropriate media overlaid with (i) Mineral Oil (CryoBioSystem, L’Aigle, France) (group 1, n = 129), (ii) Liquid Paraffin (Medicult, Lyon, France) (group 2, n = 126), (iii) Nidoil (Nidacon International, Guthenburg, Sweden) (group 3, n = 126) and (iv) Ovoil (Vitrolife, Kungsbacka, Sweden) (group 4, n = 119). Comparisons between groups were done using two by two post hoc tests, with 5% significance. The primary endpoint was the embryo quality, defined as good or top quality when embryos were with (i) less than 20% of fragmentation and (ii) 3–5/4 cells at day 2 or 6–10/8 cells at day 3, respectively.

Results

At day 2, the embryo quality was similar in all groups. However, the mean number of top quality embryos at day 3 was statistically higher into the group 4 (1.4 ± 1.8) compared to the group 1 (0.9 ± 1.0; p = 0.03) and 2 (0.8 ± 1.3; p = 0.05). Furthermore, a significant increase of the mean number of good quality embryos was observed at day 3 into the group 4 (2.6 ± 2.6) compared to the group 1 (1.6 ± 1.6; p = 0.02).

Conclusion(s)

The embryo quality could be modified according to commercial oils used to overlay culture media.     

The clomiphene citrate challenge test (CCCT) in women with elevated basal FSH: biological significance and predictive value

Objective

The rationale of the clomiphene citrate challenge test (CCCT) is that day 10 serum FSH is influenced by the quality of the recruited oocytes. Biological evidence supporting this assumption is, however, lacking. The aim of this study is to investigate the relationship between results from the CCCT and the quantity and the quality of the recruited oocytes.

Study design

Patients selected for in vitro fertilization (IVF) and who were found to have elevated basal FSH (n = 114) underwent an IVF cycle using follicles developing during CCCT. Subsequently, a subgroup of patients (n = 89) underwent a second cycle receiving high doses of gonadotropins. The main outcome considered was the transfer of viable embryos.

Results

During the CCCT cycle, the area under the receiver operating characteristics (ROC) curves for day 3 and day 10 serum FSH to predict embryo-transfer was 0.48 (95% CI, 0.37–0.60) and 0.74 (95% CI, 0.63–0.82), respectively. In the subsequent cycle, the area under the ROC curves for the two variables was 0.58 (0.43–0.72) and 0.58 (0.43–0.72), respectively.

Conclusions

CCCT effectively mirrors the quantity and the quality of the recruited oocytes but its predictive value is low.     

A potency of plasminogen activation system in long-term prognosis of endometrial cancer: a pilot study

Objective

Plasminogen activators released from cancer cells lead to degradation of basement membrane proteins and extracellular matrix, and facilitate cancer cell invasion into surrounding tissues and the blood stream. The aim of this study was to evaluate a complex tissue immunohistochemical expression of the plasminogen activation system – urokinase-type plasminogen activator (uPA) and its receptor (uPAR), tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor (PAI)-1 – in endometrial cancer, and to correlate obtained results with disease progression and course.

Study design

The study group was composed of 100 patients classified in three sub-groups according to the FIGO 2010 tumour stratification (G1 = 70, G2 = 19, G3 = 11). Expression of uPA, tPA, uPAR and PAI-1 was examined by means of immunohistochemical staining.

Results

Immunohistochemical expressions of all the studied markers did not differ between G1 and G2 patients. However, G3 subjects were found to have a significantly lower expression of uPA, PAI-1 and tPA. In addition, the patients who survived were found to be PAI-1 negative, while study participants with an unfavourable disease course were PAI-1 positive.

Conclusions

A significantly higher immunohistochemical expression of PAI-1 was found to correlate with shorter relapse-free and overall survival in patients classified as stages IB and II of endometrial cancer.     

Feasibility of endometrial assessment after thermal ablation

Objective

To evaluate the feasibility of endometrial assessment after endometrial thermal ablation.

Study design

Prospective observational study. A total of 57 women (age 47–52 years), who had undergone endometrial thermal ablation as a treatment for heavy menstrual bleeding (HMB) 3–10 years (mean 6 years) earlier, were examined with transvaginal ultrasound and saline sonohysterography. Endometrial samples were collected with a Pipelle device. Visualisation of endometrium, access to uterine cavity, change in cavity length, success in outpatient endometrial sampling and success in sonohysterography were evaluated.

Results

Endometrial thickness was 4.5 mm in amenorrhoeic women (n = 17), 5.6 mm in eumenorrhoeic women (n = 37) and 6.6 mm in hypermenorrhoeic women (n = 3). An endometrial sample was successfully taken in 44 (77%) women, and in 13 (23%) women endometrial sample taking failed. The length of the uterine cavity compared to the length measured before endometrial thermal ablation was 0.5–5 cm (mean 2 cm) shorter in 34 women, unchanged in four women and longer in five women. The uterine cavity distended regularly in only nine (16%) women. In 14 (25%) women the cavity distended irregularly or only partly, and in 24 (42%) women the uterine cavity did not distend at all, but appeared as a narrow tube. In 10 (18%) women the sonohysterography catheter did not enter the uterine cavity at all.

Conclusion

Endometrial assessment is compromised after previous endometrial thermal ablation. Both endometrial sampling and sonohysterography fail quite often, causing problems in diagnosis of abnormal bleeding. Intrauterine adhesions may also decrease the reliability of the endometrial sampling.     

Does 45,X/46,XX mosaicism with 6–28% of aneuploidy affect the outcomes of IVF or ICSI?

Objective

Several studies have shown an increased frequency of chromosomal aberrations in female partners of couples examined prior to intracytoplasmic sperm injection (ICSI). A retrospective cohort study was performed to determine whether 45,X/46,XX mosaicism affects the outcomes of in vitro fertilization (IVF) or ICSI.

Study design

Forty-six women with a 45,X/46,XX karyotype with 6–28% of aneuploidy were compared with 59 control women (46,XX), matched for age, from the female population who underwent IVF or ICSI between 1 January 1996 and 31 December 2006 at the Reproductive Medicine Unit at Brest University Hospital. The outcomes of 254 treatment cycles were compared according to patient karyotype.

Results

No difference was found in the number of retrieved oocytes (8.9 ± 5.5 vs 8.5 ± 4.7; p = 0.56) or the number of mature oocytes (7.4 ± 4.7 vs 6.9 ± 4.2; p = 0.49) between the 45,X/46,XX group and the 46,XX group, respectively. Fertilization rates did not differ between the groups for either IVF or ICSI. In addition, no difference was found in the pregnancy rate by cycle (17.4% vs 18.7%, respectively; p = 0.87). The percentage of first-trimester miscarriages was similar in both groups (13.6% vs 12.5%, respectively; p = 0.51).

Conclusion

45,X/46,XX mosaicism with 6–28% of aneuploidy has no adverse effect on the outcomes of IVF or ICSI among women referred to assisted reproductive technologies.     

Predictors of spontaneous reduction in multiple pregnancies conceived following assisted reproductive technology

Objective

To identify patient and cycle parameters that relate to spontaneous reduction in multiple pregnancies following in vitro fertilization (IVF) and embryo transfer (ET).

Study design

A retrospective cohort study was conducted in an academic infertility center. All IVF cycles between January 2007 and June 2008 were evaluated and 69 infertile women were diagnosed with multiple gestation following IVF. Multiple pregnancy was diagnosed by transvaginal sonography at 6–7 weeks gestation following embryo transfer (ET). Repeat ultrasonography undertaken in late first trimester assessed ongoing multiple pregnancy versus occurrence of spontaneous reduction. Patient and IVF cycle parameters were compared between patients experiencing spontaneous reduction (n = 26, cases) compared to those where the multiple pregnancy proceeded uneventfully (n = 43, controls).

Results

Spontaneous reduction (SR) was observed in almost 38% of the studied multiple gestations (n = 69). Women experiencing SR were significantly older (p = .047), of a leaner body mass (p = .049), and exhibited significantly higher serum estradiol (E₂) levels in the early follicular phase (p = .016) compared to the controls. Endometrial thickness (EMT) on the day of hCG administration related inversely (p = .017), whereas the number of embryos transferred (ET) related positively with the likelihood of SR (p = .027). On multivariate analyses, EMT and the number of ET were identified as independent predictors of SR following IVF–ET; EMT of less than 10 mm was associated with a fourfold increased likelihood of SR (OR 4.18; 95% CI 1.02–17.01) whereas each additional embryo transferred doubled the risk of SR in multiple pregnancies resulting from IVF (OR 2.39; CI 1.02–5.58).

Conclusions

In multiple pregnancies conceived following IVF, occurrence of SR is relatively common. Increasing number of ET and EMT measuring <10 mm are identified as independent predictors of likelihood of SR. While advancing age, body mass and baseline E₂ levels were associated with likelihood of SR, these associations disappeared on adjusted analyses. The observed relationship between EMT and SR is novel: the underlying mechanisms are unclear and merit further investigation.