IVF and tubal pathology--not all bad news

OBJECTIVES: In light of evidence that hydrosalpinges compromise the chance of success of in vitro fertilisation (IVF), the aim of this study was to analyse the results of IVF treatment at our clinic in relation to the cause for infertility and to make inferences concerning the impact of mild tubal disease on IVF outcome. DESIGN: Retrospective observational study. SETTING Tertiary fertility clinic in New Zealand. POPULATION: Nine hundred and six consecutive cycles among 639 couples receiving IVF treatment in the six-year period 1995-2000 inclusive. METHODS: Data extraction from the clinic database. RESULTS: The clinical pregnancy rate of 17.5% per ovarian stimulation cycle and 23.9% per embryo transfer for the cycles of couples with tubal disease as the only cause for infertility was not significantly different from the clinical pregnancy rate of 15.4% per ovarian stimulation cycle and 24.1% per embryo transfer for all other couples undergoing IVF. In the cycles of women with tubal disease, the clinical pregnancy rate of 6.6% per ovarian stimulation cycle where other causes for infertility were also present, was significantly lower than the clinical pregnancy rate of 17.5% where tubal factor alone was present. In the cycles of couples with multiple causes for infertility, where the overall pregnancy rate was 10.9% per ovarian stimulation cycle, there was no significant difference in pregnancy rate between those whose multiple causes included tubal disease (6.6% per ovarian stimulation cycle) and those whose multiple causes did not include tubal disease (17.5% per ovarian stimulation cycle). CONCLUSION: The overall population of women with tubal disease as the sole cause for infertility (including women with hydrosalpinges and those with non-hydrosalpinx tubal disease) does not have an overall reduced likelihood of success at IVF. This suggests that non-hydrosalpinx tubal disease does not compromise the chance of success from IVF. Surgical treatment prior to IVF for the milder forms of tubal disease is not warranted.     

白砂糖用于妇产科术后伤口愈合不良的临床研究

目的:观察白砂糖在开腹手术术后腹部切口脂肪液化,感染伤口中预防感染、促进愈合的效果。方法:对100例脂肪液化,感染致切口愈合不良者按常规方法消毒换药至切口组织新鲜,分泌物明显减少后随机分成观察组及对照组各50例,观察组50例给予白砂糖换药,并与对照组50例采用二期缝合患者进行疗效对比。结果:观察组疗效明显优于对照组,创面愈合时间较对照组也明显缩短。结论:白砂糖具有良好的抗菌消炎效果,能明显改善创面肉芽生长程度,加快创面愈合。     

Breaking bad news in prenatal medicine: a literature review

Background: The diagnosis of a fetal anomaly in perinatal medicine forces expectant parents and healthcare providers to face the difficult process of breaking bad news.

Objectives: This exploratory literature review was aimed at providing a medical and psychological view of the psychological experience in expectant parents and physicians in the context of prenatal diagnosis of a fetal anomaly.

Method: An exploratory search of PubMed and PsycINFO/PsycARTICLES databases performed by an interdisciplinary team composed of a physician and psychologists. Search terms were: prenatal diagnosis AND bad news; prenatal diagnosis AND psychological consequences; prenatal diagnosis AND psychological sequelae; prenatal diagnosis AND fetal abnormality. The processing of selected articles followed a standardised five-step procedure.

Results: A total of 860 articles were screened of which 32 were retained for analysis. Four main themes emerged from the explanatory content analysis: (1) parents’ subjective experience; (2) physicians’ subjective experience; (3) encounters between expectant parents and professionals; and (4) ethical challenges in breaking bad news in prenatal medicine.

Conclusion: Expectant parents go through a complex and multidimensional experience when the diagnosis of a fetal anomaly is disclosed. Simultaneously, physicians consider breaking bad news as a very stressful event and are poorly prepared in this regard. A better knowledge of factors underlying psychological adjustment of the parental dyad and on the subjective experience of physicians delivering these diagnoses could enable better adaptation for both patients and professionals.     

再论产前筛查质量控制的重要性

近年,随着出生缺陷二级干预知识的不断普及,经典的唐氏综合征母血清学二联筛查已得到大面积的推广.及时回顾过去的工作,讨论存在的问题,对于不断提高产前筛查质量有着十分重要的意义.本期蒋涛等[1]对六万多例中孕期母血清筛查情况的回顾,很有借鉴意义.     

Antenatal corticosteroids: the good,the bad and the unknown

PURPOSE OF REVIEW: The purpose of this review was to summarize recently published clinical and animal-based studies of antenatal corticosteroids, describe current recommendations for practice, and suggest priority areas for future research. RECENT FINDINGS: A single course of antenatal corticosteroids is known to improve newborn lung function after preterm birth and to reduce the risk of newborn death. Current evidence from animal and clinical studies suggests that additional numbers of courses do not further improve lung function and are associated with risks of adverse consequences. These risks principally include restricted intrauterine growth, altered brain development, postnatal insulin resistance and changes to the hypothalamic-pituitary-adrenal axis. SUMMARY: The research challenges in this field are now centred on uncovering the mechanisms by which cortisol is involved in programming the fetus for its future metabolic life, and discovering ways in which the effectiveness and safety of antenatal glucocorticoids can be enhanced.     

Birth plans: the good, the bad, and the future

A written birth plan encourages women to clarify desires and expectations and communicate with their providers to make a realistic plan for care during labor. Tension between health professionals and patients caused by birth plans reflects the larger problems with contemporary maternity care: conflicting beliefs about birth, what constitutes safe, effective care, and ethical issues related to informed consent and informed refusal. The focus of birth plans should be to answer three patient-focused questions: What will I do to stay confident and feel safe? What will I do to find comfort in response to my contractions? Who will support me through labor, and what will I need from them? In this article, the history and purposes of birth plans and approaches to resolving tensions will be discussed.     

Neonatal neutrophils: the good, the bad, and the ugly

Neonates are at considerable risk for bacterial and fungal infections,due in great part to a variety of age-related impairments in neutrophil function. In addition, evidence suggests that the tendency of the most immature neonates to develop chronic inflammatory disorders is also related to neutrophil dysfunction. This article provides an overview of specific functional deficiencies of neutrophils that have been reported in neonates.     

Why hypertension is good new and preeclampsia bad news-demonstrating the failure of prevention

Hypertensive disorders in pregnancy continue to be an intriguing and potentially lethal complication in humans and some other primates. In a simplistic way the current hypothesis is that the genesis of preeclampsia starts at 12 to 14 wk gestation with failure of trophoblast invasion in the spiral arteries, resulting in some degree of hypoxemia in the placenta. The hypoperfused placental tissue starts to secrete variable amounts of angiogenic and antiangiogenic factors which eventually cause endothelial damage all over the pregnant women’s body with one of the many signs of preeclampsia as the clinical endpoint. For some incomprehensible reason a major interest has existed for decades concerning the early prediction of preeclampsia, most commonly tested using uterine artery Doppler (the earlier the better) and various serum markers, alone or in combination. Any new model for detection has been welcomed enthusiastically, although nothing has changed in the outcome of women presenting with preeclampsia.     

More than just bad sex: sexual dysfunction and distress in patients with endometriosis

Objectives

The aim of the current study was to evaluate the prevalence and the impact of sexual dysfunction, sexual distress and interpersonal relationships in patients with endometriosis.

Study design

A questionnaire-based multicentre cohort study was conducted in eight tertiary referral centres in Austria and Germany. One hundred and twenty-five patients with histologically proven endometriosis and dyspareunia were included. The Female Sexual Function Index and the Female Sexual Distress Scale were used to screen women's sexuality. Additionally, we evaluated psychological parameters and pain intensity during/after sexual intercourse via a self-administered questionnaire.

Results

Female sexual distress and sexual dysfunction were observed in 97/125 and 40/125 patients. Statistically significant correlations were found between sexual dysfunction and pain intensity during/after sexual intercourse (p < 0.01/p < 0.01), a lower number of episodes of sexual intercourse per month (p < 0.01), greater feelings of guilt towards the partner (p < 0.01) and fewer feelings of feminity (p < 0.01). Thirty-eight out of 125 women agreed that the primary motivation for sexual intercourse was to conceive and nearly half of women (46%) included stated that satisfying the partner acted as primary motivation for sexual contact.

Conclusion

Overall, our findings demonstrate that dyspareunia as a common complaint in patients with endometriosis causes a severe impairment of sexual function, relationship and psychological wellbeing.