Myriam Safrai

The Rising Phoenix-Progesterone as the Main Target of the Medical Therapy for Leiomyoma

Leiomyomas, also known as uterine fibroids, are a common benign tumor in women of reproductive age. These lesions disrupt the function of the uterus causing menorrhagia and pelvic pressure as well as reproductive disorders. These women pose a true challenge for clinicians in the attempt of choosing the suitable treatment for each patient. Patients age, interest in fertility preservation, and leiomyoma location and size are all factors to be taken into account when deciding upon the preferable therapeutic option. For the past few decades, surgical treatment was the only reliable long-term treatment available. A variety of surgical approaches have been developed over the years but these developments have come at the expense of other treatment options. The classical medical treatment includes gonadotropin-releasing hormone (GnRH) agonists and antagonists. These agents are well known for their limited clinical effect as well as their broad spectrum of side effects, inspiring a need for new pharmacological treatments. In recent years, promising results have been reported with the use of selective progesterone receptor modulators (SPRM). Long-term clinical trials have shown a reduction in bleeding and shrinkage of leiomyoma mass. These results instill hope for women suffering from symptomatic leiomyomas seeking an effective, long-term medical option for their condition.

Selective Progesterone Receptor Modulators for the Treatment of Uterine Leiomyomas

Uterine leiomyomas have drawn much attention since being described more than 200 years ago. These common benign uterine tumors often present with prolonged menstrual bleeding, pelvic pressure, and reproductive disorders and pose a true financial burden on health care systems all over the world. Over the past few decades, surgical treatment of uterine leiomyomas has received most of the focus compared with other treatment options. Choosing the appropriate surgical technique depends on many factors such as uterine leiomyoma location, patients age, interest in future fertility, concomitant comorbidities, and the patients preference. Pharmacologic treatments such as gonadotropin-releasing hormone agonists and antagonists have been used for the treatment of symptomatic uterine leiomyomas with only partial success. Myriad side effects and limited clinical results have rendered them less popular and have exposed a true need for new effective medical treatments. Recently, treatment with selective progesterone receptor modulators has shown promising results with shrinkage of uterine leiomyomas and a prolonged clinical effect. Selective progesterone receptor modulators provide hope for women with this challenging condition and are a promising new option in the armamentarium of medical treatments for uterine leiomyomas.

Obstetrical and neonatal outcomes after A single episode of third trimester vaginal bleeding

Abstract Objective: The objective of this study is to determine whether a single episode of vaginal bleeding occurring between 24 and 34 weeks gestation is associated with preterm delivery and other adverse maternal and neonatal outcomes. Study design: We conducted a retrospective cohort study in the Maternal–Fetal unit of two campuses of a large tertiary, medical center with approximately 12,000 deliveries annually. The study group consisted of all women with a singleton pregnancy between 24 + 0/7 and 33 + 6/7 weeks of gestation, admitted to the high-risk antenatal ward due to a single episode of vaginal bleeding of unknown origin between May 2003 and December 2014. Maternal and neonatal parameters of the study group were compared to the maternal and neonatal parameters of the rest of the singleton deliveries occurring in our institution during the study period. The primary outcome was rate of preterm delivery while secondary outcomes were other adverse maternal and neonatal outcomes. Multivariate logistic regression was performed to identify risk factors for preterm delivery in the study group. Results: Two hundred thirty women met the inclusion criteria and 51,468 women were in the comparison group. Preterm delivery rates were 20% and 5.5% in the study and the comparison group, respectively OR = 3.55 [2.63–4.78] (p < .001). The aOR for preterm delivery among the study group for women with a previous preterm delivery was 4.62 [1.17–18.20] (p = .029) and for women with a short cervix was 9.35 [2.30–37.95] (p = .002). Conclusions: A single episode of third-trimester vaginal bleeding is an independent risk factor for spontaneous preterm delivery. The presence of a shortened cervix or a history of a prior spontaneous preterm delivery increases this risk significantly. Key message Third trimester vaginal bleeding is strongly associated with preterm delivery. Knowledge of this relationship has valuable clinical implications for practicing obstetricians.

P08.02: The correlation between parental biometric parameters and neonatal head circumference: a prospective study

withdrawn

Development of a nomogram for prediction of successful membrane sweeping

Abstract Objective: To evaluate the association of obstetric, maternal, and fetal variables with successful membrane sweeping and to develop a calculator that can predict spontaneous delivery within 24 hours of membrane sweeping. Methods: This secondary analysis of the STRIP-G Study included all singleton term parturients who underwent membrane sweeping in a tertiary center in October 2011 to July 2013. Primary end point was a 24-hour time interval from sweeping to delivery. Women who delivered without formal induction within the 24-hour interval were included in the “successful sweeping group”. Stepwise logistic regression was used to calculate the adjusted odds ratio (aOR) for successful membrane sweeping and to create the calculator. The predictive power of the calculator was evaluated by area under the curve (AUC) of the receiver operating characteristic (ROC) curve and by Nagelkerke R-square. The model was validated by the Hosmer–Lemeshow test and by these validation measures: sensitivity, specificity, and positive and negative predictive value. Results: We analyzed data from 542 women. Parity (aOR = 1.66, 95% confidence interval [CI] 1.1–2.54), cervical dilation (aOR = 3.33, 95%CI 2.04–5.44), and gestational age (aOR = 1.44, 95%CI 1.21–1.72) were independent predictors of spontaneous delivery during the first 24 hours. A cross validation procedure showed that the calculator had a good accuracy (68%). Conclusions: A simple calculator based on maternal age, parity, gestational age, cervical dilatation, effacement and station, can accurately predict the chances of delivery within 24 hours of membrane sweeping. This may assist physicians better counseling of women regarding the likelihood of successful membrane sweeping.

The effect of prophylactic antibiotic treatment for manual removal of the placenta on frequency of postpartum endometritis

To determine whether prophylactic antibiotics reduce the frequency of postpartum endometritis after manual removal of the placenta.

Massive hematuria at pregnancy caused by ruptured angiomyolipoma: A case report

Dear editor, Renal angiomyolipoma is a rare benign tumor of the kidney. Spontaneous rupture of angiomyolipomas can cause massive retroperitoneal hemorrhage and is occasionally fatal. The association of this complication with pregnancy has been sporadically reported in the literature. Herein, we present a case of a female patient who presented at term pregnancy with massive hematuria caused by ruptured angiomyolipomas. Renal angiomyolipomas (AML) are rare benign renal tumors with a tendency to rupture causing retroperitoneal hemorrhage and gross massive hematuria. AML are one of the manifestations of Tuberous sclerosis, thus pregnant women with Tuberous sclerosis are at increased risk of these complications. A 23-year old otherwise healthy primigravida female patient, presented at 40 weeks gestation at the emergency department due to massive hematuria. Pregnancy had been uneventful until this time. She reported a spontaneous left flank pain which resolved a few hours prior to her admission. She was tachycardic and normotensive with otherwise normal physical examination except for facial rash. Laboratory findings showed hemoglobin, 7.6 g/dL; creatinine, 127 mMol/L (baseline level-80 mMol/L) [reference range50–110 mMol/L]. Coagulation tests were unremarkable, Fetal heart rate tracings were normal and Obstetrical ultrasound revealed an appropriate for gestational age fetus with normal amniotic fluid index and uterine artery Doppler studies. As her facial rash was highly suggestive for adenoma sebaceum (i.e. angiofibromas) (Fig. 1A) associated with tuberous sclerosis, a ruptured AML was suspected. Abdominal sonography was performed, demonstrating a large hypoechogenic area surrounding the left kidney, resembling retroperitoneal hematoma. Following multidisciplinary consultation of an urologist, maternal fetal medicine expert and invasive radiologist, as the patient was hemodynamically stable, it was decided to continue with expectant management and labor induction with close clinical and laboratory monitoring. Continuous bladder irrigation was commenced, along with the administration of two units of packed cells. Following a few hours in which the patient remained stable without further deterioration of her kidney function, she delivered a normal appearing female infant weighing 3235 g with Apgar scores of 9 and 10 at 1 and 5 min, respectively. Computed tomography angiography (CTA) demonstrated multiple AML in both kidneys, with several hemorrhagic AML in the left kidney, replacing the renal parenchyma with signs of active bleeding (Fig. 1B). In addition, multiple lung nodules and sclerotic bone lesions were noted, suggestive of systemic manifestations of tuberous sclerosis. As there were signs of active bleeding, a