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Journal de Gynecologie, Obstetrique Et... Dec 2002To clarify the clinical features of ovarian pregnancy and to show the incapacity of Spielberg's criteria to establish the diagnosis. (Review)
Review
OBJECTIVES
To clarify the clinical features of ovarian pregnancy and to show the incapacity of Spielberg's criteria to establish the diagnosis.
MATERIAL AND METHOD
and method. Retrospective experience of ovarian pregnancies in a single maternity unit over seven years with comparison between new diagnostic criteria and those of Spiegelberg.
RESULTS
Thirteen ovarian pregnancies identified (incidence=1 for 1400 deliveries). History of pelvic disease (one case), use of an IUCD (five cases), pelvic pain (all the cases), metrorrhagia (four cases), hemorrhagic shock (two cases). Diagnosis was evoked only once by ultrasound. Eleven patients were treated by laparoscopy. None of the ovarian pregnancies in the present series met the criteria of Spiegelberg's definition.
CONCLUSION
Ovarian pregnancy is a rare form of ectopic pregnancy, but its incidence is certainly underestimated. Search for difficult to detect ultrasonographic features is essential. Criteria, other than those described by Spiegelberg, when present together confirm ovarian pregnancy: serum beta-hCG level > or = 1000 IU/l and uterine vacuity at vaginal ultrasonography; ovarian implication confirmed by surgical exploration, with bleeding, visualisation of chorionic villi or presence of an atypical cyst on the ovary; normal tubes; absence of serum beta-hCG after treatment of the ovary. Ovarian pregnancy does not compromise subsequent fertility of these patients. Recurrence is exceptional.
Topics: Adult; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Intrauterine Devices; Laparoscopy; Pregnancy; Pregnancy, Ectopic; Retrospective Studies
PubMed: 12592193
DOI: No ID Found -
International Journal of Molecular... Aug 2023Recurrent pregnancy loss (RPL) refers to two or more miscarriages before 20 weeks gestation. Its prevalence is 1-2%; its pathogenesis remains unexplained in more than...
Recurrent pregnancy loss (RPL) refers to two or more miscarriages before 20 weeks gestation. Its prevalence is 1-2%; its pathogenesis remains unexplained in more than 50% of cases, in which the cause is thought to be abnormal immune activity during placentation leading to a lack of pregnancy-induced immune tolerance. It is unknown whether immune activity is deranged in the endometrium of women with RPL. We studied the gene expression and the quantitative tissue protein levels of three immune checkpoints (CD276, which enhances cytotoxic T-cell activity, cytotoxic T-lymphocyte-associated antigen-4 [CTL-4], which reduces Th1 cytokine production, and lymphocyte activation gene-3 [LAG-3], which shows suppressive activity on Tregs and CD4+ T-cells) in endometrial samples from 27 women with unexplained RPL and in 29 women with dysfunctional uterine bleeding and previous uneventful pregnancies as controls. RNA isolation, real-time PCR, protein isolation, and ELISA were performed. CD276 gene expression and protein tissue levels were significantly lower in the endometrium of the RPL group than in the controls, whereas both CTL-4 and were significantly higher. This difference suggests defective endometrial immune regulation and overactivation of immune response in women with a history of RPL, at least in relation to controls with dysfunctional uterine bleeding and previous normal reproductive history.
Topics: Pregnancy; Female; Humans; Metrorrhagia; Genes, Regulator; Transcription Factors; Abatacept; Abortion, Habitual; B7 Antigens
PubMed: 37685876
DOI: 10.3390/ijms241713071 -
American Journal of Obstetrics and... May 2020Changes in menstrual bleeding concern many users of the 52 mg Levonorgestrel Intrauterine System. Prescribing information for Levonorgestrel Intrauterine System devices... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Changes in menstrual bleeding concern many users of the 52 mg Levonorgestrel Intrauterine System. Prescribing information for Levonorgestrel Intrauterine System devices describe an overall decrease in bleeding and spotting days over time; however, estimates derived from a variety of existing clinical data are currently unavailable.
OBJECTIVE
The objective of the study was to systematically calculate the mean days of bleeding-only, spotting-only, and bleeding and/or spotting experienced by a population of reproductive-aged Levonorgestrel Intrauterine System users with normal regular menses prior to insertion during the first year of use.
DATA SOURCES
We identified clinical trials, including randomized controlled trials and randomized comparative trials, as well as cohort studies published in English between January 1970 and November 2018 through searching 12 biomedical and scientific literature databases including MEDLINE and ClinicalTrials.gov.
STUDY ELIGIBILITY CRITERIA
We considered studies that reported data on Levonorgestrel Intrauterine System devices releasing 20 μg of levonorgestrel per day, collected daily menstrual bleeding data for at least 90 consecutive days, defined bleeding and spotting per World Health Organization standards and evaluated participants with normal regular menses prior to insertion.
STUDY APPRAISAL AND SYNTHESIS METHODS
We assessed study quality using established guidelines. Two reviewers independently conducted all review stages and rated the quality of evidence for each article; any disagreements were resolved by a third. Where possible, we pooled data using a random-effects model.
RESULTS
Among 3403 potentially relevant studies, we included 7 in our meta-analysis. We calculated the mean days of bleeding-only, spotting-only, and bleeding and/or spotting for the first four 90 day intervals after Levonorgestrel Intrauterine System insertion. Combined menstrual bleeding and/or spotting days gradually decreased throughout the first year, from 35.6 days (95% confidence interval, 32.2-39.1) during the first 90 day interval to 19.1 (95% confidence interval, 16.6-21.5), 14.2 (95% confidence interval, 11.7-16.8), and 11.7 days (95% confidence interval, 9.7-13.7) in the second, third, and fourth intervals. Measures for bleeding-only and spotting-only days similarly decreased throughout the first year, with the greatest decreases occurring between the first and second intervals.
CONCLUSION
Our study provides 90 day reference period measures that characterize menstrual patterns for Levonorgestrel Intrauterine System users with normal regular menses prior to insertion during the first year of use. Our findings provide broader generalizability and more detail than patterns described in the prescribing information. These findings quantify an overall decrease in menstrual bleeding days with longer duration of use, with the greatest decrease occurring between months 3 and 6. Accurately establishing expectations with the Levonorgestrel Intrauterine System may improve informed selection and decrease discontinuation.
Topics: Adult; Contraceptive Agents, Female; Female; Humans; Intrauterine Devices, Medicated; Levonorgestrel; Menstruation; Metrorrhagia; Time Factors
PubMed: 31589865
DOI: 10.1016/j.ajog.2019.09.044 -
Medicine Dec 2021Adenomyosis (AM) is a disease in which the endometrium (including glands and stroma) invades the myometrium and grows. The main clinical symptoms include menorrhagia,...
BACKGROUND
Adenomyosis (AM) is a disease in which the endometrium (including glands and stroma) invades the myometrium and grows. The main clinical symptoms include menorrhagia, dysmenorrhea, chronic pelvic pain, metrorrhagia, and dyspareunia, which will seriously affect the physical and mental health of patients, and most of which occur in women of childbearing age. Acupuncture, as a special external treatment of Traditional Chinese medicine, has shown good effects in the treatment of adenomyosis. At present, there is a lack of systematic review on acupuncture in the treatment of adenomyosis. We conduct this study to evaluate the efficacy and safety of acupuncture in the treatment of adenomyosis.
METHODS
We will search Chinese and English databases: Medline, Pubmed, EMBASE, Cochrane library, China National Knowledge Infrastructure (CNKI), Chinese Scientific and Journal Database, Wan Fang database (Wanfang), Chinese Biomedical Literature Database (CBM) to identify articles of randomized clinical trials of acupuncture for adenomyosis. All above electronic databases will be searched from inception to September 30, 2021. RevMan 5.3 software will be used to conduct this systematic review. No language and publication status restrictions will be applied.
RESULTS
The study will prove the efficacy and safety of acupuncture for adenomyosis.
CONCLUSION
We plan to submit this systematic review to a peer-reviewed journal.
TRIAL REGISTRATION NUMBER
CRD42021277136.
Topics: Acupuncture Therapy; Adenomyosis; Dysmenorrhea; Female; Humans; Infertility; Menorrhagia; Meta-Analysis as Topic; Research Design; Systematic Reviews as Topic
PubMed: 34889257
DOI: 10.1097/MD.0000000000028080 -
BMJ Open Jul 2023Emicizumab prophylaxis substantially reduces bleeding episodes in patients with haemophilia A (HA). The haemostatic efficacy of emicizumab in patients with HA is... (Clinical Trial)
Clinical Trial
Study protocol for assessment of the coagulation potential of concomitantly used factor VIII concentrates in patients with haemophilia A with emicizumab prophylaxis (CAGUYAMA Study): a multicentre open-label non-randomised clinical trial.
INTRODUCTION
Emicizumab prophylaxis substantially reduces bleeding episodes in patients with haemophilia A (HA). The haemostatic efficacy of emicizumab in patients with HA is estimated as approximately 15% based on mimic activity of factor (F) VIII. Although it has been proven effective in preventing bleeding, its haemostatic effect during breakthrough bleeding or surgery is considered insufficient. Therefore, haemostatic management of emicizumab-treated patients with HA without inhibitors frequently requires FVIII replacement therapy. In haemostatic management of emicizumab-treated patients with HA, conventional FVIII dosage calculations are used in clinical practice without considering the coagulant effects of emicizumab.
METHODS AND ANALYSIS
In the CAGUYAMA study, 100 patients with HA without inhibitors will be enrolled for a maximum duration of 1 year, and samples of 30 events following the concomitant use of FVIII concentrates (30±5 U/kg) with emicizumab will be collected. An 'event' is defined as obtaining blood samples at preadministration and postadministration of FVIII concentrates during a breakthrough bleeding or a surgical procedure. Global coagulation assays will be used to measure the coagulation potential of the obtained samples. Clot waveform analysis (CWA) is used to identify the primary end-point, that is, the degree of improvement in the maximum coagulation rate at preadministration and post-administration of fixed-dose FVIII concentrations. The parameter obtained from CWA, which is triggered by an optimally diluted mixture of prothrombin time reagent and activated partial thromboplastin time reagent, is reported to be an excellent marker for assessing the degree of improvement of the coagulation potential in emicizumab-treated plasmas.
ETHICS AND DISSEMINATION
The CAGUYAMA study was approved by the Japan-Certified Review Board of Nara Medical University (Approval ID; nara0031). The study results will be communicated through publication in international scientific journals and presentations at (inter)national conferences.
TRIAL REGISTRATION NUMBER
jRCTs051210137.
Topics: Humans; Female; Factor VIII; Hemophilia A; Metrorrhagia; Hemostatics; Multicenter Studies as Topic
PubMed: 37429679
DOI: 10.1136/bmjopen-2023-072565 -
The Malaysian Journal of Pathology Dec 2022Adequate sampling of gross pathology specimens and attention to microscopic details is crucial in establishing the correct diagnosis in a patient, regardless of a benign...
Adequate sampling of gross pathology specimens and attention to microscopic details is crucial in establishing the correct diagnosis in a patient, regardless of a benign pre-surgical diagnosis. Adenoma malignum is a rare HPV-negative variant of well-differentiated adenocarcinoma of the endocervix. It is difficult to diagnose in surgical pathology specimens due to its deceptively-benign appearance. This was a case of a 43-year-old woman with a history of menorrhagia and metrorrhagia and radiology interpretation of degenerating uterine fibroids. Pre-operative Pap testing and hysteroscopic dilatation and curettage were non-contributory. Following surgery, microscopic examination of the cervix revealed well-spaced, deeply-invasive, variably-sized glands with irregular outlines/haphazard arrangements, lined by cells showing mild to moderate cytologic atypia. These cells were positive for p53 and CK7 on Immunohistochemistry and Ki-67 showed a high proliferative index. Monoclonal CEA, calretinin, CD10, and P16 were all negative. A diagnosis of adenoma malignum stage pT1b2 was made. The patient was subsequently placed on platinum-based chemotherapy and is doing well 2 years after her diagnosis. Cases such as this, underscore the importance of adequately sampling surgical resection specimens, with careful attention to microscopic details as incidental pathologies may be unearthed which could have significant implications on a patient's clinical outcome.
Topics: Humans; Female; Adult; Cervix Uteri; Incidental Findings; Uterine Cervical Neoplasms; Adenocarcinoma; Adenoma
PubMed: 36591722
DOI: No ID Found -
Psychiatry and Clinical Neurosciences Apr 2007
Topics: Adult; Antimanic Agents; Bipolar Disorder; Female; Humans; Lithium; Lithium Chloride; Metrorrhagia
PubMed: 17362442
DOI: 10.1111/j.1440-1819.2007.01640.x -
Canadian Medical Association Journal Feb 1964Historical aspects of dilatation and curettage are discussed and the indications reviewed for this procedure in three major age-groups: (1) childhood and adolescence,...
Historical aspects of dilatation and curettage are discussed and the indications reviewed for this procedure in three major age-groups: (1) childhood and adolescence, (2) maturity and reproductive period, (3) menopause and post-menopause. As the most frequently performed obstetrical and gynecological procedure, it is not an innocuous operation, and clear-cut indications for its use are presented with reference to abnormal vaginal bleeding in all age groups, infertility, functional ovarian tumours, neoplasia of the uterus, cervical biopsy, and major pelvic surgery. It is concluded that dilatation and curettage has a major place in the diagnostic and the therapeutic armamentarium of the thorough obstetrician and gynecologist.
Topics: Abortion, Induced; Adolescent; Child; Dilatation and Curettage; Dysmenorrhea; Female; Geriatrics; Hemorrhage; Humans; Hydatidiform Mole; Hysterectomy; Infertility; Infertility, Female; Menopause; Menorrhagia; Metrorrhagia; Minor Surgical Procedures; Neoplasms; Ovarian Neoplasms; Postmenopause; Pregnancy; Pregnancy Complications; Pregnancy, Ectopic; Uterine Cervical Neoplasms; Uterine Hemorrhage; Uterine Neoplasms; Uterus
PubMed: 14122467
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Jul 2023: The purpose of this study was to describe and evaluate the bleeding that occurs during the first weeks of gestation and its implications throughout pregnancy....
: The purpose of this study was to describe and evaluate the bleeding that occurs during the first weeks of gestation and its implications throughout pregnancy. Secondarily, we assessed the associated complications in order to identify potential risk factors that could be used to select women at higher risk of adverse outcomes that could benefit from an early diagnosis and improved monitoring. : We made a selection of all the women who consulted in the Emergency Department of the Hospital QuirónSalud in Malaga on 2015 presenting with first trimester metrorrhagia. We refer to first trimester metrorrhagia as that which occurs until week 12 + 6. Once these pregnant women were identified, we studied several variables not related to the gestation and some others associated with it and its natural course. : The average age of the patients assessed was 34.1. Associated gestational complications were metrorrhagia in the second trimester (6.3%), threatened preterm labor (7.4%), preeclampsia (2.5%), gestational diabetes (7.4%), late abortion (1.2%), and early postpartum hemorrhage (1.8%). We sought associations to assess possible risk factors, establishing an increased maternal age as an aggravating factor for the development of complications. We also studied gestational complications, finding a higher prevalence of them in older women, such as prematurity (33.11 vs. 34.48 years), gestational diabetes (33.11 vs. 36.06 years), and preeclampsia (33.25 vs. 35 years). : Maternal age is a risk factor for first-trimester spontaneous miscarriage and for the development of complications of pregnancy. It is crucial to perform a correct screening of different pathologies throughout the pregnancy to anticipate potential complications.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Aged; Metrorrhagia; Retrospective Studies; Diabetes, Gestational; Pre-Eclampsia; Pregnancy Trimester, First; Follow-Up Studies
PubMed: 37629660
DOI: 10.3390/medicina59081370 -
Sexual Medicine Sep 2017Desquamative inflammatory vaginitis is a poorly understood chronic vaginitis with an unknown etiology. Symptoms of desquamative inflammatory vaginitis include copious...
Desquamative inflammatory vaginitis is a poorly understood chronic vaginitis with an unknown etiology. Symptoms of desquamative inflammatory vaginitis include copious yellowish discharge, vulvovaginal discomfort, and dyspareunia. Cervical ectropion, the presence of glandular columnar cells on the ectocervix, has not been reported as a cause of desquamative inflammatory vaginitis. Although cervical ectropion can be a normal clinical finding, it has been reported to cause leukorrhea, metrorrhagia, dyspareunia, and vulvovaginal irritation. Patients with cervical ectropion and desquamative inflammatory vaginitis are frequently misdiagnosed with candidiasis or bacterial vaginosis and repeatedly treated without resolution of symptoms. We report the case of a 34-year-old woman with a 4-year history of profuse yellowish discharge and dyspareunia. Upon presentation, her symptoms and laboratory results met the criteria for desquamative inflammatory vaginitis, but the standard treatments did not provide long-lasting relief. As a last resort, cryotherapy (cryosurgery) of her cervix was performed for treatment of her cervical ectropion, which provided complete resolution of her symptoms. Mitchell L, King M, Brillhart H, Goldstein A. Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis. Sex Med 2017;5:e212-e214.
PubMed: 28460993
DOI: 10.1016/j.esxm.2017.03.001