The vital statistics show that human females outlive males at every biological stage. Once the embryo arrives in the uterus, more males die at every stage, at least until the eighth decade when the majority of survivors are female. Unexpectedly, the same statistics also show that more boys are born than girls, which is difficult to explain, because the sperm that determine the sex of the fetus, are not skewed toward males. Recently, new data reveal the reason for the increased number of male births; they imply the significant loss of females before the fetus arrives in the womb. Thereafter, there is an excessive loss of males – not only in utero but throughout their lives. One likely reason for the sex differences in fetal survival is the way that humans compensate for the sex difference in number of X chromosomes.
Background: Clotrimazole is an antifungal drug commonly used in human medicine. It is considered to be safe in pregnancy. Besides this medical assumption ecotoxicology has developed over the last years an awareness of pharmaceuticals which have been detected in surface waters and are of concern for the biosphere. Some of those drugs are endocrine disruptors. So is clotrimazole.Methods: Selective internet research on this subject incorporating medical and ecotoxicological positions.Conclusions: Ecotoxicology and human medicine postulate divergent positions about the harmful effects of clotrimazole. Medicine bases its assumption on thousands of healthy newborn babies whose mothers were treated with clotrimazole during pregnancy. This argument is easy to refute as clotrimazole is an endocrine disruptor and possible consequences of exposure during sensitive periods of pregnancy will only show up much later in life. As a result medicine is challenged to incorporate ecotoxicological concerns into its advice for pregnant women.
Female genital cosmetic surgery is a set of multiple procedures focused on improving genital appearance, structure, and function. Sexual dysfunction affects a large proportion of the female population and appears to be associated with distorted genital anatomy although what women perceive as normal varies vastly depending on cultural and social beliefs. Cosmetic gynaecology office procedures are simple, quick, and effective solutions to improve sexual function as well as body image with minimal interventions and minimal side-effects. In this narrative review, we present these widely used minimally invasive aesthetic gynaecology interventions, focusing on their efficacy, and reported complications. Recommendations regarding heath professionals’ approach and ethical issues arising are also discussed.
We are the first to present results from a pilot clinical study designed for the purpose of establishing spectral mapping patterns, as a potential novel imaging assay for identifying and discriminating between functional and nonfunctional endometrial polyps in vivo. The Spectral Artificial Vision Endoscope (SAVE) was used and validated in this study. The SAVE system, adapted to a regular hysteroscope, was able to operate in several imaging modes, including color imaging, infrared imaging, narrow band imaging and spectral mapping, all acquired at a video rate and simultaneously. The spectral maps generated by the SAVE system for 28 patients with endometrial polyps displayed characteristic patterns capable of discriminating functional from nonfunctional polyps with remarkable consistency (Spearman R=0.912, p<10-6). These preliminary clinical validation results highlighted the great potential of the in vivo spectral mapping imaging modality as an adjunct tool to conventional color camera-based hysteroscopy, offering improved and quantitative diagnosis.
Spina bifida is a neural tube defect that occurs in about 1 in 1,500 pregnancies. Open spinal defects are associated with paralysis, incontinence and hydrocephalus requiring postnatal shunting of the cerebrospinal fluid. Neural tube defects are preventable through preconceptional folic acid supplementation. Occasionally, the diagnosis is made during routine anomaly scan at 18-20 weeks of gestation, as the earliest signs of the anomaly can be seen at the end of first trimester. The information provided by ultrasound plays a crucial role in patient counseling and pregnancy management. The authors report a case of prenatal diagnosis of spina bifida aperta with focus on detailed ultrasound presentation and difficulties in consulting in relation to the prognosis for the newborns.
Endometrial cancer is a common gynecological malignancy in women, which accounts for the second in malignant tumor of female reproductive system. Obesity, high blood pressure and diabetes are risk factors for endometrial cancer. At present, the treatments of endometrial cancer focus on surgical treatment, followed by radiotherapy, chemotherapy and endocrine therapy. The progress of surgical method is transferring from traditional laparotomy, laparoscopy, single port laparoscope to Da Vinci robotic surgery system. Different surgical options should be personalized according to the patient’s situation. We compared the pros and cons of different surgical methods and introduced the clinical value of the Sentinel lymph node mapping in hope of giving some information for clinic.
Advancements in cancer as well as, autoimmunological or hematological conditions treatment have significantly increased the survival rate as well as, the Quality of Life (QoL) for these patients. In addition, Assisted Reproductive Techniques (ART) offers a variety of therapeutic approaches that aim towards fertility preservation and hormonal restoration after treatment. Ovarian Tissue Cryopreservation (OTC) and Ovarian Tissue Transplantation (OTT) have been proposed as an efficient alternative to reserve fertility and hormona function in cases of prepubertal young girls and women needed to be treated immediately with radiation and/or chemotherapy. In this narrative review, current scientific evidence is summarized in order to explore OTC/OTT. In addition to the qualitive presentation of our findings, we provide cumulative evidence from other published studies to demonstrate the clinical potential and limitations of these procedures.
Purpose: Glutaric Acid Type I (GA-I) is an inherited metabolic disorder. Although the treatment guidelines for GA-I were established a decade ago, they cannot block the vertical heredity. We aim to apply genetic methods to block the inheritance of GA-I and verifies the efficiency of Next-Generation Sequencing (NGS)-based Preimplantation Genetic Testing for Monogenic disease (PGT-M) of GA-I.Materials and methods: A non-consanguineous Chinese family was diagnosed with GA-I by Sanger sequencing. PGT-M and prenatal diagnosis (PND) were performed for the carrier. 5 blastocysts were used for the trophectoderm biopsy. After Whole-Genome Amplification (WGA), the WGA products were used for Sanger sequencing, NGS-based PGT-M and PGT-A. Sanger sequencing-based PND was performed in second trimester to confirm the results of PGT-M.Results: A compound heterozygous mutation was diagnosed in the GCDH gene with co-segregation. One is [c.533G>A (p.G178E)] and another is [c.914C>T (p.S305L)]. 2 blastocysts were diagnosed as normal and one of them was transferred into the mother’s uterus. Finally, a healthy female was born 39 weeks after transplantation.Conclusion: Our study successfully applied NGS-based PGT-M to avoid GA-I and highlights the efficiency of genetic diagnoses. It has significant implications on genetic counseling and genetic diagnosis for GA-I.
Anodontia is a rare orofacial complex developmental malformation. In contrast to normal tooth germ with roundhypo echogenic structure arranged in an arch-like manner in alveolar bone, anodontia shows an arch-like hyper echogenic structure without any dental alveoli. Prenatal ultrasound is a reliable method for detecting anodontia inearly gestational age.
Emergency department cesarean section for placental abruption is an uncommon surgical procedure that requires anticipation in the prehospital environment as well as preemptive recognition of impending fetal demise by the emergency physician. The presence of an obstetrician ready to perform immediate cesarean section on an unstable patient with placental abruption may be lifesaving for both the mother and the fetus. However, there are no specific guidelines for prehospital recognition of patients with placental abruption that require emergency cesarean section. While the emergency department is not the optimum surgical theatre for an emergency cesarean section, placental abruption often deteriorates so quickly that even a few minutes of delay can have catastrophic consequences for both mother and fetus. We describe a case of placental abruption following moderate motor vehicular trauma in an eight month pregnant woman whose only complaint was moderate abdominal pain. The emergency physician’s suspicion based on the mechanism of injury caused her to mobilize the obstetrician, who was ready to perform an emergency department cesarean section with successful delivery of the fetus. Subsequent managing of the mother’s surgical incision and coagulopathy was performed in the operating room. This case highlights the importance of vigilance that prehospital providers, emergency department physicians, and obstetricians should have for a pregnant patient involved in a motor vehicle crash.
Objective: To report the safety and efficacy of single incision anchored anterior vaginal mesh repair for women with recurrent anterior vaginal prolapse.Methods: Retrospective study of women with recurrent anterior vaginal prolapse, Stage 2 or beyond, who underwent single incision anchored vaginal mesh repair with Anterior Elevate (American Medical Systems, Minnetonka, USA) between June 2012 and October 2016. Pre-operatively, the Prolapse Quality-of-Life questionnaire (P-QOL) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) were completed. Post-operatively, women completed the P-QOL, PISQ-12 and the global impression of improvement questionnaire (PGI-I). Preoperative POP-Q and post operative POP-Q examination at up to 24 months follow up were recorded. At average follow up of 36 months, participants were interviewed via telephone using questions from the P-QOL, PISQ and PGI-I.Results: 45 women had single incision anterior vaginal mesh kit repair for recurrent prolapse. Postoperatively, 85% of women reported cure of their prolapse symptoms. At 24 months, 80.0% had POP-Q stage 0 or 1 in the anterior compartment, and 93.8% achieved anatomical cure of apical prolapse (point C above 0). During structured telephone interview at mean follow up of 36 months, on PGI-I, 70% reported feeling ‘much better’ or ‘very much better’.Conclusion: Vaginal surgery using single incision lightweight mesh kits can be an effective approach for women with recurrent anterior vaginal prolapse, resulting in subjective and objective cure rates of over 80% with reasonable safety profile up to 60 months postoperatively.
Background: Tocolysis aims to prolong pregnancy by stopping labor to achieve lung maturation. Failure of tocolysis is a common situation in obstetrics with its share of risks and complications for the fetus.Objective: To identify the determinants of tocolysis failure in two Hospitals in Yaounde.Patients and methods: We carried out a case-control study over a 6 months period at Yaoundé Gyneco-Obstetric and Pediatric Hospital (YGOPH) and Yaounde Central Hospital (YCH). We compared each case (patient with failure of tocolysis after 48 hours) with 3 controls (patients with successful tocolysis after 48 hours). The association degree between two variables was measured by calculating the odds ratio (OR) with their confidence interval. Multivariate analysis was performed to eliminate confounders.Results: In this study,238 women were included: 62 cases and 186 controls after multivariate analysis, predictive factors were: sexual activity during the last two month of pregnancy (AOR = 2.76; CI: 1.06-7.23, p = 0,038), prenatal follow-up by midwife or nurse (AOR = 8.96 CI: 2,05-39.22, p = 0,003), the persistence of the temperature ≥ to 38°C after 48 H (AOR = 3.89; CI: 1.36-11.6, p = 0,011),) and the Bishop score ≥ 7 at admission (AOR = 12.50; CI: 4.30-36.27, p < 0,001).Conclusion: The determinants of tocolysis failure in our study were sexual activity during the last two month of pregnancy, prenatal midwife/nurse follow-up, temperature persistence ≥ 38°C after 48 hours of tocolysis, Bishop’s score ≥ 7 at admission.
Background: Luteal phase deficiency (LPD) was recognized as a potential cause of infertility well before the first attempts at ovarian stimulation and in vitro fertilization (IVF). However, in the subsequent IVF era, the fact that LPD is particularly frequent in the context of ovarian stimulation has driven the attention to LPD almost exclusively to stimulated cycles. Here we re-assess the role of LPD as the primary cause of infertility and suggest a possible solution.Patients and methods: This study involves 12 young couples with unexplained infertility who attended our clinic for an assisted reproduction attempt. All of the female partners had low serum progesterone concentrations on day 21 of their menstrual cycle, in spite of the presence on an apparently functional corpus luteum. The female patients underwent repeated ultrasound scans during three subsequent cycles to determine the day of spontaneous ovulation. They were counselled to have frequent sexual intercourse when the dominant follicle reached the size of >17 mm, and progesterone was administered daily, by vaginal route, in all of them beginning with the day on which ovulation had been confirmed.Results: Out of the 12 women included in this study, six became pregnant naturally during one of the three progesterone-supplemented cycles. Progesterone supplementation was discontinued progressively, based on repeated serum progesterone determinations during the early pregnancy. All of the pregnancies were singleton. One of them ended in a miscarriage, while the others went to term, resulting in the birth of five normal children.Conclusions: Our data suggest that LPD during natural ovulatory cycles may be more frequent than believed. In the present study, no other apparent causes of infertility were detected. In such cases, assisted reproduction techniques can be avoided and replaced by individualized progesterone supplementation during the early luteal phase.
Laparoscopic para-aortic lymphadenectomy (PAL) was described first in the literature in 1992. The advantages of the minimally invasive approach compared to the laparotomy are well known, with comparable surgery and long term survival results. The aim of this review is to expose the scientific evidence available on this subject, making a comparative study of the different laparoscopic techniques available to carry out the PAL, as well as other minimally invasive approaches, such as single port or robotic surgery.
Adult granulosa cell tumors are rare ovarian malignancies. They are usually stage I tumors and have a relatively good prognosis. Surgery is the mainstay of primary therapy. Recent studies showed that a minimally invasive laparoscopic approach is an option for selected patients with adult granulosa cell tumors. We report the case of a 91-year-old woman with an 18 cm solid adult granulosa cell tumor treated with laparoscopic surgery. The patient complained of pelvic discomfort and was found to have a solid ovarian tumor. The tumor was expected to be an early-stage sex cord-stromal tumor such as a granulosa cell tumor or thecoma because of the pelvic magnetic resonance imaging findings and abnormal hormonal blood test results. She underwent laparoscopic bilateral salpingo-oophorectomy. We successfully performed laparoscopic surgery in an elderly woman with an 18-cm solid adult granulosa cell tumor without scattering and spillage of the tumor, using a Vagi-Bag. She had no perioperative complications and recovery was rapid. She was doing well and disease-free at 8 months of follow-up.
Preterm birth (PTB) affects 9.6% of pregnancies worldwide and is associated with a very high perinatal mortality that depends on the gestational age at delivery. As a result, PTB has a significant health and financial impact on health systems, families and societies. Its aetiology is not fully understood, but in most cases it is multifactorial, with several maternal, paternal, and epidemiological factors associated with increased risk. Other factors include parental ethnicity, maternal age and body mass index, socioeconomic status, and where the families live. This review examines the influence of ethnicity as an individual risk factor for PTB. It also explores its influence on the epidemiology of PTB and demonstrates that data on certain ethnicities are lacking, despite the fact that these ethnic clusters are within the very ‘high-risk groups’ that are adequately represented in some Western societies. This review examines the influence of ethnicity as an individual risk factor for PTB and also explores its influence on the different epidemiological aspects. A thorough revisit of the ethnic epidemiology unveiled other unnoticed risk factors that if addressed appropriately prematurity can be prevented. Moreover, certain ethnicities were not within the attention of researchers, despite the facts that they are very ‘high-risk groups’ and are also adequately represented in some Western societies.
Background: Perinatal depression is a common complication of pregnancy and can have severe and long-termadverse effects on both mother and infant. Randomized controlled trials (RCT) assessing the effect of fish oilsupplements on perinatal depression have shown mixed results.Objectives: We performed a systematic review and meta-analysis to assess the effects of fish oil supplementation during pregnancy on perinatal depression.Methods: A comprehensive search of MEDLINE (PubMed), EMBASE, and Cochrane Central Registry were conducted in adherence with the PRISMA guideline. Only RCTs published in English from January 2000 to date were included. The participants were pregnant women receiving fish oil supplementation or placebo. Summary effect measure of each study was converted to a common effect measure (log odds ratio) and its variance was calculated to estimate the pooled odds ratio and its 95% confidence Interval using random Effects model. Heterogeneity was assessed used restricted maximum likelihood method.Results: Nine trials were included in our analysis (2,979 women). Prevention Cohort (n = 5): Fish oil supplementation during pregnancy was associated with reduced risk of developing perinatal depression (OR: 0.87; CI: 0.076 to 0.99; p = 0.03). Treatment Cohort (n = 4) Fish oil supplementation during pregnancy was associated with reduced risk of persistent perinatal depression during postpartum period but did not reach statistical significance.Conclusion: In conclusion, a meta-analysis of included RCTs data shows a significant reduction in incidences of perinatal depression in women who received fish oil supplements during pregnancy. However, there was no evidence for a similar effect among women diagnosed with perinatal depression or women with major depressive disorder.
Black women carry the burden of uterine fibroids, (AKA uterine leiomyomas), at a much higher rate than their racial counterparts. Thus, increasing awareness and discovering a solution to an endemic problem that plagues Sub-Saharan Africa is of critical importance, not only for the region itself, but also for the medical community globally. A collaborative, patient oriented, cost effective, and culturally sensitive approach must be at the forefront of this endeavor. While the exact pathogenesis of uterine fibroid development remains elusive, the racial disparity is well documented. Moreover, in the developed world, women are able to seek treatment through surgical and non-surgical means; however, sub-Saharan regions face their own challenges that, if not addressed, can ultimately extinguish the lives of many suffering women. Unfortunately, the literature is scarce on how to prevent fibroid development, which may be critical for women who do not have access to effective interventions. Recent research from our group and others has shown that vitamin D deficiency plays an important role in fibroid development and may be a preventable risk factor. Daily vitamin D supplementation is a low cost, effective intervention that could be implemented throughout the Sub-Saharan region. Similarly, education and increased awareness as to the nature and symptoms of uterine fibroids could improve the quality of life, remove negative social stigma, and reduce morbidity and mortality rates in women who seek medical care with advanced uterine fibroids.
This narrative review discusses the history of the pathophysiologic principles and utilization of point-of-care (POC) viscoelastic tests (VETs) in the definition and treatment of postpartum hemorrhage (PPH). This paper addresses the epidemiology of PPH, describes the hemostatic changes that occur in pregnancy and in PPH, and demonstrates the utilization of viscoelastic testing in the identification and treatment of patients with PPH. Additionally, a description of rotational thromboelastometry (ROTEM) and thromboelastography (TEG), the two most commonly used VETs, is detailed in this paper. VETs have only recently been used to guide blood component therapy (BCT) in trauma in the last decade. The recent increased utilization of VETs to guide BCT in PPH is following a similar trend with a delay of ten years. In a similar fashion to the trauma literature, which expanded greatly within this last decade, the literature concerning the use of VETs in PPH has also increased in the last few years. However, because of differing pathophysiologies associated with the coagulopathy of PPH verses traumatic-induced coagulopathy (TIC), utilization of VETs has been more refined and focused on the VETs’ capacity to determine low fibrinogen and to guide the utilization of blood components and prohemostatic agents. The identification and treatment of PPH depends on clinical parameters, conventional coagulation tests (CCTs) including Clauss fibrinogen, and VETs. Successful treatment of PPH will no doubt include utilization of all three strategies with an increasing utilization of VETs in the future.
