The effect of age on the ovarian response to gonadotropin and on pregnancy rate in polycystic ovary syndrome

Recent studies have proposed that ,in women affected by the polycystic ovary syndrome (PCOS) ,aging is able to regularize the menstrual cyclicity. To evaluate the ovarian response in PCOS patients according to their age ,we studied 33 PCOS patients ,20 of whom with an age ranging from 28 to 34 years (younger PCOS) and 13 ranging from 35 to 45 years (older PCOS). All patients underwent an ovulation induction therapeutic protocol with low-dose recombinant follicle stimulating hormone ,for a total of 80 cycles (44 cycles for the younger PCOS group and 36 cycles for the older PCOS group). No significant difference was found between the days of therapy (12.3 ± 5.4 vs. 13.5 ± 5.6 days) ,total amount of drugs (980.7 ± 568.9 IU vs. 1063.9 ± 469.5 IU) or ovulation rate (93% vs. 89%) in the two groups. The two groups showed a significant difference in the maximum estradiol level (2053.5 ± 1497.2 vs. 1269.0 ± 911.5 pmol/l ,p < 0.01) ,the number of the recruited and preovulatory follicles (1.7 ± 2.5 vs. 0.64 ± 0.9 ,p < 0.05 and 1.7 ± 1.1 vs. 1.2 ± 0.5 ,p < 0.01 ,respectively) and the pregnancy rate (36% vs. 14% ,p < 0.05). In conclusion ,our data clearly showed that ,also in PCOS ,advanced age is a negative prognostic factor in the ovarian response to ovulation induction therapies.     

Second-trimester uterine artery Doppler screening in unselected populations: a review

Objective: Doppler ultrasound provides a non-invasive method for the study of the uteroplacental circulation. In normal pregnancy, impedance to flow in the uterine arteries decreases with gestation, which may be the consequence of trophoblastic invasion of the spiral arteries and their conversion into low-resistance vessels. Pre-eclampsia and fetal growth restriction are associated with failure of trophoblastic invasion of spiral arteries, and Doppler studies, in these conditions, have shown that impedance to flow in the uterine arteries is increased. A series of screening studies involving assessment of impedance to flow in the uterine arteries have examined the potential value of Doppler in identifying pregnancies at risk of the complications of impaired placentation. This review examines the findings of Doppler studies in unselected populations. Methods: Searches of a computerized medical database were performed to identify relevant studies. Only those studies that provided sufficient data to allow calculation of the performance of the test were included in the analysis. Likelihood ratios were calculated for each study and are reported for pre-eclampsia, fetal growth restriction and perinatal death as well as for more severe forms of pre-eclampsia and fetal growth restriction. Results: The literature search identified 19 relevant studies, four of which were excluded from the further analysis. The main characteristics and results of the 15 remaining studies provided discrepant results, which may be the consequence of differences in Doppler technique for sampling, the definition of abnormal flow velocity waveform, differences in the populations examined, the gestational age at which women were studied and different criteria for the diagnosis of pre-eclampsia and fetal growth restriction. Nevertheless, the studies provided evidence that increased impedance to flow in the uterine arteries is associated with increased risk for subsequent development of pre-eclampsia, fetal growth restriction and perinatal death. In addition, women with normal impedance to flow in the uterine arteries constituted a group that have a low risk of developing obstetric complications related to uteroplacental insufficiency. Conclusions: The review suggests that increased impedance to flow in the uterine arteries in pregnancies attending for routine antenatal care identifies about 40% of those who subsequently develop pre-eclampsia and about 20% of those who develop fetal growth restriction. Following a positive test, the likelihood of these complications is increased by about 6 and 3.5 times, respectively.     

Prospective delivery of reliably dated term infants of diabetic mothers without determination of fetal lung maturity: comparison to historical control

Objective: To determine whether omitting fetal lung maturity (FLM) testing prior to delivery in term pregnancies complicated by gestational (GDM) and pregestational diabetes mellitus would increase the risk of neonatal respiratory distress syndrome (RDS). Methods: In a 2-year study (1990-91), 1457 pregnant women with accurately dated pregnancies were enrolled after 37 completed weeks and prospectively followed through delivery without FLM testing (study group). The prevalence of RDS and other neonatal outcomes was compared with a historical control group (n = 713, 1988-89) who had undergone determination of lecithin/sphingomyelin ratio prior to delivery at term. Logistic regression analysis was performed to determine independent predictors of RDS. Results: The study group compared to the control group had less severe diabetes: diet-controlled GDM, 35% vs. 18%, respectively; insulin-requiring GDM, 42% vs. 42%, respectively; undiagnosed type-2 diabetes, 14% vs. 31%, respectively; and pre-existing diabetes, 9.6% vs. 8.8%, respectively, p < 0.001. RDS rates in the study group (0.8%) and control group (1.0%) were not significantly different, nor were rates of resuscitation at delivery, neonatal intensive care admission or hospitalization days. Logistic regression analysis found only Cesarean delivery to be independently predictive (adjusted OR 2.21, 95% CI 2.04-2.27) of RDS. Non-predictive variables included FLM testing, diabetic classification, insulin use, poor third-trimester glycemic control, chronic hypertension, pre-eclampsia, labor, neonatal gender, gestational age or large-for-gestational-age fetuses. Conclusions: Routine FLM testing did not change the RDS prevalence in reliably dated, term infants of diabetic mothers and should be abandoned. Delivery by Cesarean section was associated with increased RDS.     

Anxiety among women who have undergone fertility therapy and who are considering multifetal pregnancy reduction: trends and implications

Objective: Our primary objective was to evaluate the assumption that women carrying multiple fetuses and who have decided upon multifetal pregnancy reduction (MFPR) have a constant high level of anxiety. Methods: A total of 66 multigestation women considering MFPR were asked to consider how anxious they were when they first started fertility therapy. Using that level of anxiety as a reference point, and using their self-assessments as a vehicle for probing the meaning they attached to their emotional state through time, they then assessed their anxiety level at different points in their pregnancy. Results: Self-reported anxiety across time displayed considerable variation: there was a large drop in anxiety with pregnancy diagnosis. The women's anxiety rose to very high levels with the diagnosis of carrying multiples. Anxiety moderated again on average with consultation, rose sharply during the course of the procedure, and finally dropped to lower levels on average after the procedure was over. Conclusions: We conclude that women with multigestation experience considerable fluctuations in their level of anxiety from the time that they first start fertility therapy until they learn that they are carrying multiple embryos. Their expectations for the future of becoming pregnant seem at last fulfilled (becoming pregnant), become complicated (with multiples), appear salvageable (with consultation), but with a morally complicated resolution (MFPR) that seems at last to have put the pregnancy back on a normal track (post-MFPR). Those working with MFPR patients before, during and after the operation must understand the nature and variability of the anxiety that their patients are confronting, and how they are attempting to construct a safe passage through the moral dilemma associated with the multiple-gestation situation.     

Vitamin D insufficiency is prevalent and vitamin D is inversely associated with parathyroid hormone and calcitriol in pregnant adolescents

Few large studies have assessed changes in calcitropic hormones and maternal 25‐hydroxyvitamin D (25(OH)D) status across pregnancy, and how this may impact maternal bone turnover and neonatal hormone status. We aimed to identify determinants of 25(OH)D, parathyroid hormone (PTH), and calcitriol across pregnancy in a longitudinal study of 168 pregnant adolescents (≤18 years of age). Maternal 25(OH)D, PTH, and calcitriol were assessed at mid‐gestation (～26 weeks), delivery, and in cord blood. Data were related to measures of maternal anthropometrics, dietary intake, physical activity, and bone turnover markers. Approximately 50% of teens and their infants had serum 25(OH)D ≤ 20 ng/mL; 25(OH)D was lower in African Americans versus whites (p < 0.001). PTH increased across gestation (p < 0.001). Elevated PTH (≥60 pg/mL) was detected in 25% of adolescents at delivery, and was associated with increased concentrations of serum N‐telopeptide (NTX) (p = 0.028). PTH and calcitriol did not significantly differ across the range of Ca intake consumed (257–3220 mg/d). In the group as a whole, PTH was inversely associated with 25(OH)D in maternal circulation at mid‐gestation (p = 0.023) and at delivery (p = 0.019). However, when the cohort was partitioned by 25(OH)D status, this relationship was only present in those with 25(OH)D ≤ 20 ng/mL, suggestive of a threshold below which 25(OH)D impacts PTH during pregnancy. Mid‐gestation 25(OH)D was inversely associated with calcitriol at delivery (p = 0.023), irrespective of Ca intake. Neonatal PTH and calcitriol were significantly lower than (p < 0.001), but unrelated to maternal concentrations. These findings indicate that maternal 25(OH)D status plays a role in calcitropic hormone regulation in pregnant adolescents. © 2012 American Society for Bone and Mineral Research     

中药生化祛瘀汤与米非司酮,米索前列醇终止初期妊娠的协同作用

为探索中药活血祛瘀法对终止初期妊娠的影响，本研究对停经３３～５３ｄ，确诊为妊娠并自愿终止妊娠的健康妇女２００例，随机分为两组，分别采用米非司酮、米索前列醇（称西药组，１００例）与采用米非司酮、米索前列醇基础上加服生化祛瘀汤（称中西药组，１００例）相对照。结果：中西药组流产成功率为９６％，流产后阴道平均出血天数为（１２．８５±８．７７）ｄ，尿中绒毛膜促性腺激素（ｈｕｍａｎｃｈｏｒｉｏｎｉｃｇｏｎａｄｏｔｒｏｐｉｎ，ＨＣＧ）恢复正常时间为２０ｄ。其流产成功率比西药组高，流产后阴道出血量、阴道出血时间、阴道平均出血天数以及尿中ＨＣＧ恢复正常时间均比西药组要少，经统计学检验，差别均有显著意义或非常显著意义。说明由当归、川芎、桃仁等组成的中药生化祛瘀汤对用米非司酮、米索前列醇终止初期妊娠有协同作用     

早期妊娠阴道出血595例B超检查结果分析

本文对５９５例早期妊娠阴道出血Ｂ超诊断进行分析。结果：先兆流产３２０例，符合率１００％，胚胎停止发育１６４例，符合率１００％，过期流产２２例，符合率９０．９％：葡萄胎３７例，符合率１００％；易位妊娠５２例，符合率９４．２％。认为：采用Ｂ超检查，对早期妊娠阴道出血作出正确判断，是一种较有效的方法，在治疗前可常规采用。     

Fetal surveillance in pregnancy complicated by diabetes mellitus: is it necessary?

This article provides a literature review and opinion concerning the need for fetal surveillance in diabetic pregnancy. Low rates of intervention for suspected fetal jeopardy accompany well-controlled diabetic pregnancies in the absence of vascular disease or hypertension. The clinical utility of routine tests of fetal surveillance in uncomplicated type 1 and type 2 diabetic and gestational diabetic pregnancy has not been established. A randomized trial designed to establish whether a benefit exists to fetal testing in this population is not feasible, largely owing to sample size considerations.     

Internal Hernia with Roux Loop Obstruction during Pregnancy after Gastric Bypass Surgery

We report the rare case of a pregnant woman who had undergone Roux-en-Y gastric bypass 8 months previously, and now presented with subacute small bowel obstruction secondary to internal herniation of some of the proximal Roux limb into the lesser sac through the transverse mesocolon rent, which was widely spread apart. At laparoscopy, the hernia contents were reduced and the defect was repaired. The patient made a good recovery. Because of the changes associated with pregnancy, gastric bypass patients may be at an increased risk of internal herniation. It is particularly important not to delay surgical exploration, even in the absence of a positive finding on imaging, because delay may lead to potentially devastating bowel strangulation and sepsis culminating in loss of fetus and mother.     

Effects of Pregnancy in Rats on Cysteamine-Induced Peptic Ulcers (Role of Progesterone)

After mating with a sexually active male, groupsof female Sprague-Dawley rats were injected withcysteamine (400 mg/kg, subcutaneously) at day 0(controls), day 5 (early-stage pregnancy), and day 18(late-stage pregnancy) of pregnancy. In contrast tolate-stage pregnancy rats, early-stage pregnancy animalsshowed a decrease of cysteamine-induced gastroduodenallesions. When subjected to cysteamine injection, both nonpregnant female and male rats treated foreight days with progesterone (300 g/rat,subcutaneously) showed a reduced incidence ofgastroduodenal lesions. No effect was found in animalspretreated with 17-estradiol (200 g/rat,subcutaneously). Furthermore, increased gastroduodenalmucus levels were found in early-stage pregnancy ratsand in animals pretreated with progesterone. Theseresults suggest that increased progesterone plasma levelsduring early-stage pregnancymay be involved inpregnancy-induced gastric and duodenal protection. Thiseffect may be related to an increase in gastric andduodenal mucus production induced by thishormone.