RESUMEN
Ectopic pregnancy results in an urgent, sometimes lifethreatening condition and always leads to pregnancy loss. We conducted a literature search on mental health after ectopic pregnancy. The level of anxiety, depression, posttraumatic stress and grief was high, comparable to the level after miscarriage. Several interventions such as good communication, information or follow-up counselling sessions improved mental health. We recommend that clinicians focus on these aspects during admission and follow-up at the general practitioners.
Asunto(s)
Aborto Espontáneo , Embarazo Ectópico , Aborto Espontáneo/etiología , Aborto Espontáneo/psicología , Ansiedad/etiología , Femenino , Pesar , Humanos , Salud Mental , Embarazo , Embarazo Ectópico/etiologíaRESUMEN
Polycystic ovary syndrome (PCOS) encompasses an ovarian and a metabolic dysfunction. Glucagon-like peptide-1 (GLP-1) analogues facilitate weight loss and ameliorate metabolic dysfunction in overweight women with PCOS, but their effect on ovarian dysfunction is scarcely reported. In a double-blind, randomized trial, 72 women with PCOS were allocated to intervention with the GLP-1 analogue liraglutide or placebo (1.8 mg/day), in a 2:1 ratio. At baseline and 26-week follow-up, bleeding pattern, levels of AMH, sex hormones and gonadotrophins were assessed and ovarian morphology evaluated. Liraglutide caused 5.2 kg (95% CI 3.0 to 7.5, P < 0.0001) weight loss compared with placebo. Bleeding ratio improved with liraglutide: 0.28 (95% CI 0.20 to 0.36, P < 0.001); placebo: 0.14 (95% CI 0.02 to 0.26, P < 0.05); between-group difference: 0.14 (95% CI 0.03 to 0.24, P < 0.05). In the liraglutide group, SHBG increased by 7.4 nmol/L (95% CI 4.1 to 10.7) and free testosterone decreased by 0.005 nmol/L (95% CI -0.009 to -0.001). Ovarian volume decreased by -1.6 ml (95% CI -3.3 to 0.1) with liraglutide versus placebo. Nausea and constipation were more prevalent in the liraglutide group. Liraglutide improved markers of ovarian function in overweight women with PCOS, and might be a possible intervention.
Asunto(s)
Hipoglucemiantes/uso terapéutico , Liraglutida/uso terapéutico , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Adulto , Peso Corporal/efectos de los fármacos , Método Doble Ciego , Femenino , Humanos , Hipoglucemiantes/efectos adversos , Liraglutida/efectos adversos , Síndrome del Ovario Poliquístico/complicaciones , Síndrome del Ovario Poliquístico/metabolismo , Testosterona/sangreRESUMEN
Background Due to improved ultrasound scanners, new three-dimensional (3D) modalities, and novel Anti-Müllerian hormone (AMH)-assays, the ultrasound criteria for polycystic ovarian morphology are under debate and the appropriate thresholds are often requested. Purpose To quantify the differences in estimates of ovarian volume and antral follicle count (AFC) from two-dimensional (2D) and 3D transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Material and Methods A cross-sectional study on 66 overweight women with polycystic ovary syndrome (PCOS) according to Rotterdam criteria. Ovarian volume and AFC were estimated from MRI, 2D TVUS, and 3D TVUS, and serum AMH levels were assessed. Bland-Altman statistics were used for comparison. Results Participants had a median age of 29 years (age range, 19-44 years) with a mean BMI of 32.7 kg/m2 (SD 4.5). Ovarian volume from 2D TVUS was 1.48 mL (95% confidence interval [CI], 0.94-2.03; P < 0.001) and 1.25 mL (95% CI, 0.62-1.87; P < 0.001) smaller than from 3D TVUS and MRI, respectively. AFC from 2D TVUS was 18% (95% CI, 13-23; P < 0.005) and 16% (95% CI, 6-25; P < 0.005) smaller than estimates from 3D TVUS and MRI, respectively. Correlations between AMH and AFC from 2D TVUS, 3D TVUS, and MRI were 0.67, 0.78, and 0.70, respectively ( P < 0.001 for all). Conclusion In an overweight PCOS population, 2D TVUS underestimated ovarian volume and AFC as compared with 3D TVUS and MRI. Serum AMH correlated best with AFC from 3D TVUS, followed by MRI and 2D TVUS. The advantage of 3D TVUS might be of minor clinical importance when diagnosing PCOS, but useful when the actual AFC are of interest, e.g. in fertility counseling and research.
Asunto(s)
Hormona Antimülleriana/sangre , Imagen por Resonancia Magnética/métodos , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Biomarcadores/sangre , Estudios Transversales , Femenino , Humanos , Folículo Ovárico/diagnóstico por imagen , SobrepesoRESUMEN
PubMed-search found studies investigating adverse effects of combined oral contraceptive pills (COC) among teenagers. Four studies found a small negative impact of COC on acquisition of bone mineral density. COC is associated with elevated risk of venous thrombotic events (VTE), especially during the first year of usage. VTE risk increases with EE dose and progestin of 3rd and 4th generation. There are several difficulties in studying COC use in teenagers: high dropout rates, ethical considerations and many different COC formulas.
Asunto(s)
Densidad Ósea/efectos de los fármacos , Anticonceptivos Orales Combinados/efectos adversos , Tromboembolia Venosa/inducido químicamente , Adolescente , Anticonceptivos Orales Combinados/administración & dosificación , Estrógenos/administración & dosificación , Estrógenos/efectos adversos , Femenino , Humanos , Progestinas/administración & dosificación , Progestinas/efectos adversos , Factores de Riesgo , Adulto JovenRESUMEN
The present study investigated the heart rate (HR) response to various types of physical education (PE) activities for 8- to 9-year-olds (five school classes, n = 93) and the fitness effects of a short-term PE training programme (three of the five classes, n = 59) with high compared to low-to-moderate aerobic intensity. HR was recorded during small-sided indoor soccer (SO), basketball (BB), unihockey (UH), circuit training (CT), walking (W) and Nintendo Wii Boxing (NWB) and Nintendo Wii Tennis (NWT). Maximal HR (HRmax) and physical fitness was determined by the Yo-Yo Intermittent Recovery Level 1 Children's test (YYIR1C) test. Following cluster randomisation, three classes were tested before and after 6 wks with 2 × 30 min/wk SO and UH lessons [high-intensity (HI), 2 classes, n = 39] or low-to-moderate intensity PE lessons (CON, 1 class, n = 20). Average HR in SO (76 ± 1% HRmax), BA (77 ± 1% HRmax) and UH (74 ± 1% HRmax) was higher (P < 0.05) than in CT (62 ± 1% HRmax), W (57 ± 1% HRmax), NWB (65 ± 2% HRmax) and NWT (57 ± 1% HRmax). Time with HR > 80% and 90% HRmax, respectively, was higher (P < 0.05) in SO (42 ± 4 and 12 ± 2%), BB (41 ± 5 and 13 ± 3%) and UH (34 ± 3 and 9 ± 2%) than in CT, W and NW (0-5%), with time >80% HRmax being higher (P < 0.05) in SO than UH. After 6 wk, YYIR1C performance was increased (P < 0.05) by 22% in HI (673 ± 57 to 821 ± 71 m), but unaltered in CON (674 ± 88 to 568 ± 81 m). HR 2 min into YYIR1C was lowered (P < 0.05) in HI after 6 wks (92.4 ± 0.8 to 89.1 ± 0.9% HRmax), but not in CON. In conclusion, ball games elicited high aerobic loading for young schoolchildren and a short-term, low-volume ball game PE-intervention improved physical fitness. Traditional PE sessions had no effects on intermittent exercise performance.
Asunto(s)
Ejercicio Físico/fisiología , Frecuencia Cardíaca/fisiología , Educación y Entrenamiento Físico/métodos , Aptitud Física/fisiología , Niño , Dinamarca , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Instituciones Académicas , EstudiantesRESUMEN
We evaluated a submaximal and maximal version of the Yo-Yo intermittent recovery level 1 children's (YYIR1C) test and the Andersen test for fitness and maximal heart rate assessments of children aged 6-10 years. Two repetitions of the YYIR1C and Andersen tests were carried out within 1 week by 6- to 7-year-olds and 8- to 9-year-olds (grade 0, n = 17; grade 2, n = 16) and 6 weeks apart by 9- to 10-year-olds (grade 3, n = 49). Grade 0-2 pupils also performed an incremental treadmill test (ITT). Grade 2 pupils had a better (p < 0.05) YYIR1C (84%; 994 ± 399 m (±SD) vs. 536 ± 218 m) and Andersen test performance (10%; 1,050 ± 71 m vs. 955 ± 56 m) than grade 0 pupils. For grade 0-2 pupils, YYIR1C, Andersen, and ITT peak heart rates were 205 ± 11, 207 ± 9, and 203 ± 7 b·min(-1), respectively (Andersen > ITT, p < 0.05), and for grade 3 pupils, YYIR1C and Andersen peak heart rates were 208 ± 9 and 204 ± 9 b·min(-1), respectively (YYIR1C > Andersen, p < 0.05). Submaximal YYIR1C heart rate (HR) was inversely correlated (p < 0.05) with YYIR1C test performance (r = -0.54 to -0.67) and VO2peak (r = -0.42). The 6-week change in submaximal HR correlated with the change in YYIR1C test performance (r = -0.42 to -0.53, p < 0.05). In conclusion, YYIR1C and Andersen tests are simple and inexpensive intermittent field tests that can detect differences in fitness levels and determine maximal HR of 6- to 10-year-old children. Additionally, submaximal YYIR1C testing can be used for frequent nonexhaustive fitness assessments.
Asunto(s)
Prueba de Esfuerzo , Frecuencia Cardíaca , Aptitud Física/fisiología , Niño , Prueba de Esfuerzo/métodos , Femenino , Humanos , Masculino , Consumo de Oxígeno , Resistencia Física , Descanso/fisiología , Carrera/fisiologíaRESUMEN
Two cases of cervical ectopic pregnancy after in vitro fertilization embryo transfer were managed conservatively. One living cervical ectopic pregnancy was treated with intra-amniotic and systemic injection of methotrexate, and the other cervical ectopic pregnancy with a fetal pole was treated with systemic methotrexate. The patient with the living cervical ectopic pregnancy had stable vital signs during the period of treatment. The patient with the fetal pole was admitted with heavy vaginal bleeding and anaemia and was stabilised before treatment was initiated. She was stable throughout the treatment.
Asunto(s)
Abortivos no Esteroideos/administración & dosificación , Cuello del Útero , Metotrexato/administración & dosificación , Embarazo Ectópico/terapia , Adulto , Cuello del Útero/diagnóstico por imagen , Transferencia de Embrión , Femenino , Humanos , Embarazo , Embarazo Ectópico/diagnóstico por imagen , UltrasonografíaRESUMEN
Polycystic ovary syndrome (PCOS) causes impaired fertility and is assumed to be associated with increased risk of miscarriage. This paper reviews the literature according to the principles of evidence-based medicine to establish whether PCOS and the clinical findings lead to an increased miscarriage rate. It is not possible to confirm any association between PCOS and miscarriage. Increased luteinizing hormone, androgens and plasminogen activator inhibitor-1 activity as well as obesity and impaired endometrial blood flow are to some degree associated with miscarriage.
Asunto(s)
Aborto Espontáneo/etiología , Síndrome del Ovario Poliquístico/complicaciones , Medicina Basada en la Evidencia , Femenino , Humanos , Síndrome del Ovario Poliquístico/metabolismo , Síndrome del Ovario Poliquístico/fisiopatología , Embarazo , Factores de RiesgoRESUMEN
The female athlete triad refers to the interrelationships among energy availability, menstrual function and bone mineral density which may have clinical manifestations including eating disorders, functional hypothalamic amenorrhea and osteoporosis. The potentially irreversible consequences of these clinical conditions emphasize the critical need for prevention, early diagnosis and treatment. Nutritionally correct food ensuring optimal energy balance is a premise to improve these conditions. Alternative treatment is oestrogen replacement therapy which can prevent progressive bone loss.
Asunto(s)
Síndrome de la Tríada de la Atleta Femenina/etiología , Factores de Edad , Densidad Ósea , Diagnóstico Precoz , Ingestión de Energía , Terapia de Reemplazo de Estrógeno , Femenino , Síndrome de la Tríada de la Atleta Femenina/diagnóstico , Síndrome de la Tríada de la Atleta Femenina/tratamiento farmacológico , Síndrome de la Tríada de la Atleta Femenina/economía , Humanos , Factores de RiesgoRESUMEN
The aim of this Danish multicenter trial was to compare the proportion of women with lower urinary tract symptoms after total abdominal hysterectomy (TAH) and subtotal abdominal hysterectomy (SAH) for benign uterine disorders. A total of 319 women were randomized to TAH (n = 158) or SAH (n = 161). Women were followed up for 1 year by strict data collection procedures, including postal questionnaires. Results were analyzed by intention-to-treat analyses. Urinary incontinence was found less often among TAH women than among SAH women. This was due to a larger reduction of the number of women with stress and urinary incontinence in the TAH group. No other differences were found between the two operation methods. The number of women with urinary incontinence and frequency was reduced from study entry for follow-up, while double/triple voiding was increased. Incontinent women had significantly lower quality of life scores than continent women
Asunto(s)
Histerectomía/métodos , Enfermedades Urológicas/etiología , Femenino , Estudios de Seguimiento , Humanos , Histerectomía/efectos adversos , Calidad de Vida , Resultado del Tratamiento , Incontinencia Urinaria/etiología , Incontinencia Urinaria de Esfuerzo/etiología , Retención Urinaria/etiología , Infecciones Urinarias/etiología , Trastornos Urinarios/etiología , Enfermedades Uterinas/cirugíaRESUMEN
BACKGROUND: The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies. AIMS: To compare total abdominal hysterectomy (TAH) to subtotal abdominal hysterectomy (SAH) regarding effects on sexuality. METHODS: In a Danish multicenter trial 319 women were randomized to TAH (n = 158) or SAH (n = 161); 185 women had self-selected TAH (n = 80) or SAH (n = 105) in a simultaneously conducted observational study. Women were followed for 1 year by strict data collection procedures, including postal questionnaires. Results were analyzed by intention to treat (ITT) analyses. RESULTS: No significant differences were observed between TAH and SAH at 1-year follow-up in both the randomized trial and the observational study regarding women's desire for sex, frequency of intercourse, frequency of orgasm, quality of orgasm, localization of orgasm, satisfaction with sexual life, and dyspareunia. None of these sexual variables changed significantly from entry to the 1-year follow-up, apart from dyspareunia, which was significantly (p = 0.009) reduced in both intervention groups. Significant (p < 0.05) predictors for satisfaction with sexual life after hysterectomy were the preoperative satisfaction with sexual life [odds ratio (OR) 32, 95% confidence interval (CI) 10-125], good relationship with partner (OR 50, 95% CI 9-354), physical well-being (OR 0.30, 95% CI 0.09-0.88) and hormone replacement therapy (OR 0.23, 95% CI 0.06-0.78). CONCLUSIONS: Both TAH and SAH significantly reduce dyspareunia without having a negative effect on sexual function. The shift toward SAH seems unwarranted.
Asunto(s)
Histerectomía , Sexualidad , Cuello del Útero/fisiología , Dispareunia/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Histerectomía/métodos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
OBJECTIVES: The concentration of bioavailable insulin-like growth factor (IGF) I and II is important to foetal growth. It is regulated by insulin-like growth factor binding proteins (IGFBP) 1 through 6. Proteolytic cleavage of IGFBP-3 takes place in human pregnancy serum; accordingly, IGFBP-3 serum levels decrease markedly during pregnancy. ADAM12 (A disintegrin and metalloprotease) is an IGFBP-3 and IGFBP-5 protease and is present in human pregnancy serum. The goal of this study was to determine whether ADAM12 concentration in maternal serum is a useful indicator of foetal health. METHODS: We developed an enzyme-linked immunosorbent assay (ELISA) for the quantification of ADAM12 in serum. The assay range was 42 to 667 micro g/L. Recombinant ADAM12 was used as the standard for calibration. RESULTS: We found that ADAM12 was highly stable in serum. Serum concentration increased from 180 micro g/L at week 8 of pregnancy to 670 micro g/L at 16 weeks, and reached 12 000 micro g/L at term. In 18 first-trimester Down syndrome pregnancies, the concentration of ADAM12 was decreased, thus the median multiple of mean (MoM) value was 0.14 (0.01-0.76). A detection rate for foetal Down syndrome of 82% for a screen-positive rate of 3.2% and a 1:400 risk cut-off was found by Monte Carlo estimation using ADAM12 and maternal age as screening markers. CONCLUSION: ADAM12 is a promising marker for Down syndrome.
Asunto(s)
Desintegrinas/sangre , Síndrome de Down/sangre , Proteínas de la Membrana/sangre , Metaloendopeptidasas/sangre , Diagnóstico Prenatal , Proteínas ADAM , Proteína ADAM12 , Adulto , Biomarcadores , Estudios de Casos y Controles , Gonadotropina Coriónica Humana de Subunidad beta/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Edad Materna , Valor Predictivo de las Pruebas , Embarazo , Primer Trimestre del Embarazo , Segundo Trimestre del Embarazo , Proteína Plasmática A Asociada al Embarazo/metabolismoRESUMEN
OBJECTIVE: Structural changes in the placenta might contribute to the lower birth weight seen among infants born to mothers who smoke cigarettes. In this study, a morphologic examination and a stereologic quantitation of placentas from mothers who smoked cigarettes and who did not smoke cigarettes during pregnancy were performed. STUDY DESIGN: Twenty-five placentas from mothers who did not smoke cigarettes, 15 placentas from mothers who smoked 5 to 10 cigarettes per day, 16 placentas from mothers who smoked 11 to 20 cigarettes per day, and 16 placentas from mothers who smoked >20 cigarettes per day were delivered at term after normal pregnancies and were fixed by dual perfusion. The volume and the surface area of villi, the trophoblast volume, and the volume and the surface area and length of villous capillaries were estimated. A measurement of the concentration of cadmium in serum was used to assess the validity of information concerning smoking habits. RESULTS: No differences were shown in the total volume of placenta between the groups. The estimated volume and surface area and the calculated lengths for villous capillaries were significantly reduced in all 3 groups of smokers. A significant increase of the trophoblast volume was observed in the mothers who smoked cigarettes. CONCLUSION: Cigarette smoking during pregnancy influences the placental vasculature. The reduced dimensions of fetal capillaries in villi may affect the placental blood flow, and the diminished area for exchange of gases and nutrients between the mother and the fetus will increase the risk of fetal undernourishment.