Carbon dioxide laser vaporization of genital condyloma in pregnancy

OBJECTIVE: To evaluate therapeutic effectiveness of the carbon dioxide laser on genital condyloma in pregnancy. PATIENTS AND METHODS: From 1998 to 2002, 18 pregnant women with genital condyloma were treated with laser vaporization. Treatment was given without regard to the gestational period. All the women were treated at least once. Condyloma localisation, treatment gestational age and complication rate were analysed. RESULTS: Patients were treated at a gestational age of 15-38 weeks. During pregnancy follow-up, 2 patients had recurrences that required repeated treatment before delivery. In each case, no condylomas were found during delivery. There were no abortions, no premature birth and no complications (bleeding, infections) in our study. CONCLUSION: Laser vaporisation is a safe and effective treatment for condyloma during pregnancy.     

Treating genital condyloma during pregnancy with the carbon dioxide laser

The therapeutic effectiveness of the carbon dioxide laser was evaluated in 43 pregnant women with extensive urogenital and anal condylomas. All patients received one treatment and were followed up for an average of 9 months after delivery. Laser failures (persistent disease) and recurrences (new disease) were stratified according to the location of the lesions and the gestational age of the patients. The overall failure rate was 5%; 6% of the women with multiple sites involved had persistent disease but none of the lesions confined to the vulva persisted after laser treatment. The recurrence rate was 14%; 33% and 17% of the patients treated during the first and second trimesters, respectively, had recurrent disease irrespective of the areas involved. Recurrences were not observed in women treated during the third trimester of pregnancy. Laser vaporization of genital condylomas was not associated with perioperative or postoperative bleeding or infections. Laser therapy is an attractive means of treating urogenital and anal condylomas during pregnancy and is most effective near term.     

Pregnancy outcome after laser vaporization of the cervix

BACKGROUND: Treatment of cervical intraepithelial neoplasia (CIN) with cold knife or CO2-laser conization is associated with obstetrical problems in subsequent pregnancies. Little is published about pregnancy outcome after laser vaporization of the uterine cervix. The aim of this study was to determine the risk of preterm delivery and low birth weight in pregnancies following this kind of treatment. METHODS: Two hundred and thirty-six women who during the 11 year period 1982 to 1992 underwent laser vaporization of the uterine cervix and after treatment gave birth were included in this study. For each case two controls matched for parity, age (-/+ 3 years) and year of delivery were identified. The material was analyzed as a matched cohort study. RESULTS: No relationship was found between laser vaporization and preterm delivery or low birth weight. Medial gestational length was in both groups 40 weeks (range 3142 weeks among cases and 2842 weeks among controls). Mean birth weight was 3428 g (range 1370 to 6130 g) among cases and 3407 (range 672 to 5470 g) among controls. CONCLUSION: Laser vaporization of the uterine cervix does not influence the outcome of subsequent pregnancy.     

Maternal and neonatal outcomes in pregnancies complicated by bone and soft-tissue tumors

OBJECTIVE: Primary bone and soft-tissue tumors occur rarely in pregnancy. The objective of this study was to describe the outcome of a large cohort of pregnant patients with these rare tumors. METHODS: Pregnant women diagnosed with bone or soft-tissue tumors during pregnancy or within 3 months after delivery were identified retrospectively for the years 1983-2003 in the University Health Network database, University of Toronto. Relevant maternal and neonatal data were collected on a standardized data form. RESULTS: In more than 60,000 deliveries during the study period, 17 patients were identified. Gestational age at diagnosis ranged from 11 weeks to 2 months postpartum. Eight cases involved the lower extremity and 6 involved the upper extremity. Osteosarcoma, chondrosarcoma, and giant-cell tumors were the most common histological types. Metastases occurred in 7 cases. Nine cases were treated surgically during the course of pregnancy. The majority of patients were delivered at term. Chemotherapy was deferred until the postpartum period. One patient elected for early termination of pregnancy. Three patients were delivered before 37 weeks of gestation to proceed with therapy. One neonate delivered at 34 weeks developed respiratory distress syndrome and required intubation. Three patients died, all as the result of metastatic disease. There were no perinatal or infant deaths. CONCLUSION: Most cases of soft-tissue and bone tumors during pregnancy can be successfully managed with surgery during gestation. Therapies with fetal toxicity were more likely to be deferred to the postpartum period.     

Immunosuppression in pregnant women infected with human immunodeficiency virus

One hundred two pregnant women at high risk of infection with the human immunodeficiency virus (62 who were drug abusers and 40 of Haitian origin) were prospectively examined for immunologic changes during and after pregnancy. Among the 63 human immunodeficiency virus-negative women, levels of CD4+ (helper) cells fell to a nadir at 8 weeks before delivery and rose rapidly just before delivery. The level of CD8+ (cytotoxic/suppressor) cells rose slowly from midpregnancy to delivery. Among the 37 human immunodeficiency virus-positive pregnant women, levels of CD4+ cells fell during pregnancy (except for a transient weak increase just before delivery) and did not recover in the postpartum period. Levels of CD8+ cells were consistently higher in human immunodeficiency virus-positive than human immunodeficiency virus-negative women. Post partum the CD8+ cells in human immunodeficiency virus-negative women stabilized at delivery levels, whereas they increased greatly in human immunodeficiency virus-positive women. The loss of CD4+ cells in human immunodeficiency virus-positive women appeared to be faster during pregnancy than in the postpartum period. These data support the hypothesis that pregnancy may accelerate human immunodeficiency virus-induced depletion of CD4+ cells and increase the risk of acquired immunodeficiency syndrome.     

Genital condylomata acuminata in pregnancy: effectiveness, safety and pregnancy outcome following cryotherapy

Summary. Fifty-one patients, 16 in the second trimester and 35 in the third, were treated by cryotherapy for genital condylomata acuminata; 19 of them had cervical cryotherapy in the second and third trimesters for cervical involvement. Cryosurgical treatment was performed on an out-patient basis, with no general anaesthesia or analgesia, and repeated every 2 weeks until resolution of the condylomata. Male partners were treated as necessary. Patients were followed every 2 weeks before and after delivery until 6 weeks postpartum. The newborn infants were examined for the presence of genital or laryngeal condylomata. Most women required two cryosurgical treatment sessions before complete resolution of condylomata; all resolved in pregnancy and no patient had residual disease at 6 weeks postpartum. There was no case of preterm premature rupture of membranes or premature delivery following cryotherapy, and no case of fetal injury. Labour and delivery were unaffected even by cervical cryotherapy.     

Genital condylomata acuminata in pregnancy: effectiveness, safety and pregnancy outcome following cryotherapy

Fifty-one patients, 16 in the second trimester and 35 in the third, were treated by cryotherapy for genital condylomata acuminata; 19 of them had cervical cryotherapy in the second and third trimesters for cervical involvement. Cryosurgical treatment was performed on an out-patient basis, with no general anaesthesia or analgesia, and repeated every 2 weeks until resolution of the condylomata. Male partners were treated as necessary. Patients were followed every 2 weeks before and after delivery until 6 weeks postpartum. The newborn infants were examined for the presence of genital or laryngeal condylomata. Most women required two cryosurgical treatment sessions before complete resolution of condylomata; all resolved in pregnancy and no patient had residual disease at 6 weeks postpartum. There was no case of preterm premature rupture of membranes or premature delivery following cryotherapy, and no case of fetal injury. Labour and delivery were unaffected even by cervical cryotherapy.     

Hepcidin levels are low during pregnancy and increase around delivery in women without iron deficiency – a prospective cohort study

Objective: To investigate hepcidin during pregnancy, delivery and postpartum in women with sufficient iron supplementation.

Methods: Hepcidin was measured using LC–MS spectroscopy in 37 women during pregnancy, delivery and postpartum period in this longitudinal study.

Results: Hepcidin was low during pregnancy and increased at delivery and postpartum. No correlations with inflammatory markers or iron metabolism were observed during pregnancy; at delivery a correlation with inflammatory markers was observed.

Conclusion: During pregnancy, in women with sufficient iron supplementation, hepcidin is low and does not reflect iron status. During delivery and the postpartum period, hepcidin functions as a marker of inflammation.     

Acyclovir suppression to prevent clinical recurrences at delivery after first episode genital herpes in pregnancy: an open-label trial

OBJECTIVE: To continue evaluation of the use of acyclovir suppression in late pregnancy after first episode genital herpes simplex virus (HSV) infection, using an open-label study design. METHODS: Ninety-six women diagnosed with genital herpes for the first time in the index pregnancy were prescribed suppressive acyclovir 400 mg orally three times daily from 36 weeks until delivery in an open-label fashion. Herpes cultures were obtained when patients presented for delivery. Vaginal delivery was permitted if no clinical recurrence was present; otherwise a Cesarean delivery was performed. Neonatal HSV cultures were obtained and infants were followed clinically. Rates of clinical and asymptomatic genital herpes recurrences and Cesarean delivery for genital herpes were measured, and 95% confidence intervals were calculated. RESULTS: In 82 patients (85%) compliant with therapy, only 1% had clinical HSV recurrences at delivery. In an intent to treat analysis of the entire cohort, 4% had clinical recurrences (compared with 18-37% in historical controls). Asymptomatic shedding occurred in 1% of women without lesions at delivery. Two of the four clinical recurrences were HSV-culture positive. No significant maternal or fetal side-effects were observed. CONCLUSIONS: In clinical practice the majority of patients are compliant with acyclovir suppression at term. The therapy appears to be effective at reducing clinical recurrences after a first episode of genital herpes complicating a pregnancy.     

No relationship between fear of childbirth and pregnancy-/delivery-outcome in a low-risk Dutch pregnancy cohort delivering at home or in hospital

Objective: To examine the relationship of fear of childbirth (FOC), general anxiety and depression during pregnancy and postpartum with birth complications. Methods: For this prospective cohort study 105 healthy women with low-risk pregnancies (until at least 30 weeks gestation) completed the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and the Hospital Anxiety and Depression Scale (HADS) at 30 weeks gestation and 6 weeks postpartum. These results were related with delivery characteristics. Results: FOC during pregnancy was not related to complications during labour and delivery. In a regression analysis, both multiparity and medical interventions were predictors for higher postpartum FOC. A positive correlation was found between FOC during pregnancy and FOC at six weeks postpartum, corrected for complications during childbirth (r = 0.45, p < 0.001). Conclusions: The birth giving process was not related to FOC during pregnancy, but the pre-partum level of FOC certainly is predictive of the level of postpartum FOC, suggesting that FOC as measured during gestation may influence the interpretation of the birth experience itself. We did find a positive relationship between both parity and medical interventions during childbirth and FOC postpartum.     

Persistent postpartum urinary retention in contemporary obstetric practice. Definition, prevalence and clinical implications

OBJECTIVE: To prospectively evaluate the prevalence, presumed etiologies and clinical implications of persistent postpartum urinary retention in modern obstetric practice. STUDY DESIGN: The study population comprised 8,402 consecutive, unselected parturients delivered in a university-affiliated maternity hospital over a one-year period. If a woman was unable to void spontaneously until the third postpartum day despite intermittent use of a Foley catheter, a diagnosis of persistent postpartum urinary retention was established. Patients were treated by insertion of a Foley catheter for up to two weeks and subsequently by a suprapubic catheter. Obstetric data were collected from the hospital records. RESULTS: Four patients (0.05% of the study population), aged 29-37 years, developed persistent postpartum urinary retention. Risk factors included vaginal delivery after cesarean section, prolonged second stage of labor, epidural analgesia, and delayed diagnosis and intervention. Urodynamic evaluation, performed on two patients one month after removal of the suprapubic catheter, revealed genuine stress incontinence in one and detrusor instability in another. None had had any lower urinary tract symptoms before pregnancy and delivery. CONCLUSION: Persistent postpartum urinary retention in contemporary obstetric practice is rare but may be associated with long-term bladder dysfunction. Early diagnosis and intervention are required to prevent irreversible bladder damage.     

Risk of stress urinary incontinence twelve years after the first pregnancy and delivery

OBJECTIVE: To estimate the impact of onset of stress urinary incontinence in first pregnancy or postpartum period, for the risk of symptoms 12 years after the first delivery. METHODS: In a longitudinal cohort study, 241 women answered validated questions about stress urinary incontinence after first delivery and 12 years later. RESULTS: Twelve years after first delivery the prevalence of stress urinary incontinence was 42% (102 of 241). The 12-year incidence was 30% (44 of 146). The prevalence of stress urinary incontinence 12 years after first pregnancy and delivery was significantly higher (P<.01) in women with onset during first pregnancy (56%, 37 of 66) and in women with onset shortly after delivery (78%, 14 of 18) compared with those without initial symptoms (30%, 44 of 146). In 70 women who had onset of symptoms during first pregnancy or shortly after the delivery but remission 3 months postpartum, a total of 40 (57%) had stress urinary incontinence 12 years later. In 11 women with onset of symptoms during the first pregnancy or shortly after delivery but no remission 3 months postpartum, a total of 10 (91%) had stress urinary incontinence 12 years later. Cesarean during first delivery was significantly associated with a lower risk of incontinence. Other obstetric factors were not significantly associated with the risk of incontinence 12 years later. Patients who were overweight before their first pregnancy were at increased risk. CONCLUSION: Onset of stress urinary incontinence during first pregnancy or puerperal period carries an increased risk of long-lasting symptoms.     

Laser laparoscopy in the treatment of endometriosis. A 5-year study

Summary. The carbon-dioxide laser used laparoscopically provides a precise and virtually bloodless technique for the vaporization of endometriotic implants in the pelvis. The technique has been used at St Luke's Hospital, Guildford, for the past 6 years and this report presents 228 consecutive patients with endometriosis treated during the 5 years between 1982 and 1987 and followed up for between 1 and 6 years. Pain was improved in 70% and 80% of the 56 infertile patients with endometriosis as the only identifiable abnormality conceived. Of the 54 pregnancies, only 37 (69%) had a successful outcome, reflecting the high pregnancy failure rate found in women with endometriosis. Hospital stay was relatively short and complications were few and usually minor and there was no injury or morbidity caused by laser energy. The main advantage of laser laparoscopy in endometriosis is that patients may be treated at the time of diagnosis with less need for medication and no delay before conception is attempted     

Management and course of histologically verified cervical carcinoma in situ during pregnancy

BACKGROUND: To study the rate of regression and progression into invasive disease of patients with histologically proven carcinoma in situ of the uterine cervix during pregnancy. METHODS: Prospective observation of all pregnant women with biopsy-proven carcinoma in situ of the uterine cervix, gained by colposcopic guided biopsy from 1996 to 2004 and correlation with the route of delivery and cytologic and histologic postpartum findings. RESULTS: Eighty-three patients with histologically verified carcinoma in situ during pregnancy were treated conservatively. Two patients were lost to follow-up, one patient had an abortion, and three are still pregnant. The study population of 77 patients were followed for a median of 140 days before delivery. Postpartum regression rate was 34.2%, two patients had a diagnosis of microinvasive cervical cancer on the postpartum cone biopsy, and persistent carcinoma in situ was found postpartum in 63.1% of patients. No difference was seen for the route of delivery. Both patients with microinvasive carcinoma were delivered by primary cesarean section and are disease-free after 24 and 38 months, respectively. CONCLUSIONS: We recommend conservative management for women with carcinoma in situ of the uterine cervix. We found no difference for the route of delivery regarding postpartum regression and recommend a postpartum evaluation after the puerperium. Colposcopic guided biopsy should rule out an invasive process during pregnancy. Cesarean section as the mode of delivery should be considered, if invasion is suspected.     

Iron status markers in nonanemic pregnant women with and without iron supplementation.

OBJECTIVE: To measure levels of markers of anemia before and after delivery in women who had high hemoglobin levels during the early stage of the second trimester of pregnancy and did not receive iron supplementation during their pregnancies. METHODS: In a randomized, double-blind, placebo-controlled trial 244 women who had a hemoglobin concentration of 13.2 g/dL or greater and a serum ferritin level higher than 15 microg/L between the 13th and 18th week of pregnancy took either one 150-mg tablet of ferrous sulfate daily or placebo during their pregnancies. Markers of anemia were measured at the time of delivery and 6 weeks postpartum. RESULTS: There were statistically significant differences between the 2 groups in hematocrit as well as hemoglobin and ferritin levels both at the time of delivery and 6 weeks postpartum (P<0.05), but these differences were not clinically significant. CONCLUSION: Not using iron supplementation did not cause a considerable decrease in markers of anemia in women with a hemoglobin concentration of 13.2 g/dL or greater in the second trimester of pregnancy.     

Laser laparoscopy in the treatment of endometriosis. A 5-year study

The carbon-dioxide laser used laparoscopically provides a precise and virtually bloodless technique for the vaporization of endometriotic implants in the pelvis. The technique has been used at St Luke's Hospital, Guildford, for the past 6 years and this report presents 228 consecutive patients with endometriosis treated during the 5 years between 1982 and 1987 and followed up for between 1 and 6 years. Pain was improved in 70% and 80% of the 56 infertile patients with endometriosis as the only identifiable abnormality conceived. Of the 54 pregnancies, only 37 (69%) had a successful outcome, reflecting the high pregnancy failure rate found in women with endometriosis. Hospital stay was relatively short and complications were few and usually minor and there was no injury or morbidity caused by laser energy. The main advantage of laser laparoscopy in endometriosis is that patients may be treated at the time of diagnosis with less need for medication and no delay before conception is attempted.     

No relationship between fear of childbirth and pregnancy-/delivery-outcome in a low-risk Dutch pregnancy cohort delivering at home or in hospital

Objective: To examine the relationship of fear of childbirth (FOC), general anxiety and depression during pregnancy and postpartum with birth complications. Methods: For this prospective cohort study 105 healthy women with low-risk pregnancies (until at least 30 weeks gestation) completed the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and the Hospital Anxiety and Depression Scale (HADS) at 30 weeks gestation and 6 weeks postpartum. These results were related with delivery characteristics. Results: FOC during pregnancy was not related to complications during labour and delivery. In a regression analysis, both multiparity and medical interventions were predictors for higher postpartum FOC. A positive correlation was found between FOC during pregnancy and FOC at six weeks postpartum, corrected for complications during childbirth (r = 0.45, p < 0.001). Conclusions: The birth giving process was not related to FOC during pregnancy, but the pre-partum level of FOC certainly is predictive of the level of postpartum FOC, suggesting that FOC as measured during gestation may influence the interpretation of the birth experience itself. We did find a positive relationship between both parity and medical interventions during childbirth and FOC postpartum.     

妊娠期糖尿病产后糖代谢异常的危险因素

目的通过对妊娠期糖尿病(GDM)患者进行产后随访,回顾性分析影响GDM患者产后糖代谢变化的高危因素。方法收集2009年1月至2011年6月在河北省沧州市中心医院门诊产前检查并分娩的GDM患者236例,产后42d回访者158例,记录其孕前和孕期信息,包括:孕期年龄、身高、孕前体重、有否糖尿病家族史、孕期使用胰岛素情况、孕期并发症及合并症情况、新生儿出生时情况;并按OGTT试验结果分为研究组和对照组,进行高危因素筛查。结果研究组为60例糖耐量异常者,包括39例IGT/IFG患者和21例DM患者;对照组为98例糖耐量正常者,比较两组患者孕前、孕期和妊娠结局情况,结果可见高龄、糖尿病家族史、孕期应用胰岛素、合并子痫前期、早产是产后发生糖代谢异常的高危因素,差异有统计学意义(P<0.05)。结论存在高危因素的GDM患者产后糖代谢异常发生率较高,应针对性地对GDM患者进行产后临床筛查和随访。     

Management of gigantomastia complicating pregnancy. A case report

BACKGROUND: Gigantomastia during pregnancy is exceedingly rare, with an incidence of 1/28,000-100,000 pregnancies. Treatment during pregnancy is a dilemma, and postpartum reduction mammoplasty remains the mainstay of treatment. CASE: Massive bilateral breast enlargement occurred at 19 weeks of gestation in a 24-year-old woman, gravida 2, and led to ulceration and sloughing. Conservative management with bromocriptine resulted in healing of the ulcers and resolution of symptoms. After six months of bromocriptine therapy postpartum, marked involution of the breasts occurred without recurrence. CONCLUSION: Prolonged bromocriptine therapy should be given after delivery to a pregnant woman with gigantomastia during pregnancy before planning surgical reduction mammoplasty.