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Journal: European journal of obstetrics, gynecology, and reproductive biology


OBJECTIVE: The purpose of this study is to determine the frequency of adverse perinatal outcome in women with hyperemesis gravidarum and identify prognostic factors. STUDY DESIGN: This is a case-control study in which outcomes of first pregnancies were compared between 254 women with hyperemesis gravidarum treated with intravenous fluids and 308 controls. Prognostic factors were identified by comparing the clinical profile of patients with hyperemesis gravidarum with a normal and an adverse pregnancy outcome. Binary responses were analyzed using either a Chi-square or Fisher exact test and continuous responses were analyzed using a t-test. RESULTS: Women with hyperemesis gravidarum have over a 4-fold increased risk of poor outcome including preterm birth and lower birth weight (p<0.0001). Among maternal characteristics, only gestational hypertension had an influence on outcome (p<0.0001). Treatment as an outpatient and/or by alternative medicine (acupuncture/acupressure/Bowen massage) was associated with a positive outcome (p<0.0089). Poor outcomes were associated with early start of symptoms (p<0.019), and treatment with methylprednisolone (p<0.0217), promethazine (p<0.0386), and other antihistamines [diphenhydramine (Benadryl), dimenhydrinate (Gravol), doxylamine (Unisom), hydroxyzine (Vistaril/Atarax), doxylamine and pyridoxine (Diclectin/Bendectin)] (p<0.0151) independent of effectiveness. Among these medications, only the other antihistamines were prescribed independent of severity: they were effective in less than 20% of cases and were taken by almost 50% of patients with an adverse outcome. CONCLUSION: Poor outcomes are significantly greater in women with HG and are associated with gestational hypertension, early symptoms, and antihistamine use. Given these results, there is an urgent need to address the safety and effectiveness of medications containing antihistamines in women with severe nausea of pregnancy.

Concepts: Pregnancy, Childbirth, Obstetrics, Antiemetic, Nausea, Hyperemesis gravidarum, Morning sickness, Diphenhydramine


To evaluate the histomorphometry and expression of Ki-67 and c-kit in ovarian follicles of pinealectomized or melatonin-treated pinealectomized rats.

Concepts: Ovarian cyst, Ovarian follicle


To evaluate the safety and efficacy of uterine artery embolisation in conjunction with hysteroscopic resection of trophoblast in the conservative treatment of cervical ectopic pregnancies.

Concepts: Pregnancy, Childbirth, Uterus, Obstetrics, Ectopic pregnancy


OBJECTIVE: Reduced CD16 expression is associated with neutrophil apoptosis. This study aimed to compare CD16 expression on neutrophils in the vagina from women with normal bacterial flora and with vaginitis. STUDY DESIGN: Vaginal lavages were sampled from volunteers diagnosed with bacterial vaginosis (BV, n=34), vulvovaginal candidiasis (VC, n=43), BV plus VC (BV+VC, n=14), and normal flora (NF, n=51). Neutrophils were identified by expression of CD15, CD16 and CD24 surface markers as assessed by flow cytometry. RESULTS: CD16 expression was elevated in neutrophils from women with vaginitis (BV p<0.0001; VC p=0.01; BV+VC p=0.0027) as compared to women with NF. CONCLUSION: The reduction in CD16 down-regulation is consistent with prolonged neutrophil viability and activity in the vagina of women with vaginitis. This may contribute to greater microbial clearance and, conversely, with inflammation-associated pathology.

Concepts: Bacteria, Flow cytometry, Gynecology, Vagina, Candidiasis, Bacterial vaginosis, Human flora, Vaginitis


OBJECTIVE: It is important to understand the underlying mechanisms of the physiological framework of the pelvic organ support system to develop more effective interventions. Developing more successful interventions for restoration of defects of the pelvic floor will lead to symptomatic improvement of pelvic floor prolapse and stress incontinence disorders. The purpose of the current study was to investigate the physiological framework related to the pelvic organ support system and propose the underlying mechanisms of pelvic organ support based on the anatomical findings. STUDY DESIGN: Ten female soft embalmed cadavers were dissected after a colorectal hands-on workshop to visualize components of the pelvic organ support system. RESULTS: The puborectalis attached at the superior pubic ramus above the arcus tendineus fasciae pelvis. The anterior half of the iliococcygeus originated at the level of the arcus tendineus fasciae pelvis but descended from the arcus tendineus fasciae pelvis before it reached the ischial spine. The fibrous visceral sheath of the endopelvic fascia covered both the bladder and the upper vagina and bound these structures together. The levator ani muscle was separated into a horizontal and a vertical part at the medial attachment of the fibrous visceral sheath. A well-circumscribed adipose cushion pillow, in the ischioanal fossa and its anterior recess, supported the horizontal part of the levator ani muscle and pressed the vertical part against the pelvic viscera. Perivascular sheaths and pelvic nerve plexuses were reinforced by condensed endopelvic fascia, they suspended the pelvic organs posterolaterally. CONCLUSION: The pelvic organ support framework consists of two mechanical structures: (1) the supporting system of the levator ani muscle, the arcus tendineus fasciae pelvis and the adipose cushion pillow, and (2) the suspension system of the neurovascular structures and the associated endopelvic fascia condensation.

Concepts: Muscle, Urinary bladder, Pelvis, Pelvic floor, Human anatomy, Pubis, Perineum, Levator ani


The majority of symptomatic uterine fibroids are currently treated by surgical interventions (myomectomy or hysterectomy) or radiological treatments (uterine artery embolisation or focussed ultrasound surgery). None of these treatments is a panacea, and what is conspicuous is the lack of an effective long-term medical therapy for a disorder so common among women of reproductive age. It has been known for some time that progesterone and its receptors enhance proliferative activity in fibroids and this has raised the possibility that anti-progestins and (PRMs) could be useful in the medical management of fibroids. Some of the compounds which have produced promising results in recent clinical trials or research studies include mifepristone, CDB-4124 (telapristone), CP-8947, J-867 (asoprisnil) and CDB-2914 (ulipristal acetate or UA). UA has recently completed Phase III clinical trials with very encouraging results, and has now acquired a licence for clinical use in Europe. While considerable research has yet to be done on the long-term safety and efficacy of UA there is nevertheless good reason for optimism on the emergence of effective medical therapy in the form of UA and possibly other PRMs.

Concepts: Medicine, Clinical trial, Uterus, Hysterectomy, Uterine fibroids, Uterine artery embolization, Selective progesterone receptor modulator, Myomectomy


To study cytogenetic damage in order to estimate the effect of pre-pregnancy smoking on pregnant women and their foetuses.

Concepts: Pregnancy, Childbirth, Infant, Fetus, Breastfeeding


The objective of the study was to measure the copeptin levels in maternal serum and umbilical cord serum at cesarean section and vaginal delivery in normotensive pregnancy and pre-eclamptic women.

Concepts: Childbirth, Infant, Embryo, Fetus, Obstetrics, Breastfeeding, Navel


To determine maternal serum concentrations of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) longitudinally in normal pregnancies, pregnancies that developed preeclampsia and pregnancies that deliver a small for gestational age (SGA) infant, in order to evaluate them as markers for the prediction of preeclampsia.

Concepts: Pregnancy, Infant, Embryo, Fetus, Growth factor, Obstetrics, Breastfeeding, Placental growth factor


To compare the efficacy of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of the adhesion reformation after hysteroscopic adhesiolysis for Asherman’s syndrome.

Concepts: Birth control, Uterus, Intrauterine device, Abortion, Endometrium, Asherman's syndrome, Hysteroscopy, Hyalobarrier