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991.
Schmidt P Pruggmayer M Steinborn A Schippert C Staboulidou I Hillemanns P Scharf A 《Archives of gynecology and obstetrics》2007,276(3):259-262
Introduction First-trimester screening according to Nicolaides uses maternal age to obtain a common background risk for trisomy 21. The
likelihood ratios by nuchal translucency, free β-human chorionic gonadotropin and pregnancy-associated plasma protein-A are
not with respect to maternal age. It was the aim of this study to investigate if likelihood ratios should better take care
of it.
Materials Pearson’s correlation and different models of regression analysis had been performed on the results of 8,116 first-trimester
screenings. The total number of pregnancies was subdivided into three subgroups of healthy fetuses (n = 8,038); fetuses with Down’s syndrome (n = 46) and fetuses with other genetic abnormalities (n = 32). Statistical testing was applied to each of the three groups.
Results Strong independence from maternal age could be found for each of the first-trimester screening measurement parameter, as well
for healthy and as for affected fetuses. Neither Pearson’s test nor nonlinear regression models could detect a correlation.
Accordingly significance of Pearson’s test is not given.
Discussion First-trimester screening would not be improved by considering the maternal age in the calculation of the likelihood ratios.
Therefore the currently used algorithm is adequate. According, to the results, it seems to be proper as well to disregard
the maternal age in newer test strategies advanced first-trimester screening (AFS) at all. 相似文献
992.
Levgur M 《Archives of gynecology and obstetrics》2007,276(1):1-15
Background To review the literature on various therapeutic modalities for uterine adenomyosis.
Methods Reviews, case-controlled studies and reports from November 1949 until August 2006 written in English or summarized in English
abstracts retrieved from Medline and Pubmed using the key words: adenomyosis and adenomyosis therapy.
Results Symptoms of adenomyosis may be alleviated by antiprostaglandins, sex hormones, danazol and GnRH analogs. Minor surgical procedures
for therapy include endomyometrial ablation, laparoscopic myometrial electrocoagulation and adenomyoma excision. Patient’s
age and symptoms, desired fertility, site and extent of lesion and surgeon’s skills should be considered in choosing the appropriate
procedure. Endomyometrial ablation is effective for lesions deeper than the endometrial–myometrial junction whereas the efficacy
of hysteroscopic ablation is limited to foci 2–3 mm deep. Focal and diffuse disease may be managed by laparoscopic electrocoagulation
or myometrial excision with preservation of fertility but risk of recurrence exists. Uterine artery embolization assumingly
invokes infarction and necrosis. Encouraging results reported in some cases warrant expanding its use for more experience.
Hysterectomy is the ultimate solution for women with deep myometrial involvement or if future fertility is not desired.
Conclusions Various therapeutic options for adenomyosis, including few minimally invasive procedures became available in the last two
decades but need evaluation and improvement. 相似文献
993.
Schmidt P Staboulidou I Soergel P Wüstemann M Hillemanns P Scharf A 《Archives of gynecology and obstetrics》2007,275(6):469-474
Objective The individual risk assessment of fetal Down’s syndrome based on measurement of nuchal translucency (NT) according to Nicolaides,
optionally complemented by the determination of PAPP-A and free beta HCG has progressively supplanted other search strategies
for fetal aneuploidies. It could be shown that this diagnostic strategy equally detects other numeric aneuploidies at a comparable
rate. A positive test result is also predictive for the presence of a fetal malformation. In this field, several computer
programs are available for clinical use. The objective of our study was to re-evaluate the first consecutive 1463 NT-risk
calculations determined by Nicolaides’ method and to compare the risk calculation to the JOY software (NT-risk calculation
module, JOY Patient Database) introduced in 2002.
Material and methods At the Department of Obstetrics and Gynecology, Hannover Medical School, 1463 consecutive complete data sets comprising first
trimester screening performed between May 2, 2000 and June 26, 2003 and corresponding fetal outcome were analysed using risk
assessment based on the Nicolaides method (PIA Fetal Database NT-Module) and compared with the risk evaluation as determined
by the JOY software (JOY Patient Database NT module). A risk exceeding 1:300 was considered to indicate the need for further
invasive testing. In a first step, only cytogenetically detectable chromosomal aberrations were analysed. Then, a second evaluation
including fetal malformations was performed.
Results Among the 1463 cases, 1445 (98.77%) fetuses revealed to be cytogenetically healthy. Both softwares showed identical detection
rates at the genetic and somatic level:13 cases of Down-Syndrome (0.89%), 2 cases of trisomy 18 (0.14%), one case of triploidy,
one Turner-Syndrome, one Klinefelter-Syndrome (0.07% each) were detected. A positive test result was found in 15 cases ending
in a spontaneous abortion, intrauterine death or peripartum death (1.03%) and in 22 cases of fetal malformation (1.50%). At
the level of genetic detection the test positive rate dropped from 92 (PIA) to 71 (JOY) (-22.8%). At the level of combined
adverse outcome the test positive rate was reduced from 100 (PIA) to 76 (JOY) (-22.0%), thus yielding in a marked improvement
of the characteristic test performance parameters.
Conclusion The novel, recently developed JOY software package allowed reliable evaluation of the risk for aneuploidy with increased specificity
whereas sensitivity was unchanged. Our data suggest an improvement of the screening for aneuploidy when using this novel software:
With an identical detection rate, the number of unnecessary invasive measures may be reduced. 相似文献
994.
Zimmer EZ Lowenstein L Bronshtein M Goldsher D Aharon-Peretz J 《Archives of gynecology and obstetrics》2007,276(5):487-490
Objective The prevalence and clinical significance of isolated mega cisterna magna in both fetuses and adults is not yet well defined.
It is therefore difficult to provide reliable parental counseling in cases of a fetal sonographic diagnosis of this anomaly.
The aim of the present study was to, determine the cognitive profile of adults with isolated mega cisterna magna.
Methods We reviewed 19,301 consecutive CT/MRI of the brain. Isolated mega cisterna magna was observed in 49 cases. A battery of neuropsychological
tests was performed in 18 adults with this anomaly and in 18 controls who had no brain anomaly on CT/MRI.
Results Subjects with isolated mega cisterna magna had a lower performance on memory tasks [RAVLT saving score (0.8 ± 0.2 vs. 1.02 ± 0.2,
P = 0.003)] and verbal fluency [phonemic fluency (9.4 ± 4.5 vs. 13.6 ± 5.3, P = 0.02), semantic fluency (19.8 ± 5.8 vs. 24.4 ± 7.5, P = 0.05)]. They did not differ from controls in regard to the Raven similarity tests indicating that this brain anomaly is
not associated with impairment of general cognitive abilities.
Conclusion Adults with isolated mega cisterna have an overall normal cognitive functioning but may score inferior to controls on some
parameters of memory and verbal fluency. Although application of adult cases to the fetuses is not well established, this
information might be of value in parental counseling in cases of a fetus with this anomaly. 相似文献
995.
Prevalence of pathology in women attending colposcopy for postcoital bleeding with negative cytology
Objective To determine the frequency of cervical pathology and the incidence of cervical neoplasia in women presenting with PCB at the
colposcopy clinic with negative cytology.
Design A retrospective study.
Setting A district general hospital.
Population Eighty-seven women with postcoital bleeding and negative cytology were seen in the colposcopy unit during 1 January 2003 to
31 December 2005.
Methods Women were identified from computer records and details were extracted from the case notes.
Main outcome measure Histopathological diagnosis.
Results Six women (6.9%) had cervical intraepithelial neoplasia. There were no cases of invasive cancer. Thus in our study 6.9% women
with postcoital bleeding had abnormal histology even though they had normal smears. Other identifiable causes were cervical
polyp (12.5%), ectopy (33.6%) and Chlamydia (2.3%). No pathology was found in 50% of women.
Conclusion Women with postcoital bleeding even with normal smears appear to be at much greater risk of cervical neoplasia than the general
population. Unfortunately there is no general consensus for management of these patients. Hence further research is needed
to standardise the management of women with PCB. Patients should be reassured that in vast majority of cases no serious pathology
is detected. 相似文献
996.
Hermans C 《Archives of gynecology and obstetrics》2007,276(3):271-276
Backgroud Hereditary angioedema (HAE) is a rare genetic disorder caused by a deficiency of the plasma protein C1 inhibitor (C1-INH).
HAE is characterised by the onset of angioedema, which may develop in one or several organs, and may last from a few hours
to several days. Oedema of the upper airway can be life-threatening. As a result of hormonal changes, some women experience
more frequent angioedema attacks during pregnancy. During pregnancy, antifibrinolytic agents should only be used with caution,
and attenuated androgens are contraindicated; therefore, replacement therapy with C1-INH concentrate represents one of few
therapeutic options, but it is not widely documented.
Case study We report the first case study of the successful management with regular infusions of C1-INH concentrate, of two successive
pregnancies in a patient with HAE. During the second half of the first pregnancy, C1-INH was administered on demand at home.
For the second pregnancy, on demand treatment was intensified to prophylactic therapy, with once or twice weekly infusions
from the middle of the second trimester in order to efficiently control the frequent attacks.
Conclusions This report illustrates that HAE can be successfully managed during pregnancy with C1-INH infusions at home. Since the number
of crises may vary between pregnancies, the treatment regimen must be adapted to the patient’s need. 相似文献
997.
Srivastava G Pilkington A Nallala D Polson DW Holt E 《Archives of gynecology and obstetrics》2007,276(5):555-557
Objective Ogilvies syndrome (OS) is a rare condition in obstetrics but occurs most commonly after caesarean section. Mortality rates
from OS can be as high as 36–50% when bowel perforation or ischemia develops which highlights the early recognition of this
condition. Early diagnosis is therefore essential to prevent serious morbidity and mortality.
Conclusion We, therefore report a case of OS after caesarean section in which early detection by senior clinicians resulted in successful
management of the condition and an excellent outcome. 相似文献
998.
Objective Case report of a rare combination of a trisomy 18 and 21 in a dizygotic twin pregnancy in a woman with a history of recurrent
miscarriage, a neonatal death, no living offspring and Graves disease.
Methods Case report and literature search.
Results Only one other report in the literature of a combined trisomy 18 and 21 twin pregnancy was found.
Conclusion The combination of a trisomy 18 and 21 in a dizygotic twin pregnancy is very rare. Despite the high frequency and clinical
importance of aneuploidy, very little is known about the factors that may modulate meiotic non-disjunction. 相似文献
999.
Araujo Júnior E Guimarães Filho HA Saito M Pires AB Pontes AL Nardozza LM Moron AF 《Archives of gynecology and obstetrics》2007,275(2):141-144
Context
The cervical teratomas are rare, benign tumors, they are formed by the three embryonic layers, and they represent only 6%
of teratomas. The prognosis depends mainly on the size and location of the lesion, on the tumor growth rate, and on the level
of tracheal compression. Prenatal diagnosis is usually reached with the aid of a two-dimensional ultrasonography (2DUS) after
the 15th week of gestation, which shows a large heterogeneous mass in the cervical region, plus a polyhydramnios, on the Doppler
mode which also shows the vascularization of the tumor.
Case report
We report a case of cervical teratoma diagnosed on the 31st week of gestation with the aid of a 2DUS and color Doppler mode.
We focus on the main findings obtained with the three-dimensional ultrasonography in surface mode, and we highlight the importance
of this methodology for the indirect evaluation of the neonatal prognosis. 相似文献
1000.
Wiwanitkit V 《Archives of gynecology and obstetrics》2007,276(6):629-631
Background Consequences of syphilis in mother, pregnancy, fetus and child are considerable, but preventable. Serological screening must
be offered at the first prenatal visit. Presently, the diagnosis of syphilis is dependent mainly on serological tests. The
most widely used screening tests for syphilis are the VDRL and the rapid plasma reagin (RPR) and for confirmation the fluorescent
treponemal antibody (FTA) and the treponema pallidum hemagglutination (TPHA) tests.
Method The four alternative nodes for diagnosis of can be a) VDRL + FTA, b) VDRL + TPHA, c) RPR + FTA and d) RPR + TPHA. Here the
author reports an evaluation of cost utility of those tests in obstetrical practice. According to this study, it can be shown
that the cost per accurate diagnosis for VDRL + TPHA is the least expensive choice and for RPR + FTA is the most expensive
choice.
Conclusion Therefore, this alternative is the best method for serological diagnosis of syphilis, based on medical laboratory economics
principles. 相似文献