Orit Moran

Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy

A series of 201 cycles of ovarian hyperstimulation syndrome (OHSS) in 154 women were reviewed. Pregnancy occurred in 75 of 201 cycles. Twelve pregnant women (16%) presented with torsion of hyperstimulated ovary, but only 3 out of 126 patients (2.3%) who did not conceive had torsion. Because diagnosis of adnexal torsion is usually uncertain and surgical intervention is likely to be delayed, these infertile women risk losing their ovaries. The clinical picture of torsion of adnexa in patients with OHSS is presented here. The combination of ovarian enlargement, abdominal pain, nausea, progressive leukocytosis, and anemias might indicate torsion of adnexa. Although during operation the adnexa appears dark, hemorrhagic and ischemic, we suggest that it can be saved by simply unwinding it. In 11 such cases intraoperative unwinding of the adnexa was performed, and in 8 patients it was the only operative procedure. No postoperative complications were noted and in all the cases the ovaries were proven functional by ultrasonography. We concluded that torsion of hyperstimulated adnexa in patients who conceived after gonadotropin therapy, is a special entity that requires more attention to achieve early diagnosis. Nevertheless even with delayed diagnosis, the ovary can still be saved.

Pregnancy Outcome After Age 50

OBJECTIVE: To evaluate pregnancy complications occurring after age 50. METHODS: We compared the pregnancy outcomes of women aged 50–64 years with those aged 45–49 years and with the general population. RESULTS: During 5 years from January 1, 1999, to June 30, 2004, 123 women aged 45 years and older gave birth. Fifty-five percent were nulliparous, 24 of 123 were aged 50–64 years, and 99 of 123 women were aged 45–49 years. All women older than age 50 conceived via in vitro fertilization with oocyte donation. For these 123 women, the overall mean gestational age at delivery was 37.6±2.6 weeks. The mean birth weight was 2,684±754 g, significantly lower than the general population, and the incidences of multifetal pregnancies, diabetes, and hypertension were high. Women aged 50 years and older were more likely to be hospitalized during pregnancy than women younger than 50 years (63% versus 22%, P<.001). Neonatal outcome was generally good. Women aged 50 years and older gave birth to significantly more low birth weight babies than those younger than age 50 years (61% versus 32%, P=.002). Gestational age and birth weight were both significantly lower for singletons and multiples in women older than age 50 years compared with those younger than age 50 years (gestational age of singletons 36.9 versus 38.4 weeks, P=.005; birth weight of singletons 2,694 versus 3,027 g, P=.019; gestational age of multiples 35.1 versus 36.4 weeks, P=.01; birth weight of multiples 1,976 versus 2,310 g, P=.038, respectively). CONCLUSION: Pregnant women aged 50–64 years have increased risks of preterm birth, low birth weight babies, diabetes mellitus, hypertension, and hospitalization. LEVEL OF EVIDENCE: II-2

CD133‐Positive Hematopoietic Stem Cell “Stemness” Genes Contain Many Genes Mutated or Abnormally Expressed in Leukemia

Affymetrix human Hu133A oligonucleotide arrays were used to study the expression profile of CD133+ cord blood (CB) and peripheral blood (PB) using CD133 cell‐surface marker. An unsupervised hierarchical clustering of 14,025 valid probe sets showed a clear distinction between the CD133+ cells representing the hematopoietic stem cell (HSC) population and CD133‐differentiated cells. Two hundred forty‐four genes were found to be upregulated by at least twofold in the CD133‐positive cells of both CB and PB compared with the CD133‐negative cells. These genes represent the hematopoietic “stemness,” whereas the 218 and 304 upregulated genes exclusively in PB and CB, respectively, represent tissue specificity. Some of the stemness genes were also common to HSC genes found to be upregulated in several recently published studies. Among these common stemness genes, we identified several groups of genes that have an important role in hematopoiesis: growth factor receptors, transcription factors, genes that have an important role in development, and genes involved in cell growth. Sixteen selected stemness genes are known to be mutated or abnormally regulated in acute leukemias. It can be suggested that key hematopoietic stemness machinery genes may lead to abnormal proliferation and leukemia upon mutation or change of their expression.

Outpatient endometrial sampling with the Pipelle curette

This study compares outpatient endometrial sampling using the Pipelle endometrial sampling curette with conventional dilation and curettage (D&C) in patients with abnormal uterine bleeding. Endometrial sampling with the Pipelle curette was performed in 172 and D&C in 97 women. No complications were encountered with either of these procedures. One hundred and seventy (98.8%) of the Pipelle aspirations attempted were successfully completed. Sufficient material for histological assessment was obtained in 154 (90.6%) of the women who underwent Pipelle endometrial sampling and in only 66 (68%) of those who underwent D&C (p < 0.0001). In postmenopausal women, adequate specimens were obtained in 74 of 88 (84.1%) by Pipelle and in only 22 of 48 (45.8%) by D&C. In 45 cases the histologic diagnosis of the endometrium obtained by Pipelle sampling was compared with the one of endometrium obtained by D&C or hysterectomy performed shortly thereafter. The diagnosis was identical in 43 (95.5%) cases. Endometrial sampling with the Pipelle was well tolerated causing occasionally only slight discomfort.

Isolated fetal umbilical vein varix—prenatal sonographic diagnosis and suggested management

To present our experience with fetuses with umbilical vein varix (UVV), to investigate possible risk factors and to suggest a management scheme of evaluation.

Head progression distance in prolonged second stage of labor: relationship with mode of delivery and fetal head station

To evaluate the clinical significance of fetal head progression distance (HPD), measured by transperineal ultrasound, during prolonged second stage of labor.

Pubic arch angle in prolonged second stage of labor: clinical significance

To evaluate the clinical significance of the pubic arch angle (PAA) measured by transperineal ultrasound during prolonged second stage of labor.

Subsequent pregnancy after stillbirth: obstetrical and medical risks

Abstract Objective: To evaluate obstetric outcome after stillbirth according to placental and prothrombotic risk factors. Methods: Obstetric outcomes of women with prior stillbirth and subsequent pregnancies were reviewed. Data on the immediate subsequent pregnancy included fetal loss, stillbirth, obstetric/medical complications, gestational age and birth weight at delivery, mode of delivery, thrombophilia, and prescribed medication. Placental stillbirth was defined as stillbirth associated with placental abruption, intrauterine growth restriction (IUGR), or histological evidence of placental infarcts. Controls were unselected women who gave birth at our center during a single calendar year. Factors influencing recurrence risks were estimated. Results: Seventy-three subsequent pregnancies were identified. Five out of 73 (6.8%) women had a repeat stillbirth, significantly higher than controls (relative risk 22.2, 95% confidence interval 8.9–55.4). Four out of five repeat stillbirth cases occurred <37 weeks gestation. Hypertensive complications, diabetes and abruption were higher, while gestational age and birth weight at delivery were significantly lower than controls. Prior placental stillbirth was associated with a 10.5 times higher risk of IUGR in the subsequent pregnancy compared with non-placental stillbirth. All five repeat stillbirth cases occurred in thrombophilic women. Conclusion: Women with prior stillbirth face an increased risk of pregnancy complications and stillbirth recurrence, especially with concurrent thrombophilia. Most repeat stillbirth cases occur preterm.

Perinatal, postnatal, and maternal outcome parameters of triplet pregnancies according to the planned mode of delivery: results of a single tertiary center.

Objective. To compare the maternal and perinatal outcome of triplet pregnancies delivered by cesarean section with those delivered vaginally and to assess whether a vaginal delivery of triplets is still acceptable among women who are interested in further births. Study design. A retrospective analysis of 73 triplet pregnancies delivered at ≥28 week between 1997 and 2005 in a single tertiary center. Twenty-six triplets planned for a trial of labor were compared with 47 sets of women with triplet gestations who delivered by scheduled cesarean section. Results. Mean gestational age was 33.1 ± 2.9 and 33.4 ± 2.6 weeks for the vaginal and cesarean groups, respectively (NS). 88.4% of the vaginally-intended group had a successful vaginal delivery of all three newborns. There were four cases of mortality among the triplets that underwent a vaginal trial of labor (50/1000) but none in the planned cesarean delivery group. Neonatal and maternal complication rates were not different between the groups. Conclusion. According to the relatively small number of patients included in this study, the safety of vaginal delivery should be considered uncertain. Vaginal delivery for triplets might be possible just in particular cases, >28 weeks, with future risks for further pregnancies, after thorough consult with the couple and under strict protocol.

Prediction of residual trophoblastic tissue in first-trimester abortions and low levels of human chorionic gonadotropin β-subunit

Abstract The clinical data and the histologic report of curettage specimens of 174 patients with first-trimester abortion and human chorionic gonadotropin β-subunit