E. Wozniakowska

Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three‐dimensional ultrasound: prospective observational study

To compare the effects of two alternative treatment options for uterine fibroids, ulipristal acetate (UPA) and uterine artery embolization (UAE), on fibroid volume and vascularity at 3‐month follow‐up.

Infertility in the light of new scientific reports – focus on male factor

Epidemiological data indicate that infertility is a problem of global proportions, affecting one- fifth of couples trying to conceive worldwide (60-80 mln). According to the trends observed, the problem is predicted to increase by another two million cases annually. In Poland, infertility-related issues are found in about 19% of couples, including 4% with infertility and 15% with limited fertility. Inability to conceive occurs equally in men and women (50%), irrespective of the direct cause. Although it is generally thought that reproductive issues concern women, infertility affects men and women equally. This study is an attempted to systematize knowledge about the role of the male factor in infertility, particularly current knowledge concerning the environmental factors of infertility. For this purpose, the Medline and CINAHL databases and the Cochrane Library was searched for articles published in English during the last 10 years, using the following keywords: infertility, male factor, semen examination and environmental factor of infertility.

Delayed Diagnosis of Herlyn-Werner-Wunderlich Syndrome due to Microperforation and Pyocolpos in Obstructed Vaginal Canal

BACKGROUND To present a rare anomaly consisting of uterus didelphys, longitudinal vaginal septum, obstructed hemivagina with pyocolpos, fistula to the open vaginal canal, and ipsilateral renal agenesis, referred as Herlyn-Werner-Wunderlich syndrome (HWWS). CASE A 14-year-old girl with recurring purulent vaginal discharge lasting for a few months. Preoperative examination revealed one vaginal canal with one cervical opening on the right side. There was a fistula leading from the obstructed vaginal canal to the left vagina. Intravaginal ultrasound examination demonstrated a longitudinal vaginal septum and a closed pyocolpos on the right side. The longitudinal vaginal septum was excised by way of electrocauterization under direct vision. CONCLUSION HWWS should be considered in the differential diagnosis in patients with uterus didelphys and unusual symptoms such as pyocolpos and vaginal discharge.

A case of unusual course of adolescent menorrhagia: decidual cast as a side effect of treatment

OBJECTIVE To present an unusual side effect of therapy for adolescent menorrhagia, with commentary on management options. DESIGN Case report. SETTING Tertiary gynecologic center. PATIENT(S) A 13-year-old girl presenting with profuse uterine bleeding. INTERVENTION(S) Dysfunctional uterine bleeding was diagnosed, and pharmacologic therapy with a monophasic oral contraceptive (OC) pill was introduced. MAIN OUTCOME MEASURE(S) A large decidual cast occurred during treatment. RESULT(S) After finishing therapy with OC followed by three cycles of cyclic progestogen, the patient experienced regular menses. CONCLUSION(S) A large decidual cast may occur during treatment of adolescent menorrhagia with OCs; patients should be informed about this possibility, to reduce stress connected with the appearance of this side effect.

Primary ovarian Burkitt’s lymphoma: a rare oncological problem in gynaecology: a review of literature

PurposeThis review presents the information about epidemiology, clinical manifestation, diagnosis and treatment of primary ovarian Burkitt’s lymphoma (BL), including a literature search of available BL cases. The purpose of this review is to draw clinicians’ attention to the possibility of ovarian BL occurrence, which may be important in the differential diagnosis of ovarian tumours.MethodsPubMed and Web of Science databases were searched using the keywords ‘‘Burkitt’s’’, ‘‘Lymphoma’’, ‘‘Ovarian’’, ‘‘Primary’’, ‘‘Burkitt’s lymphoma’’. Only cases with histopathologically confirmed diagnosis of primary ovarian BL were included in this review.ResultsFifty articles, reporting cases with an ovarian manifestation of primary non-Hodgkin’s lymphoma, were found. Twenty-one cases with a histopathologically confirmed BL were evaluated to compare various manifestations, treatment and prognosis in ovarian BL.ConclusionsPrimary ovarian BL is a rare condition, included in the entity of non-Hodgkin lymphoma. The tumour can occur uni- or bilaterally in the ovaries with major symptoms such as abdominal pain or a large abdominal mass. Differential diagnosis, based on imaging features and pathological examination of the specimens, is essential for further treatment due to various aetiology of ovarian tumours. Although most of the patients suffering from ovarian BL underwent surgery after the ovarian tumour had been detected, surgical treatment is not the treatment of choice in patients with ovarian lymphoma. The mainstay of therapy is chemotherapy without further surgery. The prognosis is better if the chemotherapy protocol is more aggressive and followed by prophylactic central nervous system chemotherapy. Nowadays, multiagent protocols are administered, which improves the survival rate.

P45.02: Ultrasound examination of the female utrethra after short‐term intravaginal estrogen treatment

Objective: The depletion of estrogens during the menopause period seems to be the cause of improper metabolism thus influencing the morphological structures of the lower urinary tract (LUT). Transvaginal ultrasound examination provides the serious possibility of the detailed assessment of the female LUT structures. The aim of the study was to evaluate the influence of vaginally administered estrogens on ultrasonographic features of the urethra in menopausal women. Material and methods: The studied group consisted of 25 menopausal women not suffering from any form of urinary incontinence. The urethral wall thickness and urethral funneling were measured before, after 1, and after 3 months of treatment with vaginal estrogens. The selected variables were measured 3 times as a single dimension using a 7.5 MHz transvaginal probe (Medison SONOACE 9900 Prime) in the sagittal plane. Transvaginal power Doppler ultrasonography was used to study the pulsatility index (PI) and resistence index (RI) of arterial vessels in the examined structure. Results: The median values of urethral wall thickness and urethral funneling before, after 1 month and after 3 months of local administration of estrogens were 3.7, 3.8, 3.9 mm (Friedman ANOVA, ÷2 = 6.36, P = 0.042) and 3.7, 3.6, 3.6 mm (Friedman ANOVA, ÷2 = 8.61, P = 0.013) respectively. No significant changes in the PI and RI in the bladder wall arterial vessels were found. Conclusion: Short-term estrogen therapy results in significant thickening of urethral wall and in the decrease in the funneling diameter, although it does not affect the vascularization of the assessed tissues.

Extensive postpartum urinary retention successfully treated with clean intermittent catheterization

We present a case of extensive urine retention after vaginal delivery. Postpartum urinary retention occurs in 0.7 to 0.9% of vaginal deliveries. In the literature, mediolateral episiotomy, epidural analgesia, perineal lacerations, macrosomic birth and prolonged 2nd stage of labor are suggested as risk factors for postpartum urine retention.

P24.13: Color Doppler ultrasound of spiral artery blood flow assessment in women with antiphospholipid syndrome

Objectives: To study fetal heart rate (FHR) patterns in pregnancies complicated by maternal epilepsy, and to analyze the influence of antiepileptic drugs on FHR and Doppler exams. Methods: Pregnant women presenting epilepsy were studied prospectively at 36–40 weeks, between December 2007 and March 2010. Eighteen fetuses whose mothers were taking anticonvulsants were compared with 25 fetuses of control group (pregnancies without maternal or fetal morbidities) at the same gestational age. The computerized cardiotocography (System8002, Sonicaid) was performed during 30 minutes and the FHR parameters were studied. Doppler exams were performed at the same day and the following vessels were studied: umbilical artery and middle cerebral artery. Results: The mean maternal age at the study group was 25.0 years (SD = 4.8) and in the control group (n = 25) was 27.3 years (SD = 6.0). No significant difference was found between the groups. The FHR parameters analyzed by computerized cardiotocography in the group with maternal epilepsy did not differ from control group, respectively: mean basal FHR (135.4 ± 14.3 bpm vs. 134.2 ± 13.8 bpm, P = 0.779), mean number of fetal movements per hour (85.3 ± 97.8 vs. 52.4 ± 48.4, P = 0.152), mean number of FHR accelerations > 10 bpm (7.7 ± 4.7 vs. 8.2 ± 4.6, P = 0.733), mean number of FHR accelerations > 15 bpm (4.7 ± 4.1 vs. 5.3 ± 3.7, P = 0.667), high variation episodes duration (13.1 ± 9.6 min vs. 14.9 ± 8.5 min, P = 0.521), low variation episodes duration (4.2 ± 6.7 min vs. 4.12 ± 5.7 min, P = 0.953), and mean short term variation (9.1 ± 2.8 vs. 10.6 ± 4.2, P = 0.188). No differences were found in the Doppler results. Conclusions: This study suggests that maternal epilepsy is not associated with abnormal FHR parameters evaluated by computerized cardiotocography. The Fetal heart rate parameters are not influenced by exposition to antiepileptic drugs at the term of pregnancy.

P04.17: Is a subchorionic haematoma a risk factor for unfavorable pregnancy outcome?

Objectives: To evaluate the incidence, combined anomaly, and outcome of prenatal diagnosis of single umbilical artery (SUA) in the first trimester ultrasound. Methods: From April 2008 to July 2009, 59 cases of single umbilical artery (SUA) of 3879 unselected pregnancies was observed, during 11–13+6 weeks scan, with Voluson Expert in Puerta de Hierro Hospital from Madrid. Results: The incidence of SUA in our population resulted 1.55%. In 42 cases were isolated SUA diagnosed in the first ultrasound at 11–12 weeks, and was confirmed again at 16 weeks scan. 36 normal pregnancies at birth and 6 cases presented growth retardation at delivery. The other 16 cases had associated ultrasound finds: 8 with congenital heart diseases; 3 skeletal anomalies, 3 central nervous system malformations, 1 kidney anomaly, and 1 cleft palate. Conclusions: During the prenatal period, the fetus with isolated SUA by 11–12 weeks ultrasound examination must be carefully monitored, if no other malformations were found normal pregnancy or growth retardation can be expected.

P20.09: The impact of low maternal plasma glucose level after glucose challenge test on fetal growth

Introduction: Intrauterine growth restriction (IUGR) is a major cause of perinatal morbidity and mortality. IUGR is characterized by the presence of a fetus with a weight lower than the 10th centile for gestational age estimated by ultrasound examination or a delivery of a neonate with a birth weight lower than 2.5 kg at term. The causes of IUGR are divided into fetal, placental and maternal ones. Maternal anemia, malnutrition, infections (rubella, cytomegalovirus), toxic substances (alcohol, smoking) may affect fetal growth. Objectives: The aim of the study was to determine the relationship between the low maternal plasma glucose level after glucose challenge test (GCT) and fetal growth restriction. Material and Methods: The studied population consisted of 141 pregnant women with a singleton gestation. The women underwent the GCT between the 24th and 27th week of pregnancy. In all patients ultrasound examination was performed between 20th and 24th week of gestation and the estimated fetal weight (EFW) was evaluated. Low maternal plasma glucose level after GCT was defined as less than 100mg/dL. Patients with glucose level higher than 140mg/dL after GCT were excluded from the study. The data obtained from the remaining women (n = 134) were compared with the fetal birth weight measured after delivery. The Yates’ chi-square test was used to perform statistical calculation. Results: The frequency of IUGR in the studied population was 12.6% (17/134). Conclusion: The study showed that in women with the plasma glucose levels lower than 100 mg/dL after GCT the frequency of IUGR was significantly higher than in those with normal results of GCT.