Effects of 17β-estradiol and trimegestone alone,and in combination,on the bone and uterus of ovariectomized rats

Trimegestone is a novel norpregnane progestin ,which is being developed ,in combination with 17β-estradiol ,for the treatment of menopausal symptoms and prevention of postmenopausal osteoporosis. A model of osteoporosis in the ovariectomized rat has been used to evaluate the effects of 17β-estradiol and trimegestone ,alone and in combination ,on bone and uterus in these animals. Two treatment protocols were investigated ,preventive with treatment starting immediately after ovariectomy and curative with treatment starting 1 or 6 months after ovariectomy. 17β-Estradiol was administered subcutaneously at a dose of 10 μg/kg/day with trimegestone or norethisterone being administered orally at a dose of 1 mg/kg/day; treatment was given 5 days per week. Treatment on both protocols was for 6 months. Given alone ,17β-estradiol maintained bone mass ,either partially or completely ,when given on the preventive protocol ,or on the curative protocol with treatment starting 1 month after ovariectomy; it did not restore bone mass when given on the curative protocol with 6 months lapsing between ovariectomy and start of treatment. Trimegestone did not block the beneficial effects of 17β-estradiol on bone. 17β-Estradiol induced uterine hypertrophy on all these protocols and this was blocked completely by trimegestone. Trimegestone administered alone had no effect on bone or uterus but ,when given in combination with 17β-estradiol ,it did not inhibit the effect of 17β-estradiol in maintaining bone mass but completely blocked its uterotropic effect. Norethisterone at a similar dose did not inhibit the effects of 17β-estradiol on bone but also did not block its uterotropic effect.     

The influence of women’s fear, attitudes and beliefs of childbirth on mode and experience of birth

Background

Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness.

Methods

In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0.

Results

253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or ??red earth sand.?? Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill.

Conclusions

This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the disconnect between healthcare providers and the community, and the critical role grandmothers play in ensuring clean delivery practices. Future interventions to address clean delivery and prevention of neonatal infections include educating healthcare providers about harmful traditional practices so they are specifically addressed, strengthening facilities, and incorporating influential community members such as grandmothers to ensure success.     

Etiology,Pathogenesis, and Malignant Potential of Uterine Leiomyoma – A Review

In uterine smooth muscle tumors (SMT), benign leiomyoma (LM) consist of smooth muscle cells, side population cells, and fibroblasts acting together within a network regulating cell proliferation and production of extracellular matrix molecules. Chromosomal alterations, activation of the WNT/ß-catenin pathway, and overexpression of genes of the HMG group are important pathogenetic steps. The features of malignancy are tumor cell necrosis (TCN), cytological atypia, and mitotic activity. However, hormones and hypoxic stress induce reactive mitotic activity. Therefore, the mitotic index by itself is not an independent predictor of malignancy. SMT with mitotic activity up to 15 mitoses/10 HPF in the absence of atypia and TCN are designated mitotically active LM. These tumors are mostly benign. SMT with cytological atypia and a mitotic count below 10 figures /10 HPF without TCN are classified as atypical LM. Tumors with questionable TCN or without TCN and atypia but with a mitotic activity of > 15 figures/10 HPF belong to the SMT of “uncertain malignant potential”. In the presence of definite TCN, LMS are diagnosed irrespective of mitotic count. In the absence of TCN, a mitotic activity of ≥ 10 figures /10 HPF and severe atypia argue for LMS. Uterine LMS are not graded. Whether uterine LMS arise from LM or de novo is still debated, although molecular studies suggest that both are formed through distinct molecular pathways.     

Maternal–fetal transport and disposition of copper,iron, molybdenum,selenium and zinc in experimentally induced diabetic rats

Objective. To assess maternal–fetal status of essential trace elements such as copper, iron, molybdenum, selenium and zinc, in experimentally induced diabetic and control pregnant rats, and to correlate the findings with those observed in human diabetic pregnancies. Fetal–maternal ratios of the elements and Cu:Zn and Cu:Fe ratios were also computed in control and study groups.

Methods. Diabetes was experimentally induced in pregnant Sprague Dawley rats by injection of streptozotocin. A cocktail of essential trace elements along with antipyrine as internal reference marker were then injected intra-peritoneally to diabetic and matched control pregnant rats on the 20th day of pregnancy. Maternal and fetal blood and tissue samples were collected after sacrificing the animals at 30- and 60-minutes following cocktail injection. Concentrations of trace elements and antipyrine in various blood and tissue samples were then determined by atomic absorption spectrophotometry and colorimetry, respectively.

Results. Concentrations of Cu, Fe, Mo, Se, Zn, and antipyrine averaged 2907.0 ± 212.0 μg/L, 3950.0 ± 766.0 μg/L, 15.8 ± 1.7 μg/L, 74.8 ± 6.5 μg/L, 726.4 ± 67.4 μg/L, and 170.5 ± 8.2 mg/L, respectively, in maternal blood in control pregnant rats (n = 5) at day 20 in the 30-minute study phase, while in the diabetic group (n = 5) the values of the various trace element concentrations and antipyrine averaged 2875.0 ± 225.0 μg/L, 5875.0 ± 688.0 μg/L, 21.2 ± 2.1 μg/L, 116.0 ± 3.6 μg/L, 753.0 ± 71.3 μg/L, and 171.7 ± 4.2 mg/L, respectively. Unpaired student's t-test showed that Fe and Se levels were significantly higher (p < 0.05) in the diabetic pregnant rats compared to controls. Cu, Mo and Zn values, however, were not significantly different (p > 0.05) between the two groups. Cu:Zn and Cu:Fe ratios showed varying differences between maternal and fetal samples in the control and study groups.

Conclusions. Considering the disparity of results in pregnant diabetic rats and pregnant diabetic women, we urge exercising caution when comparing data from animal studies to human situations.     

Influence of Peripartum Expectations,Mode of Delivery,and Perineal Injury on Women’s Postpartum Sexuality

BackgroundSexual health has been identified as an important factor for postpartum quality of life. Although pregnancy-related changes in anatomy and metabolism return to their prepregnancy state, female sexual function may not be at the level it was before birth because of physical and psychological changes.AimThe goal of our study was to explore the influence of the mode of delivery, perineal injury, and peripartum expectations on postpartum sexual function.MethodsBetween 2013 and 2018, 522 women were enrolled in this prospective investigation. At time of recruitment during the peripartum hospitalization, patients completed a standardized questionnaire addressing expectations concerning postpartum sexuality with focus on expected influence of the mode of delivery. Sexual function was evaluated using the Female Sexual Function Index (FSFI) and Sexual Activity Questionnaire (SAQ) at time of recruitment to evaluate baseline sexual function (4 weeks before pregnancy). Follow-up assessments were conducted at 3, 6, and 12 months postpartum.OutcomesPeripartum expectations, influence of the mode of delivery, and perineal injury were analyzed for their impact on women’s sexual function within 12 months postpartum by repetitive FSFI and SAQ assessments.ResultsA total of 522 women with 263 spontaneous vaginal deliveries, 41 operative vaginal deliveries, and 218 cesarean sections were analyzed. Although the data demonstrate a significant postpartum decline in sexual function at 3 and 6 months postpartum, sexual functioning converges to baseline prepregnancy values 12 months postpartum. This observation was independent of the mode of delivery and perineal injuries with no significant between-group differences at any of the analyzed time points. Apart from breastfeeding, for which negative anticipations resulted in impaired sexuality, women’s expectations (pertaining to quantity and quality of female orgasm, partner’s sexuality, fear of altered sexuality, frequency of intercourse, the mode of delivery) do not influence female sexual function at 12 months postpartum.Clinical ImplicationsDeciphering the potential influence of patient expectations as well as pregnancy- and childbirth-related aspects on female postpartum sexuality will help in the effort to improve women’s postpartum sexual health.Strengths & LimitationsAs a strength of this study, postpartum sexuality was independently assessed with 2 different scoring systems (FSFI and SAQ). Limitations include that our follow-up is incomplete and amounts to about 2-thirds of patients who were initially recruited.ConclusionThe mode of delivery and perineal trauma do not influence women’s postpartum sexual function. With the exception of breastfeeding, peripartum expectations do not result in altered sexual functioning at 12 months postpartum.Spaich S, Link G, Alvarez SO, et al. Influence of Peripartum Expectations, Mode of Delivery, and Perineal Injury on Women’s Postpartum Sexuality. J Sex Med 2020;17:1312–1325.     

Networks of E-cadherin, β1 integrin,and focal adhesion kinase in the pathogenesis of tubal pregnancy

E-cadherin, β1 integrin, and focal adhesion kinase (FAK) are reported to involved in eutopic implantation by mediating cell adhesion. However, less is documented about their roles in ectopic implantation. This study was undertaken to evaluate the roles and networks of E-cadherin, β1 integrin, and FAK in tubal pregnancy. A total of 31 Fallopian tube specimens were obtained from tubal pregnant women. Immunohistochemistry and western blot were used to analyze the distributions and levels of E-cadherin, β1 integrin and phosphorylated-FAK (Pho-FAK) in the Fallopian tube epithelium. Normal Fallopian tube samples derived from non-pregnant women with benign genital diseases were used for comparison. E-cadherin presented in the cytomembrane of tubal epithelial cells and β1 integrin mainly expressed in the cytoplasm. A lowest-level of E-cadherin was detected in the implantation site (0.63?±?0.29) when compared with the non-implantation site (0.95?±?0.37) and the controls (0.89?±?0.33) (P?<?0.05). β1 integrin, as well as Pho-FAK in the implantation site (0.81?±?0.35; 0.72?±?0.24), showed a higher-level than that in the non-implantation site (0.59?±?0.26; 0.48?±?0.27) or the control group (0.38?±?0.19; 0.36?±?0.25) (p?<?.05). The decreased E-cadherin and increased β1 integrin are implicated in tubal pregnancy. The involvement of β1 integrin maybe depends on β1 integrin/FAK signaling.     

Fertility Preservation after a Cancer Diagnosis: A Systematic Review of Adolescents', Parents', and Providers’ Perspectives,Experiences, and Preferences

Study ObjectiveSurvival into adulthood is now a reality for many adolescents facing cancer. Fertility preservation (FP) is rapidly advancing, but oncology providers and health systems struggle to incorporate the newest FP technologies into the clinical care of adolescents. Our objective was to systematically review and synthesize the available data regarding the perspectives, experiences, and preferences of adolescents, parents, and oncology providers about FP to inform clinical implementation of FP technologies.Design, Setting, Participants, Interventions, and Main Outcome MeasuresFive electronic databases (PubMed, Embase, Web of Knowledge, Cumulative Index to Nursing and Allied Health Literature, PsychInfo) were systematically searched for studies published between January 1999 and May 2014. Adolescents were defined as 12-18 years at the time of diagnosis or designated as pubertal/postpubertal and younger than 18 years of age. Studies were assessed for methodological quality, data were extracted using a standardized form, and results were synthesized using guidelines for a narrative syntheses of quantitative and qualitative data.ResultsIn total, 1237 records were identified, with 22 articles, representing 17 unique studies that met the inclusion criteria. The following topics were consistently observed across studies and populations: (1) fertility in trust; (2) decision-making challenges; (3) provider knowledge and practices; and (4) discrepancies between desired and actual experiences.ConclusionDespite the challenges associated with a new cancer diagnosis, adolescents and parents value the opportunity to discuss fertility concerns and preservation options. Providers play an important role in addressing these topics for families and efforts should be made to incorporate FP discussions into routine cancer care for all adolescents, with attention paid to the unique needs of adolescents and their parents.     

Gamete donors’ reasons for,and expectations and experiences of,registration with a voluntary donor linking register

This paper reports on a study of the views and experiences of 21 sperm donors and five egg donors registered with UK DonorLink (UKDL), a voluntary DNA-based contact register established to facilitate contact between adults who wish to identify and locate others to whom they are genetically related following donor conception. Specifically, the paper examines donors’ reasons for searching for, or making information about themselves available to donor-conceived offspring. Their expectations of registration with UKDL, experiences of being registered and finally, the experiences of those who had contacted donor-conceived offspring and other genetic relatives are investigated. While most respondents reported largely positive experiences of registration, the study found significant issues relating to concerns about donation, DNA testing, possible linking with offspring and expectations of any relationship that might be established with offspring that have implications for support, mediation and counselling. Research that puts the experiences, perceptions and interests of gamete donors as the central focus of study is a relatively recent phenomenon. This study contributes to this debate and highlights directions for future research in this area.     

Counseling patients on reproductive aging and elective fertility preservation—a survey of obstetricians and gynecologists’ experience,approach, and knowledge

Purpose

What are the experience, approach, and knowledge of US Obstetricians and Gynecologists’ (ob-gyn) towards counseling patients on reproductive aging (RA) and elective fertility preservation (EFP).

Methods

A cross-sectional survey emailed by the American College of Obstetricians and Gynecologists (ACOG) to 5000 ACOG fellows consisting of 9 demographic and 28 questions relating to counseling patients on RA and EFP.

Results

Seven hundred and eighty-four responders completed the survey. Although 82.8% agreed that conversations relating to RA should take place with patients desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these women aged 18–34 years old, compared to 75.8% aged 35–44 years old (P?<?0.01). Limited time (75.8%) and limited knowledge (41.4%) were amongst the most frequent reported barriers towards counseling patients on RA. Fifty-eight percent stated that they have been asked about EFP by patients. Although 74.8% agreed that conversations should take place related to EFP in women desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these patients on EFP (P?<?0.01). Limited time (75%) and limited knowledge (59.9%) were amongst the most frequent barriers towards counseling on EFP.

Conclusions

In the USA, methods to improve patient counseling and provider knowledge on RA and EFP are warranted and further studies are needed to address optimal methods to improve counseling and knowledge related to these topics.

     

VEGF,PIGF and HIF-1α in placentas of early- and late-onset pre-eclamptic patients

Abstract

Purpose: The aim of this study was to compare the VEGF, PIGF, and HIF-1α levels in the placentas of early- and late-onset pre-eclamptic patients, which are thought to be important in pathophysiology of pre-eclampsia.

Material and method: Pre-eclamptic early-onset (n?=?22) and late-onset (n?=?24) pregnant women and a control group of healthy pregnant women (n?=?22) were recruited for this case–control study. A semi-quantitative immunohistochemical analysis of VEGF, PIGF and HIF-1α was performed in cross-sections of the placentas of the subjects, after which results were compared.

Results: Levels of VEGF and PIGF in the placentas of pre-eclamptic patients were found to be lower than the levels in the placentas of healthy pregnant women (p?<?0.001 and p?=?0.025, respectively), whereas the levels of HIF-1α were found significantly higher (p?<?0.001). No difference was observed in terms of VEGF, PIGF and HIF-1α in a comparison of the early- and late-onset pre-eclampsia groups (p?>?0.05).

Conclusion: The results of the study indicated that there is no relationship between the time of onset of pre-eclampsia and the placental changes that occur in these factors.     

Regulation and disruption of hamster sperm hyperactivation by progesterone, 17β-estradiol and diethylstilbestrol

Purpose

Hyperactivation of hamster sperm is dose-dependently enhanced by progesterone (P) and 17β-estradiol (E). In the first part of the present study, enhancement of hyperactivation in response to the concentrations of P and E was examined in detail and in the second part, it was examined whether enhancement of hyperactivation by P and E was disrupted by diethylstilbestrol (DES).

Methods

Hamster spermatozoa were hyperactivated by incubation in modified Tyrode’s albumin lactate pyruvate medium with P, E and/or DES. After spermatozoa were recorded using a video-microscope, observations were quantified by manually counting the numbers of total, motile and hyperactivated spermatozoa.

Results

Hyperactivation was enhanced in response to the concentrations of P and E. When spermatozoa were exposed to DES with E, moreover, DES significantly and strongly suppressed P-enhanced hyperactivation by accelerating the effect of E, but DES itself only weakly suppressed P-enhanced hyperactivation.

Conclusions

Enhancement of hyperactivation was regulated by the concentrations of P and E, suggesting that in vivo hamster spermatozoa are hyperactivated through “monitoring” these concentrations in the oviduct. DES in combination with E suppressed P-enhanced hyperactivation, suggesting that DES significantly disrupts hyperactivation by acting as an accelerator of the effect of E.     

Birth-related,psychosocial, and emotional correlates of positive maternal–infant bonding in a cohort of first-time mothers

Objective

to describe the development of a shortened 10-item version of the Postpartum Bonding Questionnaire (S-PBQ) and examine the relationship between birth-related, psychosocial, and emotional factors and maternal–infant bonding.

Design

cross-sectional interview study.

Setting

women having their first baby in Pennsylvania, USA.

Participants

we interviewed 3005 women in their third trimester and at one month post partum who were enroled in the First Baby Study.

Measurements and findings

for the S-PBQ, we completed factor analysis and examined instrument properties. We examined the relationship between birth-related, psychosocial, and emotional factors and maternal–infant bonding using adjusted linear regression models. The S-PBQ demonstrated acceptable internal reliability (Cronbach?s α=0.67). Analysis revealed a socio-economic bias such that women who were older, more educated, not living in poverty, and married reported lower bonding scores. Maternal–infant bonding was significantly negatively correlated with maternal stress, maternal pain, and post partum depression, and positively correlated with partner support with the infant, and social support.

Key conclusions and implications for practice

For researchers who wish to measure maternal–infant bonding but are in need of a relatively short scale, the 10 item S-PBQ may be a useful alternative to the original version. However, it is important that researchers measuring maternal–infant bonding also investigate socio-economic bias in their studies and adjust for this effect as needed. Our results also indicate that clinicians should be aware of life stressors that may impact the maternal–infant relationship, in order that intervention may be provided to improved health outcomes for mothers, infants, and families.     

The analysis of twin pregnancy and labour in the Department of Obstetrics, Medical Academy, Gdańsk

OBJECTIVES: According to the literature the frequency of twins is increasing due to technics af assisted reproduction. Many complications of pregnancy and delivery are more likely to develop during multiple pregnancy. DESIGN: Aim of the study was to analyze labour and delivery in multiple pregnancy and assess the neonate's condition. MATERIALS AND METHODS: Authors analyzed labour and delivery and neonate's condition in twin pregnancies in Medical University of Gdansk, Poland in 1991-1995 with birth weight at least 1000g. We assessed women's age, fetuses presentation, week of pregnancy at the delivery, mode of delivery, Apgar score, weight and crown-rump length after birth and early neonatal period. RESULTS: Mean age of pregnant women was 30.0 years (18-43). Mean birth weight for the first fetus was 2412 + 601 g and for the second one--2485 + 630 g. Mean SI for the first fetus was 49.8 + 4.4cm, for the second one--50.0 + 4.15 cm. Apgar core was analyzed separately for the first and the second twin according to the presentation and mode of delivery--we found better condition of the second babies delivered from transverse presentation by the cesarean section comparing to those born vaginally. 73% of the pregnancies with the first fetus in the cephalic presentation were delivered vaginally, in other situations--cesarean section was preferred. CONCLUSIONS: At the transverse presentation of the second twin elective cesarean section seems better for the second twin.