A Longitudinal study of body composition and basal metabolic rate during pregnancy in a black population of Kinshasa, Democratic Republic of Congo (RDC)

Objective

A longitudinal study of body composition and basal metabolic rate during pregnancy in a black population of Kinshasa.

Materials and methods

Body composition and basal metabolic rate were determined by bioimpedance, and energy intake was evaluated using the 24 h recall method at 20, 34 and > 37 weeks of gestation in 76 black, Congolese women. The subjects had to be healthy, and to deliver term, singleton infants after a normal pregnancy.

Results

At 20 weeks of pregnancy, the 76 women, aged 28.5 ± 6.4 years, had a body weight of 61.1 ± 7.7 kg, a body mass index of 23.0 ± 3.8 kg/m², a fat mass of 36.6 ± 6.8% and a basal metabolic rate of 1399 ± 84 kcal/24 h. Subsequently, increases in body weight (+6.5 kg), fat-free mass (+ 5.1 kg), body water (+4.4 l) and basal metabolic rate (+297 kcal/24 h) (P < 0.0001) were observed. The increase in fat mass (+1.4 kg) was less pronounced. Energy intake was stable.

Conclusion

Changes in body composition during pregnancy in Congolese black women are comparable to those reported in other populations. Pre- and per-gravidic fat mass is higher in congelese women than in Caucasian women.     

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.     

Pregnancy outcomes following pulsatile GnRH treatment: results of a large multicenter retrospective study

Objectives

The aim of the present study was to evaluate the efficacy of pulsatile GnRH treatment in a large French cohort of patients with hypogonadotropic hypogonadism.

Methods

A retrospective study involving all women treated with pulsatile GnRH, over a 3-year period, in 24 French centers. Pregnancy rate and pregnancy outcome were the criteria for evaluation.

Results

The study included 248 women who received a total of 829 treatment cycles. The treatment routes of administration were subcutaneous (56.1% of the patients), intravenous (31.1%), or both (12.7%). The pregnancy rate per treatment cycle was 25%, while the mean number of cycles needed to obtain a pregnancy was 2.8 ± 1.7. The miscarriage rate was 8.2% and the multiple pregnancy rates 8.8%. The mean delivery term was 38.4 ± 2.4 weeks and the mean birth weight was 3009 ± 561 g. No severe ovarian hyperstimulation was recorded. Ovarian cysts occurred in 2.3% of the treatment cycles, local allergies in 1.7%.

Conclusion

Our study has shown that pulsatile GnRH treatment was well tolerated, without severe hyperstimulation. It induced a good pregnancy rate with favorable pregnancy outcomes.     

The 2004 Italian legislation on the application of assisted reproductive technology: epilogue

Objective

To evaluate how the unique Italian fertility regulations (≤3 inseminated oocytes/cycle, transfer of all embryos, prohibition of embryo cryopreservation) affected outcomes of ART.

Study design

Case–control study from the Center of Reproductive Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. We compared outcomes of ART patients between five years before (n = 1791) and five years after (n = 2474) the implementation of the law.

Results

The mean embryo transfer (ET) rate was 3.1 ± 2.1 and 1.7 ± 1.1 before and after the law. Significantly more ICSI procedures were performed in women above 35 years old during the post-law period. The ET rate was higher before (88.6%) than after (80.5%) the law (OR 1.9, 95% CI 1.6, 2.2) especially in women >37 years undergoing ICSI (88.2 vs. 76.1%; OR 2.3, 95% CI 1.3, 4.2). The clinical pregnancy rates were practically unchanged but the proportion of triplet births significantly decreased after the law (10.3 vs. 4.1%, OR 2.7, 95% CI 1.4, 5.0).

Conclusion

In contrast to interim analyses, we found that the statutory obligation to transfer all available embryos produced from up to three inseminated oocytes reduced the ET rates, especially in older women, and decreased the triplet births rate.     

Obstetric and neonatal outcome after surgical treatment of cervical dysplasia

Objectives

Conization is the gold standard today for the management of severe cervical dysplasia. However, with the increasing delay until first pregnancy, obstetric follow-up of patients with a history of conization is a growing concern.

Study design

Retrospective case–control study using data from the electronic database of a university hospital. We compared the obstetric and neonatal outcome of 106 pregnancies delivered after conization with the outcome of 212 pregnancies of patients with no history of conization.

Results

A significant reduction in the mean gestational age at delivery (38.23 ± 2.51 weeks vs. 39.15 ± 1.56 weeks) was observed, together with a higher rate of premature rupture of the membrane (9.4% vs. 1.9%), premature onset of labor (9.4% vs. 2.4%), premature delivery (17% vs. 3.8%) and neonatal hospitalization (17.9% vs. 6.6%) in the group of patients with history of conization. Children born to women who had surgery had a significantly lower birth weight (3146.9 ± 611 g vs. 3347.3 ± 502 g) and size (49.1 ± 2.6 cm vs. 50.0 cm ± 2.2 cm) than those of the control group. Furthermore, these children were more frequently admitted in the neonatal intensive care unit (22.6% vs. 10.4%, p = 0.004).

Conclusions

Conization is an important risk factor for premature birth and women with a history of conization require cautious obstetric management during pregnancy. Anti-HPV vaccination and proactive surveillance of low-grade or moderate dysplasia, instead of immediate surgery, should be encouraged in young patients.     

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.     

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.     

A randomised clinical trial of the effect of low-level laser therapy for perineal pain and healing after episiotomy: A pilot study

Objective

to evaluate the effects of low-level laser therapy for perineal pain and healing after episiotomy.

Design

a double-blind, randomised, controlled clinical trial comparing perineal pain scores and episiotomy healing in women treated with low-level laser therapy (LLLT) and with the simulation of the treatment.

Setting

the study was conducted in the Birth Centre and rooming-in units of Amparo Maternal, a maternity service located in the city of São Paulo, Brazil.

Participants

fifty-two postpartum women who had had mediolateral episiotomies during their first normal delivery were randomly divided into two groups of 26: an experimental group and a control group.

Intervention

in the experimental group, the women were treated with LLLT. Irradiation was applied at three points directly on the episiotomy after the suture and in three postpartum sessions: up to 2 hrs postpartum, between 20 and 24 hrs postpartum and between 40 and 48 hrs postpartum. The LLLT was performed with diode laser, with a wavelength of 660 nm (red light), spot size of 0.04 cm², energy density of 3.8 J/cm², radiant power of 15 mW and 10 s per point, which resulted in an energy of 0.15 J per point and a total energy of 0.45 J per session. The control group participants also underwent three treatment sessions, but without the emission of radiation (simulation group), to assess the possible effects of placebo treatment.

Main outcomes

perineal pain scores, rated on a scale from 0 to 10, were evaluated before and immediately after the irradiation in the three sessions. The healing process was assessed using the REEDA scale (Redness, Edema, Echymosis, Discharge Aproximation) before each laser therapy session and 15 and 20 days after the women's discharge.

Findings

comparing the pain scores before and after the LLLT sessions, the experimental group presented a significant within-group reduction in mean pain scores after the second and third sessions (p=0.003 and p<0.001, respectively), and the control group showed a significant reduction after the first treatment simulation (p=0.043). However, the comparison of the perineal pain scores between the experimental and control groups indicated no statistical difference at any of the evaluated time points. There was no significant difference in perineal healing scores between the groups. All postpartum women approved of the low-level laser therapy.

Conclusions

this pilot study showed that LLLT did not accelerate episiotomy healing. Although there was a reduction in perineal pain mean scores in the experimental group, we cannot conclude that the laser relieved perineal pain. This study led to the suggestion of a new research proposal involving another irradiation protocol to evaluate LLLT's effect on perineal pain relief.     

Are plasma levels of visfatin and retinol-binding protein 4 (RBP4) associated with body mass,metabolic and hormonal disturbances in women with polycystic ovary syndrome?

Objective

To analyze potential interactions of visfatin and retinol-binding protein 4 (RBP4) levels with body mass, metabolic, and hormonal status in normal weight and obese women with PCOS.

Study design

Body composition was determined by bioimpedance in 83 women (44 obese) diagnosed with PCOS and in 67 women (36 obese) without PCOS. In addition, serum glucose, lipids, androgens, FSH, LH, SHBG, insulin, visfatin, and RBP4 were measured in a fasting state and the free androgen index (FAI) was calculated, as was insulin resistance using the HOMA-IR assessment.

Results

Plasma RBP4 levels were significantly higher in women of normal weight compared to obese subjects when both were diagnosed with PCOS (14.1 ± 4.6 vs.10.9 ± 4.5 ng/mL, p < 0.001); while in non-PCOS subjects the opposite was found (10.8 ± 4.5 vs. 18.4 ± 11.6 ng/mL, p < 0.01; respectively). Plasma visfatin levels were similar in PCOS and non-PCOS subjects. In non-PCOS subjects, positive correlations between RBP4 level and anthropometric parameters were observed. In PCOS, RBP4 levels inversely correlated with serum insulin levels and HOMA-IR values. No correlation was found between plasma visfatin levels and anthropometric parameters in all study groups. Similarly, no correlation was found in PCOS and non-PCOS subgroups. Additionally, there was an inverse correlation between RBP4 and LH concentrations and LH/FSH ratio in all study subjects.

Conclusions

Plasma visfatin level is not a useful biomarker of insulin resistance and hyperandrogenism. RBP4 level reflects visceral body fat content in non-PCOS women. Decreasing RBP4 release along with increasing insulin resistance and hormonal disturbances may be a compensatory mechanism preventing deterioration in obese PCOS.     

Induction of labour at term for women over 35 years old: a survey of the views of women and obstetricians

Objectives

To determine the views of UK women and obstetricians relating to induction of labour at term for women over 35 years of age.

Study design

Cross-sectional web-based survey sent to members of the British Maternal and Fetal Medicine Society (BMFMS) and pregnant or recently delivered members of a large social network site for parents (www.mumsnet.com). One hundred and twenty-eight consultant obstetrician members of BMFMS and 663 pregnant or recently delivered women responded.

Results

Two hundred and eighty-eight women (43%) would consider induction of labour for maternal age alone, and 192 women (29%) would consider participating in a randomised trial of induction of labour at term versus expectant management in a future pregnancy. Three percent (n = 4) of consultant obstetricians offer induction of labour at term to women at 35–39 years of age, 37% (n = 47) to women at 40–44 years of age and 55% (n = 70) to those over 45 years. Sixty-one consultants (48%) would participate in a trial to test the effect of a policy of induction for nulliparous women over 35 years old.

Conclusions

The policy of offering induction of labour at term for advanced maternal age is widespread and a significant percentage of women consider it to be a valid indication.     

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.     

Comparison of active and expectant management on the duration of the third stage of labour and the amount of blood loss during the third and fourth stages of labour: a randomised controlled trial

Background

Postpartum haemorrhage is one of the most important causes of maternal death.

Objectives

To evaluate the effect of active management of the third stage of labour on the amount of blood loss in the third and fourth stages of labour, and the duration of the third stage of labour.

Methods

A randomised controlled trial was completed on 200 women who gave birth at a maternity unit in Iran. In the intervention group (n=100), 10 IU of oxytocin was injected intramuscularly into the mother following birth of the anterior shoulder of the baby. After clamping and cutting the umbilical cord, the uterus was pushed upwards and posterior, while the cord was pulled down with constant and intermittent traction until the placenta was delivered. In the control group (n=100), on observing signs of placental separation, the placenta was expulsed by maternal force. In both groups of women, blood loss was measured at birth using collecting devices, and drapes and sheets were weighed to estimate blood loss.

Findings

Mean blood loss during the third stage of labour was 216.93±165.16 ml and 232.12±150.35 ml in the intervention and control groups, respectively; the difference was not significant (p=0.49). In contrast, mean blood loss during the fourth stage of labour differed significantly (422.62±324.7 ml and 327.27±255.99 ml in the intervention and control groups, respectively; p=0.02). The mean duration of the third stage of labour was less in the intervention group than in the control group (4.69±5.51 mins and 6.34±5.03 mins; p=0.028).

Conclusions

Active management did not decrease blood loss during the third stage of labour, but did decrease the duration of this stage. Active management was associated with increased blood loss during the fourth stage of labour. Due to conflicting results between studies, further research should be undertaken to determine the optimal method by which to manage the third stage of labour.     

Laparoscopic uterine nerve ablation versus vaginal uterosacral ligament resection in postmenopausal women with intractable midline chronic pelvic pain: a randomized study

Objective

To assess and compare the laparoscopic uterine nerve ablation (LUNA) and the vaginal uterosacral ligament resection (VUSR) in postmenopausal women with chronic pelvic pain (CPP).

Study design

Eighty postmenopausal women with intractable and severe midline CPP were randomized to undergo LUNA or VUSR. Costs of two surgical procedures were assesses. Cure rate, severity of CPP, and deep dyspareunia were also evaluated after 6 and 12 months from surgery.

Results

The mean cost of LUNA resulted significantly higher in comparison with VURS (2078 ± 637 versus 1497 ± 297, P < 0.001). The cure rate was not significantly different between the two groups at 6 (33/40, 82.5% versus 35/40, 87.5% for groups A and B, respectively; P = 0.530; RR 0.94, 95% CI 0.78–1.13), and 12 months (27/36, 75.0% versus 28/38, 73.7%, for groups A and B, respectively; P = 0.901; RR 0.90, 95% CI 0.78–1.33) of follow-up. At same times, a significant (P < 0.01) decrease in severity of CPP and deep dyspareunia was observed in both groups with no difference between them.

Conclusions

Both LUNA and VUSR are equally effective surgical treatments in postmenopausal women with central CPP but VUNR is significantly cheaper than LUNA.     

Pregnancy outcome after gestational exposure to the new macrolides: a prospective multi-center observational study

Objectives

To determine whether the use of the new macrolides (azithromycin, clarithromycin, roxithromycin) during the first trimester of pregnancy is associated with an increased risk of major malformations.

Study design

In a prospective multi-center study, pregnancy outcome was compared between pregnant women exposed to one of the new macrolides during the first trimester of pregnancy and two comparison groups one exposed to other antibiotics and the other to other non-teratogenic medications. All women enrolled in the study called one of the three participating teratogen information services (TIS). Group 1 macrolides (n = 161), group 2 other antibiotics (n = 213) and group 3 non-teratogens (n = 740).

Results

A total of 161 women exposed to the new macrolides (118 were exposed in the first trimester of pregnancy) and 953 from a comparison groups were followed up. The rate of major malformations in the study group was 4.1% compared to 2.1% in the other antibiotics exposed group (OR = 1.41, 95% CI 0.47–4.23) and 3.0% in the non-teratogens exposed group. The rate of elective terminations of pregnancy was significantly higher in the exposed group in compare to both comparison groups.

Conclusion

Our study, although relatively small sized, suggests that the use of the new macrolides during the first trimester of pregnancy does not represent an increased risk for congenital malformations strong enough for an induced abortion after such an exposure. Elective terminations of pregnancy because of early exposure to these medications should be reconsidered.     

A prospective randomized study to compare four different mineral oils used to culture human embryos in IVF/ICSI treatments

Objective(s)

We aimed to evaluate and compare the embryo quality at early cleavage stages using different oils overlaying media to culture human embryos during IVF/ICSI treatments.

Study design

A total of 500 IVF/ICSI treatments from 500 women were analyzed in a prospective randomized study. Oocytes/embryos were treated into microdroplets of appropriate media overlaid with (i) Mineral Oil (CryoBioSystem, L’Aigle, France) (group 1, n = 129), (ii) Liquid Paraffin (Medicult, Lyon, France) (group 2, n = 126), (iii) Nidoil (Nidacon International, Guthenburg, Sweden) (group 3, n = 126) and (iv) Ovoil (Vitrolife, Kungsbacka, Sweden) (group 4, n = 119). Comparisons between groups were done using two by two post hoc tests, with 5% significance. The primary endpoint was the embryo quality, defined as good or top quality when embryos were with (i) less than 20% of fragmentation and (ii) 3–5/4 cells at day 2 or 6–10/8 cells at day 3, respectively.

Results

At day 2, the embryo quality was similar in all groups. However, the mean number of top quality embryos at day 3 was statistically higher into the group 4 (1.4 ± 1.8) compared to the group 1 (0.9 ± 1.0; p = 0.03) and 2 (0.8 ± 1.3; p = 0.05). Furthermore, a significant increase of the mean number of good quality embryos was observed at day 3 into the group 4 (2.6 ± 2.6) compared to the group 1 (1.6 ± 1.6; p = 0.02).

Conclusion(s)

The embryo quality could be modified according to commercial oils used to overlay culture media.