The aim of the study. To demonstrate the role of laparovaginal surgery as minimal invasive method in early cervical cancer. Methods. We operated 44 patients between 2006 and 2011, with cervical cancer IA2-IB1 stages in private practice. In 21 cases we performed radical trachelectomy with sentinel node sampling and in 23 cases radical vaginal hysterectomy (Schauta Stoeckel) with laparoscopic pelvic lymphadenectomy. The deep surgical technique is further presented. Results. This study presents the data concerning operative time, blood loss, and perioperative complication. Conclusion. Using the combination of vaginal and laparoscopic surgery we offer to the surgeon the possibility to conserve the anatomy and function in early cervical cancer. This study is relevant as it presents a significant number of patients with radical trachelectomy - a procedure not very frequently reported in the literature. The authors consider it significant also in regard with the 100% survival rate.
The use of synthetic mesh in the treatment of urinary stress incontinence represents a modern approach, but specific complication can occur. A case of urinary incontinence, manifested when patient changed position from supine to standing, is presented. The symptoms appeared after a previous intravaginal sling insertion, with transobturator passage, for urinary stress incontinence. The tape got hooked in the pubococcygeus muscles, and their contraction stretched opens the urethra. The patient presented urine loss, on getting off a chair or out of bed, similar to "tethered vagina" syndrome after prior anterior vaginal repair. Urodynamic and ultrasound exams were used in order to make the differential diagnosis with internal urethral sphincter deficiency, and tape sliding under the urinary bladder neck. The surgical cure was resection of the tape and reinsertion of a retropubic tape. The result was very promising, without notice the urine loss when getting up. We found only one description in literature of the "tethered vagina" case after transobturator tape insertion.
The present case report shows the use of small diameter rigid hysteroscope in diagnostics and treatment of vaginal foreign body (i.e. alkaline battery) in a 12 years old girl, inserted by accident. In our study, the diagnostic and operative hysteroscopy confirmed to be ideal for removing foreign body, although respecting the postulates of minimally invasive gynecology.
Objective. The link between preeclampsia and inflammation has directed the research to the investigation of inflammatory markers in preeclampsia. The present study aimed to evaluate serum amyloid A (SAA) levels in preeclamptic and healthy pregnant women detecting the relationship between the preeclampsia and SAA levels. Methods. Twenty preeclamptic women and eighteen pregnant women without any medical history, which constitute the control group, having between 35th to 41st gestational weeks, were included in the present study. For the analysis of SAA levels, maternal blood samples were collected within two hours before caesarean section, and the umbilical cord blood samples were collected at birth. SAA levels were measured using the enzyme linked immunosorbent assay method. Results. No significant difference was observed between the preeclamptic women and healthy pregnant women in terms of SAA levels (286.46 ng/mL versus 83.24 ng/mL; p>.144, median values). Furthermore, the same results were found in the umbilical cord blood SAA levels between the babies born from preeclamptic women and those born from healthy pregnant women (7.66 ng/mL versus 7.84 ng/mL; p=.725, median values). Conclusions. An elevated plasma level of SAA in healthy and preeclamptic women should be considered pathologic, and in this respect, the response of relationship between the preeclampsia and SAA levels could be caused by an inflammatory condition other than preeclampsia.
Endometriosis represents a frequently encountered pathology of the women at reproductive age that corresponds to the ectopic development of endometrial glands outside the uterine cavity. The purpose of the current study was to evaluate the efficiency of MRI imaging in diagnosing endometriotic lesions. The current study was performed during September 2011 - January 2012 on a total of 38 patients that underwent an 1.5T examination for endometriosis suspected at clinical or ultrasound examination. MRI diagnosed endometriosis in 26 out of the 38 patients, adenomyosis associated to endometriosis in two cases, adenomyosis not associated to endometriosis in one case, abdominal wall endometriotic implant associated to endometriosis in one case and no endometriosis lesions in eight cases. MRI is a method that can realize an accurate presurgical mapping of all localizations of endometriosis. A correct and complete interpretation of the MRI examination facilitates an adapted surgical treatment. The originality of the current study consists in reevaluating the diagnostic criteria for adenomyosis, describing the association of deep endometriosis with uterine adenomyosis and reconsidering the MRI protocol for research of endometriotic lesions.
This paper is intended to provide a concise overview of EBCOG, its organization and background and its activities. More in-depth information on the activities of EBCOG can be found on the EBCOG website: www.ebcog.org. EBCOG is the Board of the Section of Obstetrics and Gynaecology of the Union Europeenne des Medecins Specialistes (UEMS). The Sections are a statutory part of UEMS and the Boards are considered by UEMS to be the Working Groups of the UEMS Sections. The purpose of UEMS is to harmonize and improve the quality of medical specialist practice in the EU. EBCOG’s aim is to improve the health of women and unborn and newborn babies by promoting the highest possible standards of care. EBCOG’s core activities are education and training.
Objective. To evaluate the effect of both pre-pregnant body mass index and gestational weight gain on preterm delivery. Design. Retrospective study using the pregnancy risk Assessment Monitoring System Phase IV data. Setting. Centers for Disease Control and Prevention and 22 state health departments. Sample. Women having delivered a live birth were randomly sampled using stratified systematic sampling. Methods. Women were asked to complete a self administered questionnaire, merged with the respective birth certificate. Those with multiple pregnancies, preterm premature rupture of fetal membranes, and those presenting with several indications for medically induced preterm birth were excluded. A multinomial logistic regression model and the Wald's test were used to estimate and compare adjusted odds ratios associated with risk factors for preterm delivery and potential confounders. Main outcome measure. Gestational age at delivery. Results. The sample included 30,108 women representing a population of 1,495,474. The risk of very preterm birth (<33 WG) was significantly increased when compared to the risk of moderate preterm birth (33-37 WG) in women with either low or excessive weight gain, regardless of body mass index (BMI). Age <18 years, African American origin, Medicaid insurance, no prenatal care, smoking during pregnancy, or a large for gestational age fetus were associated with a significantly increased risk of very preterm birth compared to the risk of moderate preterm birth. Conclusions. Variations and interactions between the rates of pre-pregnant body mass index and weight gain during pregnancy impact preterm delivery. Their effects appear to be interactively related with the risk of preterm delivery and hence should not be studied separately.
There are several situations which may indicate the use of surrogacy like infertility due to uterine factors or medical conditions which make pregnancy and delivery dangerous. The advanced of assisted reproductive technology (ART) made Complete surrogacy possible. The infertile woman donates the oocyte and her husband donates the sperm. The pre-embryo, formed by in vitro fertilization, is placed in the womb of another woman, the surrogate mother. Surrogacy is a source of great controversy in society, the medical profession and the public. The practice of surrogacy is not considered to be a medical treatment according to The World Health Organization. The implementation of surrogate motherhood in an IVF program gives rise to several legal problems. Ethical committees in several countries have dealt with the issue of surrogacy. Surrogacy practice may affect individual liberty, equality and the family. On the one hand, surrogacy appears to reinforce the traditional family by allowing infertile married couples to create biologically-related children. On the other, surrogacy possesses the potential to radically destabilize and disrupt the traditional concept of the family.
Umbilical cord blood (UCB) is an alternative for stem cell transplantation in the treatment of various diseases. Objective. In order to find out whether the maternal, placental or fetal pathology before storage might have an impact on the quality of umbilical cord stem cells (UCBSC) and on the success of sampling and cryopreservation, viability and quantity of UCB were assessed. Methods. All 145 CB samplings with Biogenis Cord Blood Bank between 2007-2009 of 93 healthy pregnant women and 52 women with pregnancy pathology were investigated in a 3 years retrospective multicenter clinical study. Were analyzed: gestational age at delivery, birth weight, child sex, mode of delivery, pregnancy pathology, umbilical cord and placental pathology. Primary outcomes included umbilical cord blood (UCB) amount, white blood cells (WBC) quantity and viability. Results. Neither gestational age, mode of delivery, child sex, maternal, placental or umbilical pathology affected the WBC quantity. By contrast, cumulative associated maternal pathology negatively affected WBC vitality (p=0.038). The placental pathology significantly influenced both UCB amount and CD34+ concentration. The placental pathology and birthweight are independentely correlated to UCB mass. The unsuccessful collection of UCB was signifficantly correlated with placental pathology (p<0.0001). Conclusions. Data of this study show that perinatal factors are influencing the quality or quantity of UCB. Standard multiple regression models may prove useful for predicting successful UCB mass sampling. In addition, sampling conditions procedures are requisite for pursuing the banking and release of quality UCB for successful transplantation.
Objectives. to determine the influence of the APOE genotypes on blood lipid levels, the degree of severity and perinatal outcome of preeclampsia. Study design. the APOE genotypes were performed in 101 pregnant women, 51 preeclamptic and 50 healthy pregnant women using PCR-FRLP methods. We compared genotype and allele frequencies between women with preeclampsia and normal pregnant women by Fisher's exact test two-sided. We calculated odds ratio (OR) and 95% confidence intervals (95% CI). The significance of results was defined as p < 0.05. Results. Different distribution of the APOE genotypes in pregnant women with preeclampsia compared to normal pregnant women was observed. Higher frequency of epsilon 3/epsilon 4 genotypes was found in pregnant women with PIH, mild and severe preeclampsia compared to normal pregnant women. Higher TG and LDL-C levels and lower HDL-C levels in women with the epsilon 4 allele as compared to women with the epsilon 3/epsilon 3 genotype was observed. Preeclamptic women with the epsilon 4 allele delivered earlier neonates with lower birth weight compared to preeclamptic women with epsilon 3/epsilon 3 genotype. The study is of interest in part due to the novelty of the methods applied for the epsilon 4 allele determination. Conclusions: We observed a significant association of the epsilon 3/epsilon 4 genotype with PIH and severe preeclampsia. The epsilon 4 allele represents a risk factor for dyslipidemia and influence the perinatal outcome of preeclampsia.
Objective. Assessment of patients’ profile with post par tum hys te rec tomy. Material and methods. A 8 years retrospective study (2001-2008), conducted in a ter ti a ry referral obstetrical unit, “Dr. Ion Cantacuzino” Cli nical Hospital, Bucharest, with the analysis of the re la tion ship between patient’s history and pregnancy outcome and hysterectomy indication. Results. There were 19388 births (15745 vaginal deliveries (79.81%), 3913 ce sarean sections (CS) (20.18%)), no maternal death. Hys te rec to my was performed in 19 cases (0.98/1000 obstetric ca ses), 7 nulliparas (36.84%) and 12 mul tipara (63.15%). Uni la te ral adnexectomy (UA) was performed in 5 cases. Week end obstetric hysterectomies (WOH, i.e. performed in week end) were 12 (63.15%). Indication for hysterectomy was ute rine atony (7 cases, 36.84 %), placenta accreta (7 cases, 36.84%), ute rine rupture (2 cases, 10,52 %), va gi nal haematoma, vascular fis tu la after cesarean sect ion and uterine myoma (1 case each, 5.26%). Six ca ses (31.57%) were considered preventable obstetric hys te rec to mies (POH): 2 cases of uterine rupture, 2 cases of uterine atony after vaginal delivery, 1 case of vaginal hae ma to ma and 1 case of vascular fistula after cesarean sec tion. POH followed vaginal de livery, respectively CS, in 80%, respectively 14.29%, p = 0.0072. POHs represent 100% of WHs, compared with 46.15% during week; p = 0.0237. WH was associated with severe intraoperative com pli ca tions in 41.66% cases, compared with 0% during week, p = 0.0466. Fetus was dead (anteor intrapartum) in 4 patients with severe intraoperative complications (57,14%), compared with one fetal death in patients with out severe intraoperative com plications (8.33%); p = 0.0198. UA was performed only non-monitored pa tients (5 cases out of 11; 45.45%), compared with 0% in mo ni tored patients (p = 0.0263). UA was necessary in 5 ca ses (71.43%) with dead fetus, com pared with 0% when fe tus was alive; p = 0.0006. Mean haemoglobin loss was 5.52 g/dL in POH, greater than 3.1 g/dL in non-POH; p = 0.0448. Conclusions: Post partum hysterectomy is a week end drama, performed on a mul ti para, with neglected labour, non-monitored; fetal death and ad nexectomy could serve as a retrospective marker of severity.
Vasa previa represents a rare, but very dangerous condition, whose major complication is fetal exsanguination and death in utero. The diagnostic must be set antenatally by ultrasound using transvaginal probe and color Doppler. Most authors recommend the extraction of the fetus by cesarean section at 35 weeks of gestation. It is presented a case of vasa previa diagnosed at 22 weeks, where the extraction of the baby was delayed after 35 weeks of gestation. The mother was under constant surveillance, remained in the hospital after 36 weeks, the membranes was broken spontaneously at 37 weeks and an emergency cesarean section was performed.
Primary ovarian pregnancy is rarely seen. The definitive diagnosis of ovarian pregnancy is difficult before operation and based on Spiegelberg's four criteria. However, destroyed ovarian tissue around the gestational sac in laparoscopic surgery or ruptured ovary at the time of operation can not fulfill Spiegelberg's criteria in some cases. The treatment of choice is laparoscopy, to preserve the reproductive functions of ovary. We suggest that Spiegelberg's criteria require modification for the histopathologic diagnosis of ovarian pregnancy after performed ovarian tissue sparing surgery to preserve fertility.
Nowadays bladder injury during cesarean section is quite uncommon and potentially serious complications are urinary tract infection and formation of vesicovaginal or vesicouterine fistula. There are only few case series of bladder injury at the time of cesarean section in the literature. Most injuries were found intraoperatively, but rarely some may not be recognized during the case. We present a case of late diagnosed bladder perforation at the time of cesarean section and managed by conservative approach. Her clinical picture mimicked renal failure. Conventional cystography failed to demonstrate the bladder perforation, cystoscopy allows recognition of undetected urinary system injury by conventional cystography and intravenous pyelogram. Nonoperative management by concomitant transuretral catheter drainage and ciprofloxacin treatment could be a safe alternative treatment option for even late diagnosed small injuries.
Preterm delivery (PTD) is the main cause of neonatal morbidity and mortality in the developed world, generating a significant public health burden. PTD is a complex disorder and it is unlikely that one generalized prevention strategy will be effective in all patients. The purpose of this review is to follow the recent developments in risk identification and prognostication of PTD in connection with appropriately targeted prophylactic interventions. The recent literature has treated PTD prevention focusing exclusively on either progesterone use or cerclage, leaving the practitioner without any guidance on when to proceed with medical or surgical prophylaxis. Understanding that high risk populations are not homogeneous and no single approach modality is likely to be generally applicable, we have combined the available evidence on both progesterone and cerclage to provide guidance on how to identify subgroups of women at significantly in creased risk for PTD and how to preferentially consider progesterone versus cerclage or viceversa.
Recurrent abortion is defined as three or more consecutive spontaneous abortions before 20 weeks of gestation. The incidence is 0.5-1% of all pregnancies, but the risk of recurrence increases with the number of previous pregnancy failure. Only in 50% of the cases it is possible to identify a causing factor. Most of the cases are due to genetic factors, anatomic abnormalities of the uterus, endocrine factors, infections and immunological factors. Increasingly, however, are discussed the hematological factors, acting either via specific antibodies, or directly, with implications for coagulation and thrombosis process. The fibrinogen deficiencies, the disorders of the Factor XIII and the thrombophilia are still studied and their treatment requires randomized clinical trials for clarification.
The aim of this review was to discuss the role of toll like receptors in the female reproductive tract. Toll-like receptors (TLRs) are considered a link between innate (non-specific) and adaptive (specific) immunity and TLRs contribute to the immune system's capacity to efficiently combat pathogens. This is done by means of the induction of signaling cascades resulting in the induction of type I interferons (IFNs I) and other cytokines. Recognition of pathogen associated molecular patterns (PAMPs) by TLRs results in the activation of signaling events that induce the expression of effector molecules such as cytokines and chemokines. A normal immune response leads to an adequate clearance of the infection, but the key element of the immune response activation is recognition of the pathogen trough TLRs receptors. The immune response in endometriosis is characterized by a small number of TLR 3 and 4 in the endometrial ectopic cells. The naturally powerful immunostimulatory property of TLR agonists can be exploited for active immunotherapy against cancer. The expression levels of TLR3, TLR4 and TLR9 have clinical interest as indicators of tumor aggressiveness in breast cancer. TLRs may represent also therapeutic targets in breast cancer. Dampened TLR expression in the cervical mucosa is a type-specific mechanism by which HPV 16 interferes with innate immune responses, contributing to viral persistence. TLR up-regulation and resultant cytokine induction are important in subsequent viral clearance.
