Does tubal sterilization influence the subsequent risk of menorrhagia or dysmenorrhea?

OBJECTIVE: To evaluate the relation between tubal ligation, change in menstrual cycle characteristics, and early follicular phase hormones. DESIGN: Cross-sectional analysis of women 36-44 years of age. SETTING: The greater Boston area. PATIENT(S): Nine hundred seventy-six premenopausal women with intact uteri. INTERVENTION(S): A comparison of women with and without a history of tubal ligation. MAIN OUTCOME MEASURE(S): Menstrual and reproductive histories were self-reported. Early follicular phase blood samples were obtained to assess FSH, LH, and E(2). We compared menstrual cycle changes from the first 5 years after menarche with completion of the baseline questionnaire in women with and without a prior history of tubal ligation. RESULT(S): Cycle length, cycle regularity, menses length, flow volume, dysmenorrhea, and hormone levels were similar in women with and without a history of tubal ligation. However, among parous women with a history of cesarean section, those with a tubal ligation >5 years ago experienced a marginal increase in volume of menstrual flow compared with women with no tubal ligation history. CONCLUSION(S): We found no significant change in menstrual cycle characteristics or hormone levels in women with or without a history of tubal ligation. However, tubal ligation may have a modest effect on the change in menstrual flow volume over time among parous women with a history of cesarean section.     

The impact of miscarriage and stillbirth on maternal–fetal relationships: an integrative review

Objective: To synthesise and summarise existing literature investigating whether and how psychological distress as a consequence of perinatal loss and associated coping impact upon maternal–fetal relationships subsequent to miscarriage and stillbirth.

Background: Although now widely accepted that the relationship between mother and child develops in utero, little is known about how a previous miscarriage or stillbirth impacts upon these processes in a subsequent pregnancy.

Methods: An integrative review methodology was chosen for the review.

Results: Fifteen empirical and theoretical articles were reviewed and summated into two topic areas: psychological distress following perinatal loss and the subsequent maternal–fetal relationship, and coping following perinatal loss and the subsequent maternal–fetal relationship.

Conclusions: Studies show that perinatal loss can cause psychological distress in subsequent pregnancy. It is not clear whether and how such distress impacts on maternal–fetal relationships because studies have yielded mixed findings. Mothers employ a complex self-protective mechanism to cope with this distress, and use strategies to reassure themselves and to maintain hope that the pregnancy will result in a live birth. It is not clear whether the use of this mechanism impacts upon the development of the mother–fetus relationship in subsequent pregnancy. Further research is now required to determine how these strategies are employed, the impact of these strategies on pregnancy-specific anxiety, maternal–fetal relationships and the postnatal attachment relationship. Health professionals working with parents in these circumstances should acknowledge that anxiety and associated coping behaviours are common, and support be provided when parents show signs of considerable psychological distress.     

Mondor's disease of the breast: is there any relation to breast cancer?

Ten cases of Mondor's disease of the breast (9 females, 1 male) are described. The diagnosis was based mainly on clinical examination, while breast imaging, used in five cases, was complementary. Most of our cases (9) had complete restoration of the thrombosed subcutaneous breast vein, either spontaneously (4), or after anti-inflammatory medication (5). Only one of our patients had surgical management (vein excision) due to delayed remission. None of our cases was related to breast cancer.     

When is fasting really fasting? The influence of time of day, interval after a meal, and maternal body mass on maternal glycemia in gestational diabetes.

OBJECTIVE: The object of the study was to determine whether time of day, interval after a standard meal, and maternal body mass influence plasma glucose concentrations in women with gestational diabetes mellitus. STUDY DESIGN: Identical mixed meals were administered on 2 separate occasions 1 week apart to 30 women with dietarily treated gestational diabetes and pregnancies between 28 and 38 weeks' gestation. One meal was administered at 7 AM (morning meal) and the other was administered at 9 PM (evening meal), each after a fast of >/=5 hours. The order of the meals (morning first versus evening first) was assigned randomly. Sixteen of the women had a body mass index >/=27 kg/m(2) (overweight) and 14 women had a body mass index <27 kg/m(2) (lean). Venous plasma concentrations of glucose, insulin, free fatty acids, beta-hydroxybutyrate, and bound and free cortisol were measured hourly for 9 hours after each of the test meals. RESULTS: When all women were considered together glucose concentrations after the morning meal were significantly greater at 1 hour, were not different at 2 hours, and were significantly lower from 3 through 9 hours postprandially than those at corresponding times after the evening meal. Plasma beta-hydroxybutyrate and free fatty acid concentrations were higher between 5 and 9 hours after the morning meal than at the same times after the evening meal. Total and free cortisol levels were higher for the first 7 hours after the morning feeding, reflecting known diurnal variation in cortisol concentrations. Overweight patients' glucose values were significantly greater than those of lean subjects during the last 4 hours of the overnight fast. CONCLUSIONS: Among women with dietarily treated gestational diabetes the glucose concentrations were significantly higher from 3 to 9 hours after an evening meal, whereas suppression of free fatty acids and beta-hydroxybutyrate was less sustained after a morning feeding. The mechanisms underlying these differences remain to be determined but may involve diurnal influences of counterregulatory hormones. The relationships between measurements of maternal glycemia and maternal and perinatal outcomes in pregnancies complicated by gestational diabetes may be clarified by establishing a uniform duration of a fast and by developing meal-specific preprandial and postprandial maternal glucose targets for these patients.     

Myolysis of uterine fibroids: is there a role?

Myolysis is among the new procedures under development for the treatment of symptoms related to uterine leiomyoma. The procedure targets the destruction of fibroids using one of a number of focused energy delivery systems including those based upon radiofrequency electricity, supercooled cryoprobes, and, most recently, focused ultrasound monitored by real time magnetic resonance imaging. For thermomyolysis and cryomyolysis, delivery of the energy requires access to the tissue by laparoscopy, and, in some instances, hysteroscopy. For focused ultrasound, the patient is detached from the energy source, which is delivered by an array of external beams. Clinical evaluation has been confined to case series, but it is evident that the approach results in a variable degree of reduction of the total uterine mass, and, usually, a reduction in uterine bleeding. Clearly, longer term appropriately designed comparative trials are required that evaluate and compare myolysis with myomectomy, uterine artery embolization, and hysterectomy, to name a few.     

Is there a relationship between the grade of maternal hydronephrosis and birth weight of the babies?

Mild hydronephrosis may be present in upto 90% of pregnancies. The degree of hydronephrosis was determined by maximal calyceal diameter (MCD). The aim of this study is to investigate whether there is a relationship between grade of maternal hydronephrosis and birth weight of the babies. Subjects were examined in three groups: group 1 MCD of 5–10?mm (grade I), group 2 10–15?mm (grade II) and group 3 patients >15?mm (grade III). There were 45, 30, 13 patients in the groups, respectively. Estimated fetal weight (EFW) at the time that hydronephrosis was diagnosed, birth weight and duration of pregnancy were compared. The average birth weight of the babies was not statistically different in the three groups (p?>?0.05), but there was a statistically significant difference in fetal weights at the time of diagnosis (p?=?0.02). The grade of maternal hydronephrosis does not affect the duration of pregnancy.     

Gene therapy for the fetus: is there a future?

Gene therapy uses the intracellular delivery of genetic material for the treatment of disease. A wide range of diseases - including cancer, vascular and neurodegenerative disorders and inherited genetic diseases - are being considered as targets for this therapy in adults. There are particular reasons why fetal application might prove better than application in the adult for treatment, or even prevention of early-onset genetic disorders such as cystic fibrosis and Duchenne muscular dystrophy. Research shows that gene transfer to the developing fetus targets rapidly expanding populations of stem cells, which are inaccessible after birth, and indicates that the use of integrating vector systems results in permanent gene transfer. In animal models of congenital disease such as haemophilia, studies show that the functionally immature fetal immune system does not respond to the product of the introduced gene, and therefore immune tolerance can be induced. This means that treatment could be repeated after birth, if that was necessary to continue to correct the disease. For clinicians and parents, fetal gene therapy would give a third choice following prenatal diagnosis of inherited disease, where termination of pregnancy or acceptance of an affected child are currently the only options. Application of this therapy in the fetus must be safe, reliable and cost-effective. Recent developments in the understanding of genetic disease, vector design, and minimally invasive delivery techniques have brought fetal gene therapy closer to clinical practice. However more research needs to be done in before it can be introduced as a therapy.     

Gonadotropins and the uterus: is there a gonad-independent pathway?

In the gonads, LH and hCG act via the same receptor to stimulate the production of progesterone in the luteal phase of the menstrual cycle and in early pregnancy. There are numerous reports that these two hormones can have direct actions on the uterus in addition to their indirect actions via stimulation of ovarian steroid hormones. However, unlike the situation in the gonads, various uterine tissues have been shown to respond to the related hormones FSH and TSH or the alpha-subunit common to these hormones. These additional actions cannot be mediated by the gonadal LH/hCG receptor. There have also been a series of reports that the uterus contains LH/hCG receptors. Attempts to characterize the molecular structure of these receptors have been difficult; thus, the possibility of a variant receptor cannot be excluded. The possibility also exists of a nonhomologous receptor, which would explain the differences in ligand specificity in uterine tissues. I will review the evidence regarding gonadotropin action in nongonadal tissues, primarily the uterus. In addition, the data regarding receptors will be reviewed. Finally, the clinical areas informed by this information will be explored.     

Manipulation of the follicular phase: Uterodomes and pregnancy - is there a correlation?

Background  

Manipulation of the follicular phase uterine epithelium in women undergoing infertility treatment, has not generally shown differing morphological effects on uterine epithelial characteristics using Scanning Electron Microscopy (SEM) and resultant pregnancy rates have remained suboptimal utilising these manipulations. The present study observed manipulation of the proliferative epithelium, with either 7 or 14 days of sequential oestrogen (E) therapy followed by progesterone (P) and assessed the appearance of pinopods (now called uterodomes) for their usefulness as potential implantation markers in seven women who subsequently became pregnant. Three endometrial biopsies per patient were taken during consecutive cycles: day 19 of a natural cycle - (group 1), days 11/12 of a second cycle after 7 days E then P - (group 2), and days 19/22 of a third cycle after 14 days E then P - (group 3). Embryo transfer (ET) was performed in a subsequent long treatment cycle (as per Group 3).