RESUMEN
This paper aims to evaluate the effects of i.m. progesterone on bleeding patterns after in-vitro fertilisation embryo transfer (IVF-ET). It is a retrospective cohort study conducted in the reproductive endocrinology and IVF department of a teaching hospital. One hundred consecutive women were studied who had undergone IVF-ET using 'long protocol' stimulation with leuprolide acetate-recombinant follicle stimulating hormone (rFSH) and who did not become pregnant. Intramuscular (i.m.) progesterone (50mg once daily) was started the day before oocyte retrieval and continued for a minimum of 12-14 days following embryo transfer. The main outcome measures were time interval between oocyte retrieval and onset of bleeding, luteal phase serum progesterone and oestradiol (E2) levels, and midluteal endometrial thickness. Of the 100 patients whose charts were reviewed, 67 bled (group A) before progesterone treatment was discontinued (17 days after oocyte retrieval) and 33 (group B) bled after progesterone treatment was discontinued (> 17 days). Mean onset of bleeding was 16.2+/-2.6 days after oocyte retrieval. Serum progesterone concentrations were similar in the two groups on the day of hCG administration, whereas progesterone concentrations (in-group B) were higher on days 7 and 15 after oocyte retrieval. No statistically significant differences were found between two groups with respect to mean midluteal endometrial thickness and mean serum E2 concentrations on days 0, 7 and 15. The results suggest that i.m progesterone administration for luteal support in assisted reproduction cycles elongates luteal phase in some patients due to supraphysiological serum progesterone levels. However, most patients start to bleed in the absence of pregnancy despite continued progesterone treatment.
Asunto(s)
Fertilización In Vitro , Fase Luteínica/efectos de los fármacos , Menstruación/fisiología , Progesterona/administración & dosificación , Adulto , Estudios de Cohortes , Esquema de Medicación , Transferencia de Embrión , Endometrio/fisiología , Estradiol/sangre , Femenino , Humanos , Inyecciones Intramusculares , Progesterona/sangre , Estudios RetrospectivosRESUMEN
We investigated the effects of vaginal delivery (VD) and cesarean section (CS) on bladder neck (BN) mobility and genuine stress incontinence (GSI). Of the 230 patients included in the study, 95 had CS, 95 had VD and the remaining 40 continent nulliparous women served as controls. In both the CS and the VD groups 40 women had delivered once, 35 women twice and 20 women three times. Perineal ultrasonography was performed in all patients. Vaginal delivery affects BN mobility and its position more negatively than does CS, and increases its mobility in two directions. The CS group also has similar findings after the third delivery. The GSI rate was not significantly different between the CS and the VD groups, but the VD group had a higher percentage. Our study also shows that BN mobility is associated with GSI compared to the continent controls.
Asunto(s)
Cesárea/efectos adversos , Parto Obstétrico/efectos adversos , Vejiga Urinaria/fisiología , Incontinencia Urinaria de Esfuerzo/etiología , Adulto , Femenino , Estudios de Seguimiento , Humanos , Perineo/diagnóstico por imagen , Embarazo , Ultrasonografía , Vejiga Urinaria/anatomía & histología , Incontinencia Urinaria de Esfuerzo/fisiopatologíaRESUMEN
We assessed the bladder neck (BN) by perineal ultrasonography of 39 patients before and 1 year after hysterectomy, and we compared them with 30 control cases in terms of stress urinary incontinence. We evaluated the BN position and mobility in the downwards and backwards directions. The bladder neck was found to be significantly lower at rest, in the downwards direction, in the postoperative period. The stress position of the BN was not significantly different. Its downwards mobility decreased, but not significantly. There was no significant difference in the location of the BN with respect to the pubis, at rest and during stress, in the backwards direction, between the preoperative and postoperative periods. Backwards mobility of the BN decreased significantly following hysterectomy. Stress incontinence was not significantly different between the study group and the control group after one year. We concluded that hysterectomy did not weaken urethral support and did not increase the rate of stress incontinence.