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911.
Objective To investigate obstetric outcomes in singleton pregnancies conceived by in vitro fertilization (IVF) to nulliparous women
older than 35 compared to those of their younger counterparts.
Methods Nulliparous women 35 years and older at delivery conceived by IVF (n = 89) were compared with nulliparous women 34 years and younger at delivery conceived by IVF (n = 48). Data included antenatal data, gestational age at delivery, maternal and neonatal complications and mode of delivery.
Results The incidence of pregnancy-induced hypertension in the younger group was significantly higher than that in the elderly group
(13 vs. 3.4%, P = 0.043). There were no measurable differences in other obstetric outcomes such as placental abnormality, premature delivery
or neonatal asphyxia between the two groups.
Conclusion The current results suggest that obstetric complications in pregnancies conceived IVF are attributed to mechanisms other than
those depend on advanced maternal age. 相似文献
912.
Saglam A Bozdag G Kuzey GM Kuçukali T Ayhan A 《Archives of gynecology and obstetrics》2008,277(6):557-562
Objective To present a unique case of a 63 year-old woman with coexistent adenocarcinoma of the ovary, endometrium, cervix and fallopian
tube.
Materials and methods A case report from a tertiary health center.
Results A woman presenting with postmenopausal bleeding and abdominal distantion was assessed by endometrial biopsy and explorative
surgery. The frozen section of the mass on the right adnex revealed malign mucinous carcinoma of the ovary. As usual, optimal
debulking was performed as initial surgical staging procedure of ovarian cancer. The microscopic examination of the right
ovary revealed a typical mucinous cystadenocarcinoma. Furthermore, the focal endometrial irregularity at the left uterine
cornus turned out to be a well differentiated endometrial carcinoma of the endometrioid type with <1/3 myometrial invasion.
The pale infiltrative lesion in the cervix also turned out to be an adenocarcinoma of the endocervical type with deep stromal
invasion and areas of diffuse glandular dysplasia and in-situ glandular neoplasia at the periphery. Besides, several sections
from the left fallopian tube uncovered diffuse dysplasia in the lining epithelium and a focus of adenocarcinoma with papillary
and cribriform pattern.
Discussion When compared with patients having metastatic lesions, most synchronous female malignancies are accompanied with early stage
and low-grade with a more favorable prognosis. However, there is paucity of data for the exact criterion to distinguish primary
tumors from metastatic lesions. In such cases, the validity of immunohistochemical and cloning studies are not clear. 相似文献
913.
Morimatsu Y Matsubara S Hirose N Ohkuchi A Izumi A Ozaki K Ozawa K Suzuki M 《Archives of gynecology and obstetrics》2008,277(3):267-270
Background Disseminated intravascular coagulation (DIC) caused by placental abruption usually improves rapidly after prompt delivery
and adequate anti-DIC treatment.
Case A 30-year-old nulliparous woman suffered from placental abruption at the 25th week of pregnancy, and emergent cesarean section
was done immediately. She exhibited DIC, which continued even after termination of the pregnancy and anti-DIC treatment. She
also showed neutropenia. We closely observed her, and at the 58th day postpartum, blast cells appeared in the peripheral blood
and she was diagnosed with acute promyelocytic leukemia (APL). Induction chemotherapy was done successfully. The close observation
after delivery enabled us to make the prompt diagnosis/treatment, leading to the complete remission.
Conclusion APL should be added to the list of differential diagnosis when DIC persists even after prompt delivery and appropriate anti-DIC
treatment after placental abruption. 相似文献
914.
Objectives To establish reference ranges for maternal serum inhibin A in normal first trimester pregnant women.
Materials and methods This was a cross-sectional study. We measured maternal serum inhibin A in normal pregnant women gestation age between 6+0 and 14+6 weeks using the enzyme-linked immunosorbent assay (ELISA) method. Maternal serum inhibin A was analyzed according to gestational
ages (GA).
Results Serum of 300 pregnancies was analyzed and the outcome demonstrated the median of maternal serum inhibin A according to gestational
age. The levels of maternal serum inhibin A during the 60–6+6 week of gestations are lowest when compared with other gestational age. The levels of maternal serum inhibin A during 90–9+6 week of gestations are maximal. Maternal serum inhibin A then declined until 14 weeks of gestation.
Conclusion Serum inhibin A can be measured during the first trimester of pregnancy by using the recent ELISA technique. Our reference
ranges might be useful for further studies, such as prediction of adverse pregnancy outcome in threatened abortion. 相似文献
915.
Brimacombe M Iffy L Apuzzio JJ Varadi V Nagy B Raju V Portuondo N 《Archives of gynecology and obstetrics》2008,277(5):415-422
On the basis of 333 documented cases of permanent perinatal neurological damage, associated with arrest of the shoulders at
birth, the authors conducted a retrospective study in order to evaluate the predisposing role, if any, of the utilization
of extraction instruments. The investigation revealed that 35% of all injuries occurred in neonates delivered by forceps,
ventouse or sequential ventouse–forceps procedures. This frequency was several-fold higher than the prevailing instrument
use in the practices of American obstetricians during the same years. A high rate of forceps and ventouse extractions was
demonstrable in all birth weight categories. Average weight and moderately large for gestational age fetuses underwent instrumental
extractions more often than grossly macrosomic ones. This circumstance indicates that forceps and ventouse are independent
risk factors, unrelated to fetal size. Their use entailed central nervous system injuries significantly more often than did
spontaneous deliveries. The findings suggest that extraction procedures may be as important as macrosomia among the factors
that lead to neurological damage in the child in connection with shoulder dystocia. Because they augment the intrinsic dangers
of excessive fetal size exponentially, the authors consider their use in case of ≥4,000 g estimated fetal weight inadvisable.
Sequential forceps–ventouse utilization further doubles the risks and is, therefore, to be avoided in all circumstances. 相似文献
916.
Laparoscopic findings in female genital tuberculosis 总被引:1,自引:1,他引:0
Sharma JB Roy KK Pushparaj M Kumar S Malhotra N Mittal S 《Archives of gynecology and obstetrics》2008,278(4):359-364
OBJECTIVES: To evaluate the laparoscopic findings in genital tuberculosis (TB). METHODS: A total of 85 women of genital TB, who underwent diagnostic laparoscopy for infertility or chronic pelvic pain were enrolled in this retrospective study conducted in our unit at All India Institute of Medical Sciences, New Delhi, India from September 2004 to 2007. RESULTS: The mean age was 28.2 years and the mean parity was 0.24. Most women were from poor socioeconomic status (68.1%). Past history of TB was seen in 29 (34.1%) women with pulmonary TB in 19 (22.35%) women and extrpulmonary in 10 (11.7%) women. Most women presented with infertility (90.6% primary 72.9%; secondary 17.6%) while the rest had chronic pelvic pain (9.4%). The mean duration of infertility was 6.2 years. A total of 49 (57.6%) women had normal menses, while hypomenorrhea, oligomenorrhea, secondary amenorrhea and menorrhagia were seen in 25 (30.1%), 3 (3.5%), 5 (5.9%), and 2 (2.4%) women respectively. Diagnosis of genital TB was made by histopathological evidence of TB granuloma in 16 (18.8%) (Endometrial biopsy in 12.9%, laparoscopy biopsy in 5.9%) women, demonstration of acid fast bacilli (AFB) on microscopy in 2(2.3%), positive AFB culture in 2 (2.3%), positive polymerase chain reaction (PCR) in 55 (64.7%) and laparoscopic findings of genital TB in 40 (47.1%). The various findings on laparoscopy were tubercles on peritoneum (12.9%) or ovary (1.2%), tubovarian masses (7.1%), caseous nodules (5.8%), encysted ascitis in 7.1% women. Various grades of pelvic adhesions were seen in 56(65.8%) women. The various findings on fallopian tubes were normal looking tubes in (7.1%), inability to visualize in 12(14.1%), presence of tubercles on tubes in 3 (3.52%), caseous granuloma in 3 (3.52%), hydrosalpinx in 15 (17.6%) (Right tube 11.7%, left tube 5.9%), pyosalphinx in 3 (3.5%) on right tube and 2 (2.35%) in left tube, beaded tube in 3 (3.5%) on right tube, 4 (4.7%) in left tube with tobacco pouch appearance in 2 (2.35%) women. The right tube was patent in 9 (10.6%) while left tube was patent in 10(11.7%) cases only, while they were either not seen (absent in one case due to previous salphingectomy, inability to see due to adhesion in 14.12%) or blocked at various sites with cornual end being most common in 3 (3.5%) showing multiple block in right tube and 4.7% in left tube. CONCLUSION: There is a significant pelvic morbidity and tubal damage in genital tuberculosis. 相似文献
917.
Lawrence GC Rettenmaier MA Heinemann S Chang M Goldstein BH 《Archives of gynecology and obstetrics》2008,278(4):383-386
Chorioangiomas are common placental neoplasms that are primarily asymptomatic, but the larger subtypes have a variable presentation and can result in severe pregnancy complications. We report a case of a pregnant patient who presented with a 10 x 12 x 10 cm placental chorioangioma at 32 weeks, despite an unremarkable ultrasound at 28 weeks. Since these more substantial chorioangiomas can induce fetal mortality, close surveillance with perinatology and neonatology consultation is necessary to enhance the probability of a favorable patient prognosis. 相似文献
918.
Background Aggressive angiomyxoma (AA) is a rare vulvovaginal mesenchymal neoplasm with a marked tendency to local recurrence but which
usually does not metastasize.
Case report We describe a case of AA in the left labium majus pudendi in a 47-year-old woman who underwent incomplete surgical excision.
Follow-up 2 years later revealed no recurrence.
Conclusion In the past, most authors advocated wide excision even if genitourinary and digestive tract resection were necessary. These
days, a less radical surgery is recommended, but the significance of hormonal treatment and/or radiation therapy is not clear
yet. Further investigation is necessary. 相似文献
919.
Objective To evaluate the rate and characteristics of postoperative intrauterine adhesions (IUA) that might be formed following hysteroscopic
reproductive surgery from both a gross and a histologic perspective as determined by early and late follow-up diagnostic hysteroscopy.
Methods Retrospective analysis of 61 women wishing a pregnancy and suffering from a significant intrauterine pathology affecting their
reproductive outcome were reviewed. All patients were treated hysteroscopically. Subsequently, they were randomly assigned
to perform a follow-up diagnostic hysteroscopy at a variable intervals from their initial surgery. Multiple hysteroscopic-guided
biopsies from IUA, when present, were obtained in several cases. Twenty patients were in the early group and had follow-up
hysteroscopy performed 2–4 weeks after the initial operation. The late diagnostic group consisted of 41 patients with follow-up
hysteroscopy at about 12 months (8–16 months). The two groups were similar to composition. Postoperatively, none of the early
diagnostic group underwent hysterosalpingography (HSG) whereas all of the late group performed HSG 4 months following the
initial surgery, which showed at least one-third of the cavity free of adhesions. When adhesions were present, no effort was
made to lyse them.
Results At follow-up hysteroscopy, 25% of both groups had no significant adhesions. Grade I adhesions (thin, filmy) occurred in 60%
of the early hysteroscopy patients and in only 12% of the late group (P < 0.05). Grade II adhesions were present in 10% of the early group and in up to 41% in the late group (P < 0.05), whereas Grade III adhesions were present in only 5% of the early hysteroscopy group, but in 22% of the late one
(P < 0.05). Correlation between hysteroscopic and histologic findings were good in most of cases in both groups. Follow-up to
determine the subsequent reproductive outcome revealed similar conception rates in both groups.
Conclusion The IUA that might be formed immediately following hysteroscopic reproductive surgery are histologically different from those
appearing a longer time after the original operation. Routine early follow-up hysteroscopy can influence the prognosis resulting
from the original surgery. 相似文献
920.
OBJECTIVE: An endometrioid adenocarcinoma (EAC) with true trophoblastic differentiation is a rare event with a highly aggressive clinical course. CASE: We report an endometrioid adenocarcinoma of the endometrium in which there was a morphologically conventional-appearing EAC component admixed with multinucleated giant cells and large pleomorphic tumor cells that resembled a choriocarcinoma without an elevated serum level of human chorionic gonadotropin (hCG) in a 42-year-old unmarried woman with a history of abnormal uterine bleeding. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection were performed. Histopathologic study of the specimen showed endometrioid adenocarcinoma extended to the deep myometrium with a focus of hemorrhagic and necrotic tumor composed of multinucleated giant cells, large pleomorphic tumor cells, suggesting choriocarcinomatous differentiation (CD). Immunohistochemical studies demonstrated intense reactivity of tumor cells for human chorionic gonadotropin (hCG) confirming the diagnosis. A complete clinical workup ruled out metastatic spread to the brain, lungs, skeleton, or abdomen. The patient was alive with no evidence of disease 6 months later. CONCLUSION: Although endometrioid adenocarcinoma with choriocarcinomatous differentiation is known to behave in a more aggressive course, this disease may have a good prognosis with a clinically indolent course when it is small, and without elevated serum hCG levels. 相似文献