RESUMEN
Prolonged oligohydramnios following extreme preterm prelabour rupture of membranes (EPPROM) is traditionally associated with a high morbidity and mortality to both the mother and the baby. The clinical maternal evaluation and fetal ultrasound assessment may provide important prognostic information for the clinicians and should be taken into account when counselling the patients so as to provide them with enough information to make decision of continuing or interrupting the pregnancy. Current financial constraints on the National Healthcare Service (NHS) resources make it imperative for clinical decision-makers and budgetary planners to make the right decision of continuing or terminating a second trimester pre-viability amniorrhexis for desperate parents. To assess the economic consequences following EPPROM, the risk of infection to both baby and mother, psychological impact on the parents and associated complications and further disability after delivery on this fragile group of patients to the NHS resources. We review the clinical course, outcome, and the challenges to parents and health care professionals on three pregnancies complicated by EPPROM, occurring before 24 weeks' gestation with a membrane rupture to delivery interval (latent period) of 14 days or more. The anticipated birth of an extremely premature infant poses many challenges for parents and health care professionals. As parents are faced with difficult decisions that can have a long-term impact on the infant, family and country's resources, it is critical to provide the type of information and support that is needed by them. Taking all these into consideration with the period of ventilation and respiratory assistance in Neonatal Intensive Care Unit (NICU) is essential to provide maximum chances for survival, minimizing the risk for long term sequelae of the neonate and provides the parents enough time to decide on making the right decision with the associated guidance of the healthcare provider.
RESUMEN
OBJECTIVES: Mirena® has been shown to improve symptoms in women with minimal to moderate endometriosis. The precise mechanisms for this have not been thoroughly investigated. We investigate here one possible mechanism-alteration in the number of mast cells in the endometriotic tissue. STUDY DESIGN: Tissues (endometrial, endometriotic and normal peritoneal biopsies) prospectively collected from twenty-eight women with laparoscopically confirmed minimal to moderate endometriosis before and 6 months after treatment with Mirena® were processed for immunohistochemistry for ER and PR expression followed by toluidine blue staining for mast cells. Photographs were obtained and the receptors and mast cells identified and quantified. RESULTS: The mean (± SEM) age of the twenty-eight women was 31 (±7.2) (range 18-42) years. Eight of the endometrial biopsies were in the proliferative phase and twenty in the secretory phase. Six months after Mirena®, the number of mast cell expressed in the tissues decreased significantly in the eutopic (P=0.0358) and ectopic endometrium (P=0.0220) but not in the normal peritoneum (P>0.05). There were no ERs or PRs found in mast cells. CONCLUSION: Mirena® causes a reduction in mast cell numbers in ectopic and eutopic endometrium in women undergoing symptomatic treatment of minimal to moderate endometriosis. This reduction could partly explain the efficacy of Mirena® in modulating pain in these women.
Asunto(s)
Anticonceptivos Femeninos/administración & dosificación , Endometriosis/tratamiento farmacológico , Endometriosis/patología , Dispositivos Intrauterinos Medicados , Levonorgestrel/administración & dosificación , Mastocitos/efectos de los fármacos , Adolescente , Adulto , Biopsia , Recuento de Células , Anticonceptivos Femeninos/uso terapéutico , Endometriosis/inmunología , Endometriosis/metabolismo , Endometrio/efectos de los fármacos , Endometrio/inmunología , Endometrio/metabolismo , Endometrio/patología , Femenino , Fase Folicular , Humanos , Levonorgestrel/uso terapéutico , Fase Luteínica , Mastocitos/inmunología , Mastocitos/metabolismo , Mastocitos/patología , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
OBJECTIVES: The levonorgestrel (LNG) intrauterine system (LNG-IUS) has been shown to improve symptoms in women with minimal to moderate endometriosis. The precise mechanism for this is unknown. We hypothesized that this involves alteration in the expression of estrogen receptors (ER) and progesterone receptors (PR). STUDY DESIGN: A prospective study of tissues obtained prospectively from 28 women with laparoscopically confirmed minimal to moderate endometriosis treated with LNG-IUS for 6 months. Endometrial and endometriotic biopsies obtained before and 6 months after treatment were processed and stained for ER-α, ER-ß and PR expression by immunohistochemistry. Photographs were obtained and the receptors quantified. RESULTS: The mean (±SD) age of the 28 women was 31±7.2 (range 18-42) years. Eight of them at initial biopsy were in the proliferative phase and 20 in the secretory phase. ER-α, ER-ß and PR expression decreased significantly in the glandular (P<0.0001) and stromal (P<0.0001) compartments of the eutopic endometrium after treatment with LNG-IUS. Similarly, ER-α, ER-ß and PR were significantly decreased in the stromal compartment of ectopic endometrium (P<0.0001), and significantly decreased in the ectopic glands of ER-α (P<0.0001), ER-ß (P=0.0002) and PR (P=0.0064) expression. CONCLUSION: The ameliorative effect of LNG-IUS on the symptoms of minimal to moderate endometriosis is likely modulated through a decrease in the expression of glandular and stromal ER-α, ER-ß and PR in the ectopic endometrium.
Asunto(s)
Sistemas de Liberación de Medicamentos , Endometriosis/tratamiento farmacológico , Endometrio/efectos de los fármacos , Levonorgestrel/administración & dosificación , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Adolescente , Adulto , Biopsia , Regulación hacia Abajo/efectos de los fármacos , Endometriosis/metabolismo , Endometriosis/patología , Endometrio/metabolismo , Endometrio/patología , Femenino , Fase Folicular/metabolismo , Humanos , Inmunohistoquímica , Levonorgestrel/uso terapéutico , Fase Luteínica/metabolismo , Isoformas de Proteínas/metabolismo , Índice de Severidad de la Enfermedad , Adulto JovenAsunto(s)
Endometriosis/diagnóstico , Anticonceptivos Hormonales Orales/uso terapéutico , Errores Diagnósticos , Dismenorrea/etiología , Dispareunia/etiología , Endometriosis/tratamiento farmacológico , Femenino , Hormona Liberadora de Gonadotropina/antagonistas & inhibidores , Humanos , Examen Físico/métodosRESUMEN
Successful pregnancy in Noonan's syndrome and balanced Robertsonian translocation women is extremely rare. This is because pregnancies in these women usually end in spontaneous miscarriage or termination before 24 weeks gestation due to severe congenital anomaly. In this article, we report the case of a 41-years-old woman with Noonan's syndrome and balanced Robertsonian translocation. She was delivered by an elective caesarean section at 38 weeks of a live male infant following a second attempt of in vitro fertilisation (IVF) and embryo transfer from donor oocytes. The use of donor eggs and IVF in these women means more of them will achieve successful term pregnancy as in this case. It is therefore important that Obstetricians understand this rare condition and optimise care. This case highlights some of the medical problems encountered by Obstetricians in managing patients in this high risk group.
Asunto(s)
Síndrome de Noonan/patología , Donación de Oocito , Complicaciones del Embarazo/patología , Translocación Genética , Adulto , Femenino , Fertilización In Vitro , Humanos , Masculino , Síndrome de Noonan/genética , Embarazo , Complicaciones del Embarazo/genética , Resultado del Embarazo , Edema Pulmonar/terapiaRESUMEN
A 34-years-old primigravida conceived following a fourth attempt at in vitro fertilization and embryo transfer for severe bilateral tubal disease and grade IV endometriosis. Pregnancy progressed well until 17 weeks gestation when she spontaneously ruptured her membranes. She elected to continue with the pregnancy despite the significant risks associated with prolonged rupture of membranes (PROM) and anhydramnion at extremes of viability. Pregnancy was carried to 28 weeks gestation, when delivery was necessitated by a major antepartum haemorrhage following abruption placentae. A male infant weighing 1,100 g was delivered by emergency caesarean section in good condition, and with no features oligohydramnion tetrad (Potter's features, skeletal deformities, intrauterine growth restriction, and pulmonary hypoplasia). This case adds to the small number of cases in the literature of successful outcome following prolonged pre-viability PROM. Counselling and psychological support to the parents in this situation is extremely important since the anxiety and uncertainty associated with expectant management of PROM does not end with the "successful" delivery of the baby but persists all through the neonatal period and for several years later.