Q fever during pregnancy: an emerging cause of prematurity and abortion

BACKGROUND: Although the pathogenic role of Coxiella burnetii infection during pregnancy is controversial, some cases of stillbirth and abortion occurring after an acute or chronic infection have been mentioned in the literature. Recently, Q fever has been advocated as a significant cause of morbidity and mortality in pregnancy CASE: We describe an 18-year-old primipara woman admitted to our hospital for high fever and pancytopenia during an acute C. burnetii infection. She was successfully treated with clarithromycin, overcoming fever and pancytopenia. Finally, she gave birth to a healthy infant, and 1 year later both remained well. CONCLUSION: Q fever is a potentially serious disease in pregnancy owing to the possibility of placenta infection and fetal transmission affecting its outcome. Q fever infection should be suspected in unexplained febrile episodes or abortion during pregnancy, when epidemiologic and clinical data are present. We believe that C. burnetii serology should be tested in cases of fever of known origin or unexplained abortions, as the TORCH infections are.     

Fertility,pregnancy outcomes and deliveries following myomectomy: experience of a French Caribbean University Hospital

Background

Myoma is the most common benign tumor in women of childbearing age, with a high frequency in Afro-Caribbean than in other women. Depending on their number, size and location, myomas are suspected to be a cause of infertility. Conservative treatment by myomectomy is possible for symptomatic patients wishing to preserve their fertility.

Purpose

The aim of this study was to evaluate the fertility of patients undergoing myomectomy in the University Hospital of Pointe-à-Pitre, Guadeloupe.

Methods

We conducted a retrospective study including all patients under age 42 who had conservative surgery from January 1st, 2005 to December 31st, 2009. The main judgment criteria were the occurrence of postoperative pregnancy and its outcome.

Results

Of 297 operated patients, 220 were interviewed by phone (74.1 %), 124 (56.3 %) had tried to obtain a pregnancy and 54 patients (43.5 %) had 66 pregnancies (59.1 % being live births and 25.8 % miscarriages). For fertility after surgery, univariate analysis identified the number (more than 6, P = 0.0027) and an intramural location (P = 0.027) of myomas as negative factors and multivariate analysis identified age (over 35 years, RR = 2.45) and the association of other causes of infertility (RR = 2.21) as negative factors for pregnancy.

Conclusion

The modest conception rate (43.5 %) after myomectomy among those women trying to obtain a pregnancy may be linked to the specificities of our population, and in particular its relatively high age and the frequent association of multiple causes of infertility.     

Abdominal pregnancy at the University College Hospital, Ibadan: a ten-year review

Fourteen cases of abdominal pregnancy managed at the University College Hospital, Ibadan, Nigeria, over a ten-year period (January 1994 to December 2003) were reviewed. The incidence ratio of abdominal pregnancy was one in 654 deliveries. It accounted for 4.3% of ectopic pregnancies. Age range was 20 to 43 years; 63.4% of the patients were unemployed and 50% were nullipara. Pre-operative diagnosis was possible only in half of the cases. Only two patients with advanced pregnancies and live fetuses (14.3%) were allowed to have conservative management while the others had immediate laparotomy. Live birth rate was 7.1%, but overall fetal survival rate was 0%. Fetal malformations were common, with talipes equinovarus and jaw abnormalities occurring in 49.2% and 14.3% respectively. Twelve patients (85.7%) who had complete removal of the placenta, though lost more blood, had better outcome than those with placenta left in-situ. The case fatality rate was 7.1%.     

External radiation therapy for endometrial carcinoma: the University Hospital of Ioannina experience

PURPOSE OF INVESTIGATION: The aim of our study was to present the experience of our department in the treatment of endometrial cancer with postoperative external beam radiotherapy (EBRT) without intracavitary brachytherapy (BRT) and to evaluate the efficacy of such a method. METHODS: We retrospectively retrieved the medical records of all patients with endometrial cancer treated with surgery and EBRT alone (median dose 50.0 Gy). Thirty-one women (median age: 67 years) of all clinical stages were reviewed and analyzed for recurrences (local or metastases) and late post-radiation side-effects. RESULTS: Within a median follow-up of 17 months one patient developed local recurrence and four developed metastases. Overall survival was 97% and disease-free survival was 87%. Three women developed post-radiation colitis. No other treatment-related late side-effects were observed. CONCLUSION: EBRT without BRT achieved an excellent local control in women with endometrial cancer although some of them were candidates for supplementary BRT.     

Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience

OBJECTIVE: Our purpose was to evaluate the effectiveness of single-dose intramuscular methotrexate in the treatment of ectopic pregnancies by physicians in the Department of Obstetrics and Gynecology of Northwestern Memorial Hospital and to compare the results with those of previously published studies. STUDY DESIGN: A retrospective chart review was performed of 50 patients with ectopic pregnancies treated with single-dose methotrexate according to the protocol of Stovall et al. from January 1992 to February 1995. RESULTS: The mean pretreatment level of β-human chorionic gonadotropin was 1896.4 ± 2399 mIU/ml. Only 32 women (64%) were successfully treated with a single dose of methotrexate. An additional 7 women required a second or third injection. The combined success rate for medical management of ectopic pregnancy with one to three doses of methotrexate was 78% (39 women). Pretreatment β-human chorionic gonadotropin levels were significantly lower in women who responded to single-dose therapy than in those who required either two or three doses or who had failure of medical management (p = 0.0011). The mean time to resolution of β-human chorionic gonadotropin was 26.5 ± 17 days. Higher pretreatment levels correlated with longer resolution time (r = 0.83, p < 0.001). Eleven women (22%) with failure of medical management required surgery. CONCLUSIONS: In our series single-dose methotrexate was only 64% successful. Women with a pretreatment β-human chorionic gonadotropin level >5000 mIU/ml had a greater probability of requiring either surgical intervention or multiple doses of methotrexate. The potential for emergency surgery remains an important risk. (Am J Obstet Gynecol 1996;174:1840-8.)     

Fetal impact of cholestasis of pregnancy: experience at Tenon Hospital and literature review

Cholestasis of pregnancy is a liver disorder that occurs during the second half of pregnancy, causing pruritus and elevated serum bile acid levels. Its etiology remains unknown but probably involves vascular and humoral immune responses, mediated by bile acids. This disorder is associated with substantially increased fetal morbidity and mortality. The most satisfactory treatment consists in delivering the fetus as soon as pulmonary maturation has occurred.     

The Norplant experience at the University Hospital of the West Indies.

Sixty-eight patients had Norplant inserted between May 1992 and November 1993 as part of a pre-introductory study. The main side effect was weight change which occurred in 85.3% (58 patients); weight loss occurred in 25.0% (17 patients, one patient voiced a complaint) and weight gain occurred in 60.3% (41 patients, 10 of whom voiced a complaint). Menstrual problems were the next most frequent side effect occurring in 70.4% (48 patients); spotting occurring in 22% (15 patients, none of whom complained) and heavy bleeding in 7.3% (five patients, all of whom complained). Amenorrhoea occurred in 41.1% (28 patients). Other complaints were minor. No pregnancies have been recorded to date. There were no procedural complications and all patients were satisfied with the cosmetic appearance. To date there have been 36 removals, the majority for menstrual complications. Norplant is a safe, effective means of 'reversible sterilisation' which should be utilised in family planning programmes throughout the country.     

Typhoid fever and pregnancy

Typhoid fever is rare in Europe, but well-recognized endemic disease in tropical zones. We report our findings in a series of 25 cases of typhoid fever during pregnancy observed in French Guiana and reviewed the literature on clinical signs, diagnosis and treatment. Salmonellea typhi causes septicemia of digestive origin that can cross the placenta resulting in chorioamniotitis. Maternal-fetal infection with S. typhi can lead to miscarriage, fetal death, neonatal infection, as well as diverse maternal complications. In order to avoid maternal complications and possible fetal transmission, treatment with ceftriaxone should be initiated as early as possible     

Sexuality after hysterectomy at University of Jordan Hospital: a teaching hospital experience

Purpose

This research concentrates on evaluating the sexual activity of the patients after having hysterectomy for benign disorders.

Setting

This analysis took place at the University of Jordan hospital.

Material and methods

The retrospective record was reviewed for over 2 years (from January 2008 to January 2010). The sample of study included a total number of 124 patients with benign disorders who underwent hysterectomy. The sexual life parameters indicate that 93 patients (75 %) felt general improvement in their performance, while 14 patients (11.3 %) complained of having suffered bad performance, 6 patients (4.8 %) noticed no changes, and 11 patients (8.9 %) did not provide any comment. As for the partner’s sexual function (as relayed by the patients themselves), 69 patients (55.6 %) felt improvements in their performance and 23 (18.5 %) commented that their partners had bad performance, while 18 patients (14.5 %) noticed no changes and 14 (11.3 %) did not provide any comment. Patients were interviewed by the operating physician each of whom was subjected to an average of half an hour verbal interview after obtaining the prior written consent of the patient. Questionnaire forms were used to record the answers given by each patient. The interview data recorded in the questionnaires were analyzed.

Conclusion

The result of these analyses significantly indicated that sexual function is a major cause of women’s concern for scheduled hysterectomy. That is because they were influenced by both physiological and psychological factors. Even though the analysis results implied that there was a sizeable minority who evidently suffered a considerably worse outcome, it was recognized that hysterectomy leads to improvement in sexual function and health for the majority of women. Therefore, it is important to spread awareness among women and let them know that most probably they will neither lose their sexual desire after hysterectomy, nor they will lose their feminine shape or style.     

Technical considerations in hand-assisted laparoscopic live donor nephrectomy: initial Taiwan experience from National Taiwan University Hospital.

This report describes the initial experience of laparoscopic live donor nephrectomy (lap-LDN) in Taiwan and discusses the technical considerations and modifications of our technique. From September to November 2000, three (one right and two left) lap-LDNs were performed at our institute. The right kidney was retrieved in one donor because of an early branching of the left renal artery. The details of our technique are described for both left and right LDN. The perioperative parameters were compared to those of the 10 immediately preceding cases of LDNs using the traditional open approach. All lap-LDNs and open LDNs were successful, and all 13 recipients had smooth recovery of renal function. The donors recuperated better in the lap-LDN group with resumption of oral intake on postoperative day (POD) 1 and discharge on POD 5 (vs POD 3.4 and 8.5, respectively, in the open group). The mean blood loss was lower and narcotic use was less in the lap-LDN group (75 vs 164 mL, 25 vs 47 mg morphine sulfate equivalent, respectively). The extraction wound was much shorter in the lap-LDN group (6.5-8 vs 23 cm). The warm ischemia time was slightly but not significantly shorter in the open group (4 vs 2.75 min), and the average operative time was shorter in the open group. The results of our initial experience suggest that for surgeons with laparoscopic surgery experience, lap-LDN is a feasible procedure that decreases donor discomfort, while improving the quality of graft kidneys and the safety of the donor.     

Combined pregnancy: the Mount Sinai experience

Nine recent cases of coexisting intra- and extrauterine pregnancy at The Mount Sinai Medical Center are presented. The myriad of clinical presentations is exemplified in the postabortal, endometriosis, posttreatment; ovulation induction, and routine "rule-out ectopic" situations. A brief review of the literature follows detailing historical reports of diagnostic inaccuracy and delayed diagnosis. Several studies are cited supporting the difficulty of correctly diagnosing heterotopic pregnancy as well as factors which may predispose to it. The advantages and pitfalls of ultrasonography are mentioned as well as recommendations for early laparoscopic intervention when clinical history and ultrasound are suggestive. Caution is advised in those infertility patients who may undergo "routine" curettage at laparoscopy for ectopic pregnancy and thus, be at risk for inadvertent termination of an otherwise salvageable intrauterine pregnancy. This report further supports several other reviews in noting that the incidence of combined pregnancy may be much greater than formerly appreciated.     

Laparoscopically assisted Schauta operation: learning experience at the Gynecologic Oncology Unit, Buenos Aires University Hospital

OBJECTIVES: The aim of this study was to show the learning experience of the employment of laparoscopic lymphadenectomy followed by a Schauta operation to treat patients with cervical carcinoma at a university hospital and to evaluate the feasibility, complications, hospital stay, delay in return to work, and overall survival of this procedure. METHODS: Between June 1, 1993, and December 30, 1997, 56 patients were selected. Surgical treatment began with a pelvic laparoscopic lymphadenectomy followed by a Schauta operation. Patients were staged according to FIGO criteria (Ia2, 10 cases; Ib1, 33 patients; Ib2, 8 cases; IIa, 3 cases; and IIb, 2 patients). Patients had a follow-up of 47 months. Overall survival was calculated with Kaplan-Meier tables. RESULTS: The procedure was not completed in 9 pts, in 5 cases among the first 20 pts that were entered on the trial due to technical problems and in 4 due to extracervical spread of disease (2 with gross laparoscopically unresectable lymph node metastases, 1 with parametrial infiltration, and 1 with rectovaginal septum involvement). In the 47 pts in which the procedure could be completed, the laparoscopic approach was done in 102 min and the vaginal part in 165 min. There were 4 complications: 1 ureteral injury, 1 abscess of the ischiorectal fossa, 1 hematoma of the Schuchardt incision, and 1 case of leg edema. The mean number of resected nodes was 17. Among the 47 cases in which the surgical procedure was completed, overall survival was 100% for Stage Ia, 88% for Ib1, and 85% for Ib2 after a mean follow-up of 4 years. Four pts have relapsed and died; 3 were stage Ib1 and the other was stage Ib2. They had pelvic recurrences. CONCLUSIONS: This surgery is secure and has an excellent outcome, so it can be considered a valid approach for the treatment of patients with cervical carcinoma, but in our hands, 20 cases were needed to obtain the minimum skill needed to perform it.     

Single-embryo transfer: Rennes' Hospital experience

In 2005-2006, 905 punctures of oocytes were realised in the Assisted Reproductive Technology Centre of Rennes' Hospital in France, the source of 173 pregnancies after fresh embryos transfers and 185 pregnancies after frozen embryos transfers. The single-embryo transfer (SET) was proposed in all patients aged less than 38 years with at least two embryos type I or II on the first two cycles. Sixty-three percent of patients (n=293 cycles) chose the SET with 21.5% pregnancies through fresh embryo transfer. The SET with frozen embryos has been completed on 708 cycles with 16.8% of pregnancies per transfer. The cumulative rate of pregnancies by puncture is 39% and the overall risk of multiple pregnancies has dropped to 12%. The SET associated with an effective embryo cryopreservation therefore allows to reduce the risk of multiple births while maintaining a satisfactory pregnancy cumulative rate.     

Dengue fever in pregnancy: a case report

Background  

Dengue, a mosquito-borne flavivirus infection, is endemic in Southeast Asia. Currently, the incidence has been increasing among adults.     

Delivery and immigration: the experience of a Greek Hospital

INTRODUCTION: In this retrospective study we investigate the differences regarding the mode of delivery between Greek and immigrant women. MATERIAL AND METHODS: We collected data from the Birth Registry of the hospital delivery room for the period from March 1, 2000 to February 29, 2004. We assigned the women into two groups according to their nationality: Greeks and immigrants. We studied the following parameters: age, nationality, parity of women, mode of delivery instrumental delivery (ID), vaginal birth (VD), cesarean section (CS), the indications of CS, and gender and weight of the newborn; 3,071 women met the inclusion criteria. RESULTS: The average immigrant's age was 2.9 years lower than in the Greek group; 35.2% of the women were Greeks and 64.7% were immigrants. A significant difference was found in the percentage of multipara and the indications for CS--especially prolonged labor (significantly higher in the immigrants), and preeclampsia (significantly higher in the Greeks). There were no significant differences between the two groups referring to the rate of CS, ID or VD, the gender of the newborn, and the birth weight. DISCUSSION/CONCLUSION: We did not find any significant differences between the two groups regarding the rate of caesarean delivery. In exploring health-related differences between population groups, it is important to determine how race/ethnicity contributes to these differences. A statistically significant association between race or ethnicity and an undesirable health outcome does not by itself establish causality. Health outcomes usually have multiple causes that can be either direct or indirect and are often interrelated and interactive. Race/ethnicity and social class influence health through complex pathways.     

Multifetal pregnancy reduction and selective termination: the Canadian experience

OBJECTIVE: To describe the experience of two Canadian referral centres with multifetal pregnancy reduction (MFPR) and selective termination (ST). METHODS: Retrospective chart review of all MFPR and ST procedures during the periods from January 1, 1990, to December 31, 1997 (Vancouver), and from September 1, 1995, to December 31, 1997 (Toronto). Outstanding outcome data were obtained by telephone. All women were managed according to standard protocols. Non-parametric analysis of continuous variables and Fisher's exact test for categorical variables were used. RESULTS: 61 women underwent transabdominal MFPR (n = 44) or ST (n = 17). Median maternal age: MFPR and ST 33.0 years; gestational age at reduction: MFPR 11.4, ST 20.2 weeks; procedure duration: MFPR 4, ST 10 min. 89% MFPR and 12% ST cases followed assisted reproduction. 7% MFPR and 18% ST pregnancies lost <24 weeks (n.s.). 97% MFPR and 83% ST non-reduced fetuses delivered alive. Median delivery gestational age: MFPR and ST 37 weeks. CONCLUSIONS: The results are similar to published series. This procedure has increased options for Canadian couples, offering the procedure 'close to home', reducing costs and, more importantly, the significant psychological morbidity following these procedures.     

Q Fever in pregnancy: a case report and review of the literature

Endemic occurrence of Q fever among persons in close contact with domestic animals is well known in some rural regions of Germany. The prevalence of antibodies indicating acute Q fever in pregnancy reported in the literature varies between 0.2 % and 4.7 % of the screened population. Q fever in pregnancy initially manifests as placentitis and often leads to premature birth (30 %), growth restriction (46 %), spontaneous abortion (22 %) or fetal death in utero (7 %). Some impairment of pregnancy is observed in over 70 % of cases with seroconversion during pregnancy. Thus Q fever serology should be tested in all pregnant women presenting with atypical pneumonia and/or prolonged fever of unknown etiology. It is of interest that medical staff members in contact with Cociella burnetii infected pregnant women are also at risk of acquiring an acute Q fever infection. We report about a patient presenting with confirmed acute and later chronic Q fever during pregnancy in whom antibiotic treatment with rifampicin and clarithromycin proved to be effective and led to the vaginal delivery of a premature but healthy infant. We believe that maternal serum screening for transmissible infections should also include Q fever serology in certain rural regions.