Carlos Calhaz-Jorge

Acute effects of maternal cigarette smoking on fetal heart rate and fetal body movements felt by the mother

Acute effects of maternal cigarette smoking on fetal heart rate (FHR) and fetal body movements felt by the mother (FM) were studied in 51 pregnant volunteers. Thirty four were chronic smokers (6 or more cigarettes per day, with an average of 14 cigarettes/day) and 17 were sporadic smokers (1 to 5 cigarettes per day, with an averaged of 3 cigarettes/day). In both groups the number of FM, fetal reactivity and short-term FHR variability decreased significantly in the 20 minutes following cigarette smoking; a sustained FHR rise of 10 or more beats/min was also found after the cigarette in more than 50% of the cases in the 2 groups. No statistically significant differences were found among the 2 groups when the post-cigarette data were compared. We conclude that maternal cigarette smoking produces important acute effects upon FM and FHR regardless the average daily number of cigarettes smoked by the mother.

Somatic stem cells and their dysfunction in endometriosis.

Emerging evidence indicates that somatic stem cells (SSCs) of different types prominently contribute to endometrium-associated disorders such as endometriosis. We reviewed the pertinent studies available on PubMed, published in English language until December 2014 and focused on the involvement of SSCs in the pathogenesis of this common gynecological disease. A concise summary of the data obtained from in vitro experiments, animal models, and human tissue analyses provides insights into the SSC dysregulation in endometriotic lesions. In addition, a set of research results is presented supporting that SSC-targeting, in combination with hormonal therapy, may result in improved control of the disease, while a more in-depth characterization of endometriosis SSCs may contribute to the development of early-disease diagnostic tests with increased sensitivity and specificity. Key message: Seemingly essential for the establishment and progression of endometriotic lesions, dysregulated SSCs, and associated molecular alterations hold a promise as potential endometriosis markers and therapeutic targets.

Influence of body mass index in anti-Müllerian hormone levels in 951 non-polycystic ovarian syndrome women followed at a reproductive medicine unit

PurposeAnti-Müllerian hormone (AMH) is a useful marker of ovarian reserve. Obesity/overweight are increasing and may affect the reproductive health. Previous studies regarding the effect of body mass index (BMI) on AMH levels are discordant. Our main goal was to evaluate the influence of BMI on AMH levels in women without polycystic ovarian syndrome.MethodsRevision of medical records of 951 women who performed AMH determinations as part of their fertility workup, between 2011 and 2016.ResultsMedian AMH concentration was 1.75 [interquartile range (IQR) 2] ng/mL (12.9 pmol/mL) and median age at AMH determination was 35 (IQR 6) years. These women evidenced a median BMI of 23 (IQR 5) kg/m2. Caucasian women were more represented [889(89.3%)]. Smoking habits (present/past) were present in 359(36.1%), and 147(14.8%) harboured a history of ovarian surgery. On univariable analysis AMH was not correlated with BMI (r = 0.048/p = 0.135); the only factors influencing AMH were age (p < 0.001), ethnicity (p = 0.004), and previous ovarian surgery (p < 0.001). On multivariable analysis, age was the only variable significantly associated with AMH, evidencing a reduction of 6.2% for each additional year (p < 0.0001). Furthermore, we verified a trend suggesting an AMH reduction of 22% (p = 0.08) in black patients comparing with the caucasian ones, when controlling for the other variables.ConclusionWe report one of the largest series evaluating the influence of BMI on AMH levels and, consequently, on ovarian reserve. BMI does not seem to affect AMH levels. The reported concerns on infertility in overweight and obese women may be related to follicular development/oocyte maturation or endometrial disorders, rather than decreased ovarian reserve.

An approach to interpretation and classification of sinusoidal fetal heart rate patterns

Sinusoidal fetal heart rate (SHR) records were obtained in 8 cases, either antepartum (3 cases of fetal Rh disease) or intrapartum (one case with an acute episode of fetomaternal transfusion as possible cause, 2 after meperidine administration to the mother and 2 others without attributable causes). Characteristics of both SHR patterns and related clinical pictures are described and compared to similar cases published elsewhere. The possible underlying mechanisms of SHR are discussed. Two different profiles of SHR patterns (smooth and jagged waveforms) are characterized and correlated with their most usual clinical backgrounds and prognostic significance. A classification of SHR into 2 main types is proposed, with clinical use in mind.

Topical Therapy With Imiquimod for Vaginal Intraepithelial Neoplasia: A Case Series.

V aginal intraepithelial neoplasia (VaIN) is a far less common premalignant condition of the genital tract compared with cervical intraepithelial neoplasia (CIN), and almost all knowledge about its pathophysiology is based on extrapolation from cervical neoplasia. Vaginal intraepithelial neoplasia is classified according to the depth of epithelial involvement: VaIN1 involves the lower one third, VaIN2 involves the lower two thirds, and VaIN3 involves more than two thirds of the epithelium. Carcinoma in situ (CIS) is included in VaIN3. In 2012, the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology, as part of lower anogenital squamous terminology, proposed a revised classification, replacing VaIN1 for low-grade VaIN (vaginal low-grade squamous intraepithelial lesion [LSIL]) and VaIN2 and VaIN3 for high-grade VaIN (vaginal high-grade squamous intraepithelial lesion [HSIL]). Imiquimod 5% cream has been reported as a possible treatment of external genital warts and low-grade/high-grade vulvar intraepithelial neoplasia, acting as an immunemodulator of the response to human papillomavirus (HPV), by inducing the secretion of interferon α, interleukin 12, and tumor necrosis factor α from mononuclear cells. The purpose of this study was to describe a case series of patients who received imiquimod 5% cream for high-grade VaIN (see Table 1) and a summary of the available evidence regarding the potential therapeutic role of imiquimod in the conservative treatment of VaIN. All lesions were diagnosed using a colposcope with application of acetic acid 5% solution and Lugol iodine and were confirmed by guided biopsy. Our protocol of treatment consisted of 1 sachet of 5% imiquimod cream applied with a spatula by a clinician to vaginal lesions 3 times a week for 12 weeks. Follow-up included clinical examination at 1 month and then periodical vaginal cytology and colposcopy every 6 months. The hospital ethical committee granted permission for the anonymous retrospective studies, and all patients gave consent to the use of data and anonymous images for scientific purposes.

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome

INTRODUCTION Polycystic ovary syndrome is the most frequent cause of anovulatory infertility and management involves a multistep approach. Laparoscopic ovarian diathermy is accepted as a second-line treatment of patients who failed to respond to clomiphene citrate. The aims of this study were to determine the efficacy of this technique at short and long-term and to perform an analysis of predictive factors of spontaneous pregnancy. MATERIAL AND METHODS This retrospective study involved 76 women who underwent laparoscopic ovarian diathermy between 2004 and 2013 in a university hospital. Main outcomes were cycle regularity and pregnancy. Short-term outcomes recorded during followup in our centre were reviewed and long-term outcomes were evaluated by a telephone interview to all women whose surgery was undertaken more than three years ago. Clinical and biochemical data were analysed as predictive factors of spontaneous conceptionin patients without other infertility factors. RESULTS Menstrual cycle regularity was initially achieved in 53 (70%) women and in the long-term follow-up subgroup, 52% (12/23) had regular periods. In general, 53 (70%) women conceived and 77 pregnancies were achieved, 60% of which were spontaneous. The only prognostic factor found to be significantly associated with spontaneous conception was a shorter duration of infertility (< 3 years) (p < 0.05). DISCUSSION Laparoscopic ovarian diathermy showed pregnancy rates comparable to other ovulation induction treatments with the advantage of having a long lasting beneficial effect in menstrual regularity and fertility. CONCLUSION Laparoscopic ovarian diathermy is a safe and effective treatment option for anovulatory infertility in women with polycystic ovary syndrome.

European view of subspecialty training on behalf of the European Society of Human Reproduction and Embryology (ESHRE).

Specialist training in reproductive medicine within Europe continues to evolve. Recent revisions, updates, and initiatives have helped to refine the core educational needs for the specialist trainee.