Uterine transplantations are a groundbreaking procedure for women with uterine factor infertility (UFI). Through this procedure, women with UFI are able to carry and deliver their own biological children with the implementation of a live or dead donor uterus. With the recent birth of a baby from a dead donor uterus in Penn Medicine’s UNTIL trial, uterine transplantations are being considered as a viable third option for women with UFI. Traditionally, women with UFI have only had the option of adoption or in-vitro-fertilization (IVF) using a gestational carrier. Despite the rapid advances in the development of uterine transplantations, the ethical issues surrounding this novel procedure have been vaguely addressed. In this paper, we will analyze the ethical concerns surrounding uterine transplantations, which includes a consideration of emotional, physical, psychological, and financial factors. With an understanding of these ethical concerns, we will make an argument for the use of uterine transplantations for women with UFI. Recommendations for the selection of donors and recipients for uterine transplantations will also be provided.
Study Objective: In Nigeria, sexual assault is now a silent epidemic among adolescents. Accurate data are needed to prevent it. We aimed at estimating the prevalence and predictors of sexual assault among adolescents in Ekiti State, Nigeria. Methods: This was a cross-sectional cohort study involving 192 senior public high students across 16 local government areas in Ekiti State, Nigeria. Self-administered structured questionnaires were used to obtain data from participants during a summer youth camp in August 2019. Data were analysed with SPSS version 20. A p value < 0.05 is taken as statistically significant. Results: Twelve adolescents (6.3%) among the respondents had been sexually assaulted prior to this survey, and both sexes were evenly affected. Route of sexual intercourse (χ2 =69.37, p<0.001), age at sexual debut (χ2 =66.56, p <0.001), prior experience of non-contact sexual violence (χ2=18.06, p=0.002) and having a friend who had procured an abortion (χ2= 7.68, p=0.010) were significantly associated with sexual assault. Experience of sexual assault was predicted by having a friend who had procured abortion (adjusted odds ratio [AOR] 4.23; 95% Confidence Interval [C.I.]: 1.05 – 17.00, p = 0.042), and having suffered two or more variants of non-contact sexual violence (AOR 8.44; 95% C.I.: 1.92 – 37.03, p = 0.005). Conclusion: Sexual assault is prevalent among the study population. There is a need to design institutional framework for identifying, reporting, preventing and accessing medical care immediately after non-contact sexual violence and sexual assault in order to ensure prosecution of perpetrators.
Objective: To assess the optimal elective cesarean section schedule for uncomplicated twin pregnancy, we examined the incidence of intrapartum cesarean delivery before the scheduled date in twin pregnancy. Methods: We reviewed the obstetric records of 184 uncomplicated dichorionic twin pregnancies planned elective cesarean delivery beyond 37 weeks of gestation due to maternal request at Japanese Red Cross Katsushika Maternity Hospital form 2002 through 2017. In this study, we examined the changes in the incidence of intrapartum cesarean delivery before scheduled date and the incidence of neonatal respiratory disorders. Results: the incidence of neonatal respiratory disorders was decreased beyond 37+3 weeks of gestation (p = 0.03), while the incidence of the intrapartum cesarean delivery was increased beyond 37+6 weeks of gestation (p < 0.01). Conclusion: The optimal timing of scheduled cesarean delivery for uncomplicated twin pregnancy was estimated to be 37+3-37+5 weeks.
SummaryThrombocytopenia is observed in 6 to 15% of pregnant women at the end of pregnancy, and is usually moderate. Gestational thrombocytopenia (defined as a mild thrombocytopenia, occurring during the 3rd trimester with spontaneous resolution postpartum and no neonatal thrombocytopenia) is the most common cause of thrombocytopenia during pregnancy but a low platelet can also be associated with several diseases, either pregnancy specific or not, such as preeclampsia, HELLP syndrome, or idiopathic thrombocytopenic purpura (ITP). The differential diagnosis between ITP and gestational thrombocytopenia is clinically important with regard to the fetus, due to the risk of neonatal thrombocytopenia. However, this differential diagnosis is very difficult during pregnancy.Thrombocytopenia which need to be investigated are the following: thrombocytopenia known before pregnancy, thrombocytopenia occurring during the 1st and 2nd trimester, platelet count < 75 G/l in the 3rd trimester or thrombocytopenia in case of pregnancy with complications. Investigations have to be discussed in function of history and clinical examination, gestational age and severity of thrombocytopenia.No treatment is required in case of gestational thrombocytopenia. There are few data to distinguish management of ITP between pregnant and non-pregnant women but management is different because of the potential adverse effects of the treatment for the woman and/or the fetus, the requirement for a good hemostasis at delivery and the risk of neonatal hemorrhage. One important problem is that it is not possible to predict the risk of neonatal thrombocytopenia in babies born from women with ITP.
Topical use of lidocaine is more effective than oral Ibuprofenat reducing pain during office-based gynaecological procedures. Additionally, a topical spray increases overall patient satisfaction with pain control during procedure.
Objective : to evaluate the accuracy 3D transvaginal ultrasound with SIS in the assessment of the endometrial cavity in women undergoing first IVF. Study design : This is prospective observational cross-sectional study. Women prepared for first trial of IVF were evaluated by 3D transvaginal ultrasound with saline infusion sonohysterography followed by office hysteroscopy. RESULTS : 581 patients were eligible for the study. Three-dimensional transvaginal sonography and saline infusion sonography in comparison with office hysteroscopy demonstrated 100% sensitivity, 100% specificity in detection of uterine anomalies. However, it demonstrated 79.4% sensitivity, 99.6% specificity in detection of endometrial polyp. Furthermore, its sensitivity and specificity was 75%, 100% in detection of intrauterine adhesions. Conclusion : Three-dimensional saline infusion sonography can be considered not only a safe and reliable tool for evaluation of uterine abnormality but also as an alternative tool to office hysteroscopy in infertile patient prior to 1st trial of IVF.
Neu-Laxova syndrome (NLS) is a rare, lethal and multisystemic disease that can be identified by ultrasound (1). Currently about 70 cases are reported (1,2) and two variants of the disease have been described. In type 1 cases there is no accumulation of subcutaneous adipose tissue while type 2 cases exhibit fat deposition on the skin, which causes the echographically visible 'subcutaneous edema' (1,3). The authors present a case of a full-term newborn affected by NLS.
Although fundamental treatment of hypertensive disorders of pregnancy is termination of pregnancy, prematurity of infants becomes a problem and careful management is required in the early gestational weeks. We report a 21-year-old woman who had a dichorionic, diamniotic twin pregnancy and conceived naturally, but fetal growth restriction occurred in one fetus from early pregnancy. Symptoms of preeclampsia appeared from 25 weeks’ gestation. Maternal symptoms improved at 32 weeks’ gestation with intrauterine fetal death of one twin as a trigger. Continuation of pregnancy became possible and a healthy child was delivered at 37 weeks’ gestation. Few such cases of complete resolution of preeclampsia following the death of a single fetus have been previously reported. In this report, we discuss our case in the context of these other cases.
Introduction Avulsion of the levator ani muscle is a major issue that can arise as a result of childbirth. The risk of avulsion of the levator ani muscles increased when operative vaginal delivery was performed. Operative vaginal deliveries are forceps extraction or vacuum extraction. Delivery by vacuum extraction considered to have a higher risk for levator ani avulsion compared to forceps extraction delivery. Two-dimensional ultrasonography is a tool that can diagnose the presence of avulsion of the levator ani muscle. Method This study was a cross-sectional analytical study. The samples were 17 patients who delivered with forceps extraction and 17 patients gave birth with vacuum extraction, in the period from August to November of 2013, and then compared the incidence of levator ani avulsion. Result There were significant differences in the incidence of levator ani avulsion between forceps and vacuum extraction deliveries (p<0,05). Avulsion of the levator ani muscles occurred in 8 patients (47,1%) with forceps extraction, and 2 patients (11,8%) in the vacuum extraction. There were a total of 10 levator ani muscles avulsions. On repeat ultrasound examination 42 days after delivery, all of levator ani may still be found. Conclusion There are differences in the incidence of avulsion of the levator ani between forceps and vacuum extraction. The incidence of avulsion of the levator ani muscle is higher in forceps compared to delivery by vacuum extraction.
Background: Peripartum cardiomyopathy (PPCM) is an unusual and uncommon form of non-ischemic dilated cardiomyopathy that presents in the last month of pregnancy or within 5 months after delivery in the absence of other causes. The incidence of PPCM is 1 in 3.000 normal pregnancies with mortality rate as high as 50% to 75%. Etiology of PPCM could be many potential causes, including viral myocarditis, abnormal immune response in pregnancy and abnormal response to the increased hemodynamic burden of pregnancy. The occurrence of PPCM in woman with preeclampsia is a very rare case. This case series present two women with preeclampsia underwent Cesarean Section and suffered by PPCM. The limitation on data and the rarity of similar case cause difficulties in the management.
