Serum C-reactive protein in the differential diagnosis of ovarian masses

Objective

A number of serum tumor markers have been investigated to aid clinicians in the differential diagnosis of ovarian masses. Serum C-reactive protein (CRP) is a widely used biomarker of inflammation and has been previously shown to be a promising biomarker in patients with ovarian cancer.

Study design

In a retrospective single-center study, we evaluated serum CRP in 576 patients with benign and in 242 patients with malignant (ovarian tumors of low malignant potential [LMP]: n = 44, epithelial ovarian cancer [EOC]: n = 198) ovarian masses. Results were correlated to clinical data.

Results

Median (25th, 75th percentiles) serum CRP in patients with benign ovarian tumors, with ovarian tumors of LMP, and with EOC were 0.5 (0.5, 0.6) mg/dL, 0.5 (0.5, 0.9) mg/dL, and 1.36 (0.5, 4.9) mg/dL, respectively (p < 0.001). In the subgroup of patients with EOC, serum CRP significantly correlated with FIGO stage (p < 0.001), residual tumor mass (p < 0.001), and patients’ age (p = 0.04), but not with tumor grade (p = 0.2) and histologic type (p = 0.4). In univariable and multivariable models including serum CRP, serum CA 125, and patients’ age, serum CRP independently predicted the presence of malignant ovarian masses (p < 0.0001; Odds Ratio [OR] 5.3, 95% Confidence Interval [CI] 3.8–7.4). Serum CRP had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying malignant ovarian masses of 49.8%, 84.1%, 57.1%, and 79.8%, respectively.

Conclusion

Serum CRP is associated with the presence of malignant ovarian tumors independent of serum CA 125 and patients’ age and can therefore be used as additional diagnostic marker in the differential diagnosis of ovarian masses.     

C-reactive protein serum levels are closely associated with lymph node status,but not with prognosis in patients with vulvar cancer

Objective

To evaluate whether C-reactive protein (CRP) serum levels can be used as prognostic parameter in patients with vulvar cancer.

Study design

CRP serum levels were measured at the time of first diagnosis of squamous cell vulvar cancer. Sixty-seven patients were enrolled; results were correlated to clinical data.

Results

Mean CRP serum levels in patients with vulvar cancer were 0.8 (0.80) mg/dL. CRP serum levels were significantly associated with lymph node involvement (p = 0.003), but not with tumor stage (p = 0.03), histological grade (p = 0.86) and patients’ age (p = 0.64). Univariate analysis showed lymph node involvement, tumor stage and histological grade, but not CRP serum levels and patients’ age to be associated with overall survival. A multivariable analysis determined only lymph node involvement as independent prognostic parameter for disease-free interval and overall survival.

Conclusion

CRP serum levels are closely associated with lymph node status but cannot be used as prognostic parameter in patients with vulvar cancer.     

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.     

Severely decreased activity of placental dimethylarginine dimethylaminohydrolase in pre-eclampsia

Objectives

Asymmetric dimethylarginine (ADMA) is a key regulator of nitric oxide production. Elevations of ADMA have previously been associated with endothelial dysfunction in pre-eclamptic women. ADMA is degraded mainly by dimethylarginine dimethylaminohydrolase (DDAH), which is also expressed in placental tissue. Therefore, we measured placental DDAH expression and activity in pre-eclampsia and normal pregnancies in order to determine whether impairment of this enzyme in the pre-eclamptic placenta could contribute to elevations of ADMA levels in these women.

Study design

ADMA plasma levels were measured by LC–MS/MS in 18 pre-eclamptic patients and 28 controls. Placental DDAH activity was determined by measuring the degradation of [²H₆]-labeled ADMA in tissue homogenates from placental biopsies in 15 women with pre-eclampsia and 16 controls. Placental mRNA expression of DDAH 1, DDAH 2, endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS) and protein-arginine methyltransferase 1 (PRMT1) was determined in tissue biopsies by RT-PCR.

Results

Placental DDAH activity was almost undetectable in pre-eclampsia, and it was significantly higher in controls. ADMA plasma levels were higher in pre-eclampsia as compared to normal pregnancies (0.51 ± 0.15 μmol/l vs. 0.42 ± 0.07 μmol/l; p = 0.005), and the difference between maternal and fetal ADMA levels (feto-maternal ADMA gradient) was lower in pre-eclampsia (0.63 ± 0.20 μmol/l vs. 0.80 ± 0.18 μmol/l; p = 0.02). Furthermore, mRNA expression levels of DDAH 2 were significantly lower in pre-eclamptic women (p = 0.04), while PRMT1 expression levels were the same. In pre-eclampsia, we found only weak correlations between maternal ADMA levels and DDAH 1 (r = −0.41; p = 0.22) and DDAH 2 expressions (r = −0.45; p = 0.17) but a slightly stronger correlation between DDAH 2 expression and feto-maternal ADMA gradient (r = 0.60; p = 0.07).

Conclusion

Decreased DDAH activity in the pre-eclamptic placenta might contribute to elevated ADMA levels in these patients.     

Is there any relation between IL-6 gene −174 G>C polymorphism and postmenopausal osteoporosis?

Objective

IL-6 gene single nucleotide polymorphisms (SNPs) have been reported to have a protective effect against bone resorption. We aimed to investigate the association between bone mineral density and IL-6 promoter region −174 G>C SNP.

Study design

This study included 356 postmenopausal Turkish women, of whom 201 were osteoporotic (lumbar spine T score < −2.5 SD) and 155 non-osteoporotic (lumbar spine T score > −1.5 SD). Bone mineral density (BMD) measures were obtained using dual-energy X-ray absorptiometry. SNP of the IL-6 gene (−174 G>C) was examined by polymerase chain reaction-restriction fragment length polymorphism.

Results

The frequencies of the variant C allele (24% vs. 30%, p = 0.074) and mutant CC genotype (12% vs. 20%, p = 0.094) were higher in non-osteoporotic women. Lumbar spine and total hip BMD values were lowest among women with the G/G genotype, intermediate in the heterozygotes, and highest in women with the C/C genotype. The GG (p = 0.022) and GC (p = 0.037) genotypes were covariates which approached statistical significance in the regression model fitting of BMD.

Conclusion

IL-6 promoter region SNP showed an association with BMD in this postmenopausal Turkish population and these data suggest that the wild GG genotype influences the phenotype.     

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.     

Clinical estimation of fetal weight and the Hawthorne effect

Objective

The Hawthorne effect refers to improvement in performance solely due to the subject's knowledge that he or she is being studied. We sought to determine if an obstetrician's clinical estimation of fetal weight (EFW) is influenced by the Hawthorne effect seen in some clinical trials.

Study design

We compared obstetricians’ clinical EFW's obtained during a study period to those obtained prior to the study period in one institution. We included any patient presenting at ≥37 weeks gestation. We excluded multiple pregnancies and patients with a recent sonographic EFW.

Results

There was no difference in regards to the proportion of EFW's within 10% of the birthweight (67.9% vs. 68.5%, p = .91), the mean absolute difference of EFW-birthweight (282 ± 227 g vs. 285 ± 232 g, p = .88), or the mean absolute percent error (8.5 ± 7.4% vs. 8.6 ± 7.2%, p = .96). We also could not find any Hawthorne effect when we excluded resident physicians’ EFW's and when we analyzed the subgroup of newborns with a birth weight ≥4000 g.

Conclusion

An obstetrician's knowledge that he or she is being studied is unlikely to improve clinical EFW accuracy. Published clinical EFW accuracies are likely to be similar to those obtained in clinical practice.     

L-arginine pathway in neonates with meconium-stained amniotic fluid

Objective

To study the arginase, nitric oxide synthase and nitric oxide pathways associated with passage of meconium.

Study design

Cord blood samples were collected from 20 newborns with meconium-stained amniotic fluid (MSAF) and from 23 newborns with clear amniotic fluid. Cord blood pH, arginase, nitric oxide synthase and nitric oxide levels were compared between the groups.

Result

The differences between the arginase and nitric oxide measurements of the newborns with MSAF and those with clear amniotic fluid were significant. In the MSAF group arginase levels were significantly lower (p = 0.007) and nitric oxide levels were significantly higher (p = 0.032) than the clear amniotic fluid group.

Conclusion

Hypoxia may be involved in the pathogenesis of meconium passage due to decreased arginase and increased nitric oxide levels.     

Comparative evaluation of the Joel-Cohen cesarean section versus the transrectal incision

Objective

The aim of this study was to compare the Joel-Cohen method for cesarean section to the traditional transrectal incision.

Method

Fifty-two patients requiring a caesarean section were enrolled in this prospective study. Overall morbidity and post-operative pain was assessed. Four surgeons participated to this study, each included 13 patients. The main judgement criterion was post-operative pain on the first day.

Results

Post-operative pain on the first day was less important (50 vs 23% p = 0.04) in Joel-Cohen's. This method was shorter compared to the transrectal incision (33,6 + 6,4 min vs 51,2 + 8 min p < 0.0001). There was no difference in overall morbidity between the two groups.

Conclusion

Joel-Cohen's method decrease post-operative pain and is a shorter procedure compared to the transrectal incision.     

First-trimester maternal serum metastin, placental growth factor and chitotriosidase levels in pre-eclampsia

Objective

To investigate whether the serum levels of metastin and PIGF and chitotriosidase activity early in pregnancy differ in women who develop pre-eclampsia from those who remain normotensive.

Study design

A retrospective case–control study of prospectively collected data. Thirty healthy pregnant women and 31 women with pre-eclampsia were included in the study. Serum samples were collected at 11–14 weeks and stored at −70 °C. Levels of metastin, PIGF and chitotriosidase activity were measured in serum from pregnant women with subsequent development of pre-eclampsia and matched controls.

Results

Mean maternal serum metastin (1554 ± 385 pmol/L vs 1995 ± 375 pmol/L, p < 0.001) and PIGF (111.9 ± 7.0 pg/mL vs 124.9 ± 13.5 pg/mL, p < 0.001) levels were significantly lower and chitotriosidase activity was significantly higher (681.6 ± 248.3 nmol/mL/h vs 527.7 ± 223.1 nmol/mL/h, p < 0.01) in women who subsequently developed pre-eclampsia than in those who remained normotensive. The areas under the curve equal to 0.797, 0.831 and 0.681 (p < 0.001, p < 0.001 and p < 0.01) for metastin, PIGF, and chitotriosidase respectively were determined for the prediction of pre-eclampsia.

Conclusions

Metastin and PIGF levels and chitotriosidase activity are altered in the first trimester serum of women destined to become pre-eclamptic, reflecting placental dysfunction. Metastin, like PIGF, may have a potential to be used as a first-trimester biomarker of pre-eclampsia.     

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.     

Assessment of preoperative serum prolidase activity in epithelial ovarian cancer

Objective

Prolidase is a cytosolic exopeptidase that cleaves iminodipeptides with C-terminal proline and hydroxyproline and plays a major role in collagen turnover. The aim of this study was to evaluate preoperative serum prolidase activity, total oxidant status (TOS), and total antioxidant capacity (TAC) in patients with newly diagnosed epithelial ovarian cancer (EOC).

Study design

Serum prolidase activity, TOS, and TAC were measured spectrophotometrically in both EOC cases (n = 28) and controls (n = 28).

Results

Preoperative serum prolidase activity and TOS were significantly higher in patients with EOC compared to controls (p = 0.009 and 0.008, respectively), whereas TAC was significantly lower in cases (p < 0.001). A significant positive correlation was found between the stage, grade, and CA-125 level of EOC and serum prolidase activity (rho = 0.466, p = 0.012; rho = 0.501, p = 0.007; and rho = 0.447, p = 0.017, respectively) and TOS (rho = 0.588, p = 0.001; rho = 0.412, p = 0.029; and rho = 0.568, p = 0.002, respectively). In contrast, there was a negative correlation between TAC and the stage, grade, and CA-125 level of EOC (rho = −0.555, p = 0.002; rho = −0.566, p = 0.002; and rho = −0.581, p = 0.001, respectively).

Conclusion

Findings of the present study demonstrate that serum prolidase activity is significantly associated with the stage, tumor grade, and preoperative CA-125 level of EOC.     

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.     

Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes

Objective

To test the incidence and sonographic parameters of pyelonephritis during pregnancy, and to examine risk factors and pregnancy outcomes of women with acute antepartum pyelonephritis.

Study design

A retrospective population-based study comparing all singleton pregnancies of patients with and without acute antepartum pyelonephritis was performed. Patients lacking prenatal care as well as multiple gestations were excluded from the study. Multiple logistic regression models were used to control for confounders.

Results

Out of 219,612 singleton deliveries in 1988–2010, 165 women (0.07%) suffered from acute antepartum pyelonephritis. Abnormal sonographic findings were found in 85.7% of the patients with pyelonephritis. Pyelonephritis was significantly associated with nulliparity (46.1% vs. 24.4%, p < 0.001), younger maternal age (26.3 ± 6.0 vs. 28.6 ± 5.8 years, p < 0.001), intrauterine growth restriction (IUGR) (6.7% vs. 2.1%, p < 0.001), placental abruption (3.6% vs. 0.7%, p < 0.001), low 1 min Apgar scores (10.3% vs. 6.0%, p < 0.05), urinary tract infection (UTI) (4.2% vs. 0.4%, p < 0.001) and preterm delivery (less than 37 weeks gestation; 20.0% vs. 7.8%; p < 0.001). Using a multivariable analysis, independent risk factors for acute antepartum pyelonephritis were nulliparity (OR 2.0; 95% C.I 1.4–2.9; p < 0.001), UTI (OR 10.3; 95% C.I 4.8–22.1; p < 0.001) and younger maternal age (OR 0.96; 95% C.I 0.93–0.99; p = 0.009). Using another multivariable analysis, with preterm delivery as the outcome variable, acute antepartum pyelonephritis was found as an independent risk factor for preterm delivery (OR 2.6; 95% C.I 1.7–3.9; p < 0.001).

Conclusion

Acute antepartum pyelonephritis is associated with adverse perinatal outcomes and specifically is an independent risk factor for preterm delivery.     

The effect of chemotherapy or radiotherapy on thymidine phosphorylase and dihydropyrimidine dehydrogenase expression in cancer of the uterine cervix

Objective

To evaluate the feasibility in everyday practice and the advantages of salpingectomy for ectopic pregnancy by single-incision laparoscopic surgery with the SILS^® system.

Study design

This single-center prospective observational study included 37 women requiring salpingectomy for ectopic pregnancy who underwent single-incision laparoscopic salpingectomy with the SILS^® system. Information about feasibility and intra- and post-operative data were collected. The data for these patients were compared with those of a control group of 40 women treated by standard laparoscopy.

Results

Thirty-six (97%) patients were treated successfully with the SILS^® system. After laparoscopic confirmation of the ectopic pregnancy, salpingectomy was performed with bipolar forceps and scissors. In one case, conversion to classic laparoscopy was performed because SILS was not feasible. Compared with the control group, operative time was longer (50 ± 35 vs 35 ± 30 min, p = 0.001) but duration of hospitalization shorter with single-site laparoscopy (1.5 ± 1.5 vs 2.3 ± 1.5 days, p = 0.02).

Conclusions

Laparoscopic salpingectomy for ectopic pregnancy appears to be feasible in everyday practice by single-incision laparoscopic surgery with the SILS^® system and appears to reduce the duration of hospitalization. Larger series are necessary to confirm this conclusion.     

Interleukin 18 messenger RNA and proIL-18 protein expression in chorioamniotic membranes from pregnant women with preterm prelabor rupture of membranes

Objective

To quantify the expression of IL-18 mRNA and protein in the chorioamniotic membranes of pregnant women with PPROM and correlate expression with histological chorioamnionitis.

Study design

A case control study that included 42 pregnant women not in labor in the following groups: PPROM (n = 28) and controls with intact membranes submitted to selective cesarean section at term (n = 14). Expression of IL-18 mRNA in chorioamniotic membranes was determined by real-time polymerase chain reaction, and IL-18 protein expression was measured by western blot. Histopathological analyses and immunolocalization of IL-18 by immunohistochemistry were also performed. Analyses were performed using the Mann–Whitney or Fisher's exact tests and the group effect was considered significant if the adjusted p-values were <0.05 and the magnitude of change was greater than 2-fold for mRNA expression.

Results

IL-18 mRNA was present in 100% of samples and no difference in expression was observed between term vs. PPROM membranes (fold-change 0.12; p = 0.88). In the PPROM group, no difference was observed in IL-18 mRNA regarding gestational age (fold-change 0.11; p = 0.42) or the presence of histological chorioamnionitis (fold-change 0.26; p = 0.15). ProIL-18 was present in all samples. IL-18 was immunolocalized to amnion, chorion and decidua cells, with intense immunohistochemical staining at the choriodecidual junction.

Conclusion

Chorioamniotic membranes are sources of IL-18 mRNA and proIL-18, and their expression is unrelated to PPROM or histological chorioamnionitis.     

Risk factors of surgical failure following transvaginal mesh repair for the treatment of pelvic organ prolapse

Objective

To identify the factors associated with pelvic organ prolapse (POP) recurrence after transvaginal mesh (TVM) repair.

Study design

One hundred and thirteen women with symptomatic POP stage II to IV were scheduled for TVM procedures. All subjects underwent urinalyses and pelvic examination using the POP quantification (POP-Q) staging system before and after surgery.

Results

Seven (6.2%) of 113 women reported POP recurrence after a mean follow-up time of 30 months. We performed a univariate analysis of patients’ characteristics to identify the predictors of surgical failure after TVM. There was no difference between two groups as to body mass index, POP stage, mesh type, and preoperative urinary symptoms and urodynamic parameters (P > 0.05). However, we found that uterine prolapse (P = 0.016) and surgical experience (P = 0.043) were two significant predictors of surgical failure. Multivariate logistic regression showed similar results.

Conclusion

Advanced uterine prolapse and lack of surgical experience were two significant predictors of failure following TVM. POP recurrence after mesh repair appears to be unlikely beyond the learning curve.     

Laparoscopic treatment of endometrial cancer: feasibility and results

Objective

The aim of this study was to compare laparoscopic and abdominal approach in the treatment of endometrial cancer in our department.

Study design

From January 1999 to November 2002, 77 patients underwent surgery for stages I–III endometrial cancer. The first group of 36 patients had abdominal hysterectomy as well as salpingo-oophorectomy, with or without lymphadenectomy. The remaining 41 patients received laparoscopic assisted vaginal hysterectomy as well as salpingo-oophorectomy, with or without lymphadenectomy.In this retrospective study, we have compared the surgical results, the short- and long-term morbidity and the outcome of the two patient groups.

Results

Body mass index (BMI) was significantly higher in the laparoscopic group (27.3 versus 24.6; p = 0.009). The average time for surgery was significantly longer for the laparoscopic group (143.6 min versus 109.7 min; p = 0.0001), but lymphadenectomy was performed in more patients (63.4% versus 25%; p = 0.001).Postoperative hospital stay was significantly longer in patients undergoing the abdominal approach (4.59 days versus 3.18 days; p < 0.0001). No blood transfusions were performed and the rates of complications were similar in the two groups. No differences were found in recurrence and survival rate.

Conclusions

In our experience, laparoscopic and abdominal surgery can achieve similar results in the treatment of endometrial cancer. In our series, even with the BMI and the number of lymphadenectomies being higher in the laparoscopic group, the rates of complications were similar in the two groups.     

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.