Coeliac disease and reproductive disorders: a neglected association

Coeliac disease is a chronic disease caused by a permanent intolerance to ingested gluten resulting in immunologically mediated inflammatory damage of the small-intestinal mucosa. The wide spectrum of clinical symptoms is partly due to the malnourished state caused by the malabsorption of macro- and micronutrients. Fertility problems, sexual dysfunction and obstetrical complications are more frequently observed in patients with coeliac disease. These reproductive disorders may be a consequence of the endocrine derangements caused by selective nutrient deficiencies. Nowadays, the early diagnosis and treatment of coeliac disease is possible and not very costly. Therefore, coeliac disease must be seriously considered in the preconceptional screening and treatment of patients with reproductive disorders.     

Thyroid disease and female reproduction

Objective: To review the menstrual function and fertility in thyroid disease, mainly in hyperthyroidism and hypothyroidism. Also to register the consequences of ¹³¹I therapy, which is used widely in the treatment of Graves’ disease and thyroid cancer, on subsequent pregnancies and on fertility in these patients.

Design: A MEDLINE computer search was used to identify relevant studies. The type of menstrual disturbances and the status of fertility were recorded from all the studies found. Also, the fertility and genetic hazard of female patients with Graves’ disease and thyroid cancer who were treated with ¹³¹I were registered.

Result(s): Both hyperthyroidism and hypothyroidism may result in menstrual disturbances. Menstrual abnormalities are less common now than in previous series. In a recent study, we found that only 21.5% of 214 thyrotoxic patients had some type of menstrual disturbance, compared to 50 to 60% in some older series. The most common manifestations are hypomenorrhea and oligomenorrhea. According to the results of endometrial biopsies, most thyrotoxic women remain ovulatory. Moreover, the genetic hazard incident to radioiodine therapy in Graves’ disease and thyroid carcinoma is very small; exposure to ¹³¹I does not cause reduced fecundity, and the risk of loss of fertility is not a contraindication for its use in these patients. mIn hypothyroidism, the frequency of menstrual irregularities has very recently been reported to be 23.4% among 171 hypothyroid patients studied. This is much less than that reported in previous studies, which showed that 50 to 70% of hypothyroid female patients had menstrual abnormalities. The most common manifestation is oligomenorrhea. Severe hypothyroidism is commonly associated with failure of ovulation. Ovulation and conception can occur in mild hypothyroidism. These pregnancies are, however, often associated with abortions, stillbirths, or prematurity. The latter may be of greater clinical importance in infertile women with unexplained infertility.

Conclusion(s): These new data, mainly concerning menstrual abnormalities in hyperthyroidism and hypothyroidism, are inconsistent with what is generally believed and written in the classic thyroid textbooks and indicate that such opinions should be revised.     

Fertility problems associated with cystic fibrosis

A case of a cystic fibrosis patient with two pregnancies that ended in deliveries at 30 and 29 weeks' gestation, respectively, is presented. The author suggests that the increased life expectancy of cystic fibrosis patients because of therapeutic advances will increase the need to examine the association and effects of fertility in individuals with this genetic disease.     

辅助生育技术进展及存在的问题

1921年1月出生。1941年于上海圣约翰大学毕业,获理学学士学位。1944年获医学博士学位。1946～1949年在美国进行博士后工作。1949～1951年受聘于英国伦敦的医院做临床工作。1950年10月获英国皇家妇产科学院资格。1951年7月回国,任上海圣约翰大学医学院妇产科副教授。1952年调北京医科大学。1958年北京医科大学附属三院创建,历任妇产科主任、副教授、教授、博士生导师、国家重点学科学术带头人。发表学术论文100多篇。主编有:“中国大百科全书医学卷妇产科分册”,“妇产科经验教训101例”,并参加编写其它妇产科参考书。培育祖国大陆首例试管婴…     

The benefits and problems associated with minimal access surgery

The place of minimal access surgery (MAS) in current gynaecological practice remains controversial. As a consequence, MAS techniques have been subject to a significant amount of prospective, evidence-based assessment. The ultimate results of these comparative trials will undoubtedly have a profound impact on the future direction of our speciality. It is timely, therefore, to review the currently available data. Evidence from 2195 patients in 23 randomised clinical trials of five different treatment modalities (ectopic, ovarian cysts, myomectomy, colposuspension and hysterectomy) clearly demonstrates that uncomplicated MAS procedures produce patient friendly benefits, at least in the short term. No matter what operation is performed, the laparoscopic approach is associated with less pain, shorter hospital stay and shorter recovery. These immediate patient-orientated benefits are a generic consequence of replacing the manoeuvres of open surgery through laparotomy incisions with minimal access. These benefits must be offset against significant disadvantages. Minimal access surgery procedures always require the use of expensive, high technology equipment and usually take longer to perform. Such procedures may be more costly than current open procedures and costs will, in part, be dependent on the amount of disposable equipment employed. Patients undergoing MAS procedures may be at risk of new and/or increased risk of traditional complications. The longer-term results of most MAS procedures have not yet been determined. These potential benefits and disadvantages of MAS require that each procedure is carefully and individually assessed. This paper seeks to review the current evidence.     

Survival,neonatal and subsequent problems associated with extreme prematurity

Significant progress has been made in improving the outcome of newborn infants with advances in perinatal care over the last two decades. The most dramatic changes have been seen at the margins of viability (infants less than 26 weeks gestation) and the expectations for survival are high.Short-term morbidity is great and many babies require prolonged periods of intensive care. Many of the pathophysiological problems encountered in very immature infants are much more complex than similar conditions seen in more mature infants, and although the understanding of these differences is quite advanced, therapeutic advances are less clear. It is important not to lose sight of the long-term implications for this group of babies, as new evidence suggests that the burden of physical and cognitive impairment is far higher than in any other group of infants.It is crucial that all healthcare professionals are aware of the immediate and long-term outcomes of extremely pre-term delivery to enable effective counselling of the parents and to facilitate their involvement in clinical management.     

Post conception failures in reproduction: infectious diseases and immunitary problems

The mechanism by which early abortions may be caused by infections disease or immunological problems are discussed by the Authors. Among the first group of causes, syphilitic infections, rubela, viral diseases and others are examined. Immunological problems which may lead to early abortions are then discussed in the more complex context of mother/embryo interactions, examined also on the basis of experimental models. All the hypotheses which may explain refusal of embryo are examined, but the Authors stress the fact that also in proven cases of immunological refusal of pregnancy, the question of the usefulness of immunological therapy remains unanswered.     

Breastfeeding problems associated with the early introduction of bottles and pacifiers

Breastfeeding is a natural physiologic process upon which human survival has depended for uncounted generations. Natural selection over millions of years has ensured that breastmilk contains all the nutritional requirements of the newborn period and beyond. In order to prevent problems for the few, modern management of labour, delivery and the postpartum period has subjected most mothers and infants to routines which are contrary to the physiologic principles underlying successful breastfeeding. The early introduction of bottles may render suckling less effective or may result in breast refusal, thus paving the way for failure to thrive, hyperbilirubinemia, "colic" and crying, prolonged and frequent feedings, sore and cracked nipples for the mother, and it may contribute to the onset of plugged ducts and mastitis. Alternatives to bottles can be used when supplementation is thought to be indicated. They include using a lactation aid, finger feeding, or feeding with a cup, spoon, or eyedropper.     

Infant and maternal factors associated with maternal perceptions of infant sleep problems

Aim: Infant sleep behaviours, particularly night wakings, have been identified as one of the most common concerns of parents. Despite this, few empirical studies have examined how mothers distinguish between normative and problematic infant sleep behaviours. Methods: In this study, we examined infant and maternal factors associated with maternal perceptions of infant sleep problems in an internet sample of Canadian mothers with 6- to 12-month-old infants whose infants wake at least one night a week. Results: While infant sleep behaviours accounted for 24% of the variance in maternal perceptions of infant sleep problems, including additional infant and maternal factors in the model accounted for 43%. Factors significantly associated with maternal perceptions of infant sleep problems were infant sleep behaviours (i.e. frequent night wakings, difficulties initiating sleep), difficult infant temperament, poor maternal daytime functioning and poor maternal sleep quality. Contrary to expectations, infant daytime functioning was not predictive of maternal perceptions of infant sleep problems. Conclusions: Our findings support a focus on the family, rather than the infant, when assessing and treating infant sleep problems