RESUMEN
BACKGROUND: To analyze the effects of embryo transfer (ET) quality on clinical pregnancy (CPR) and live birth delivery rates (LBDR). METHODS: In a retrospective study at a single, private infertility center between November 2005 and December 2009 one thousand fifty-five day-3 and day-5 ETs following IVF/ICSI/IMSI were evaluated. We analyzed the impact of an atraumatic ET with a soft catheter (ET 1), after external guidance (ET 2), after probing of the cervix with a stylet (ET 3), or after grasping the portio vaginalis with a tenaculum (ET 4) on CPR and LBDR. RESULTS: The use of external guidance showed a significantly reduced LBDR as compared to an atraumatic ET (26.0% vs. 32.5%). The lowest CPR and LBDR were found in ET 4. The application of stylets in cases of difficult ETs was superior to the use of external guidance. No differences in miscarriages between ET 1-4 were noted. CONCLUSIONS: Besides embryo culture and patient history, the quality of an ET might also have an important impact on pregnancy outcome. Techniques to ensure an atraumatic ET, such as mechanic uterine cavity length measurements, before starting treatment might help identify patients at risk for a difficult ET and lead to modified treatments, such as the primary use of a stylet. Limitation of study: retrospective analysis.
Asunto(s)
Transferencia de Embrión/normas , Fertilización In Vitro , Nacimiento Vivo , Aborto Espontáneo , Adulto , Tasa de Natalidad , Transferencia de Embrión/métodos , Femenino , Humanos , Embarazo , Estudios Retrospectivos , Inyecciones de Esperma Intracitoplasmáticas/métodosRESUMEN
OBJECTIVE: Tibolone has been shown to alleviate climacteric symptoms. This study was designed to compare the effect of tibolone (Livial, 2.5 mg daily) on different climacteric complaints and its impact on the endometrium, determined by vaginal ultrasound, with that of conjugated estrogens (Premarin, 0.625 mg daily) continuously for 6 months in combination with the progestogen medrogestone (Colpron, 2 x 5 mg daily for 12 days each month). METHODS: One hundred and twenty-nine postmenopausal women were recruited and the severity of climacteric symptoms as well as endometrial thickness were recorded at the pre-trial examination and after 1, 3, and 6 months. RESULTS: With the exception of vertigo, mood depression, mood disorder, loss of libido, and dryness of skin, where tibolone was found to be more effective than conjugated estrogens/medrogestone, climacteric symptoms improved significantly in both groups over the 6-month study period. Endometrial thickness did not increase significantly in the tibolone group, whereas in the conjugated estrogens/medrogestone group there was a highly significant increase after 1 month and still a trend towards significance after 6 months. Recurrence of vaginal bleeding occurred significantly less frequently in the tibolone group than in the comparison group. CONCLUSION: Tibolone seems to offer a complete treatment of the climacteric complaints whilst avoiding some of the problems associated with classical hormone replacement therapy.
Asunto(s)
Climaterio/efectos de los fármacos , Estrógenos/uso terapéutico , Norpregnenos/uso terapéutico , Progestinas/uso terapéutico , Climaterio/fisiología , Relación Dosis-Respuesta a Droga , Endometrio/anatomía & histología , Endometrio/diagnóstico por imagen , Endometrio/efectos de los fármacos , Estrógenos/efectos adversos , Estrógenos/normas , Femenino , Humanos , Incidencia , Persona de Mediana Edad , Norpregnenos/efectos adversos , Norpregnenos/normas , Progestinas/efectos adversos , Progestinas/normas , Encuestas y Cuestionarios , Factores de Tiempo , Ultrasonografía , Hemorragia Uterina/tratamiento farmacológico , Hemorragia Uterina/epidemiologíaRESUMEN
HELLP syndrome, a combination of haemolysis, elevated liver function tests and a low platelet count, is described as a rare but serious complication of pregnancy. Some authors term HELLP syndrome an "acute autoimmune status". This thesis is based upon positive platelet IgG antibodies, autoimmune haemolysis and passive disease transfer to the fetus. We diagnosed the onset of type 1 (insulin-dependent) diabetes mellitus in a 30-year-old patient with HELLP syndrome during the 35th week of pregnancy. As immune mechanisms, together with other factors, play a fundamental role in the development of type 1 diabetes, a combination of autoimmune reactions could explain the onset of type 1 diabetes in a patient with altered immune status. To our knowledge this is the first report of such an association.
Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Síndrome HELLP/complicaciones , Embarazo en Diabéticas/complicaciones , Adulto , Cesárea , Cuidados Críticos , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/análisis , Síndrome HELLP/diagnóstico , Síndrome HELLP/terapia , Antígenos HLA-DR/sangre , Humanos , Recién Nacido , Insulina/uso terapéutico , Embarazo , Embarazo en Diabéticas/sangre , Embarazo en Diabéticas/tratamiento farmacológicoRESUMEN
Teratomas, which consist only or predominantly of thyroid tissue, are termed struma ovarii. Two cases are reported, where after previous strumectomy the histologic diagnosis was struma ovarii. Because of postoperative TSH-rise hormonal activity can be assumed. The proper diagnosis is seldomly made preoperatively, this could be done by abdominal scintigraphic imaging of radioiodine uptake in the tumour.
Asunto(s)
Neoplasias Ováricas/cirugía , Estruma Ovárico/cirugía , Femenino , Humanos , Neoplasias Ováricas/patología , Estruma Ovárico/patología , Tirotropina/sangreRESUMEN
In this prospective multi-centre-study, the new treatment of tubal pregnancies by means of local prostaglandin (PG) F2 alpha and systemic PG E2 application was compared to the usual surgical technique of eliminating the conceptus. In 71 patients treated with PG, the method proved to be successful in 81%; 21 patients (19%) required surgical intervention later. With an initial beta-hCG level of 2500 mIE/ml, the success rate increased to 88%. The duration of hospitalisation was significantly reduced in the PG group compared to the patients treated by primary operation (3 +/- 1 versus 6 +/- 2 days). In the PG-group, only 2 of 24 hysterosalpingograms showed tubal occlusions after treatment, whereas occlusion was present in 3 of 8 patients of the surgically treated group. Four subsequent intrauterine pregnancies in the PG-group occurred compared to none in the surgical group. PG treatment of tubal pregnancy in patients with a low initial beta-hCG value (less than 2500 mIE/ml) revealed promising results with regard to reduced postoperative morbidity and future fertility.
PIP: In this prospective, multicenter study, the new treatment of tubal pregnancies by means of local prostaglandin (PG) F2alpha and systemic PGE2 application was compared to the usual surgical technique of eliminating the conceptus. In 71 patients treated with PGs, the method proved to be successful in 81%; 21 patients (195) required surgical intervention at a later date. With an initial beta-hCG level of 2500 mIE/ml, the success rate increased to 88%. The duration of hospitalization was significantly reduced in the PG group compared to the patients treated by primary operation ()3 +or- 1 vs 6+or- 2 days). In the PG group, only 2 of 24 hysterosalpingograms showed tubal occlusions after treatment, whereas occlusion was present in 3 of 8 patients of the surgically treated group. 4 subsequent intrauterine pregnancies in the PG group occurred compared to none in the surgical group. PG treatment of tubal pregnancy in patients with a low initial beta-hCG value (2500 mIE/ml) revealed promising results with regard to reduced postoperative morbidity and future fertility. (author's)
Asunto(s)
Abortivos no Esteroideos/administración & dosificación , Abortivos/administración & dosificación , Dinoprost/administración & dosificación , Embarazo Tubario/tratamiento farmacológico , Gonadotropina Coriónica/sangre , Gonadotropina Coriónica Humana de Subunidad beta , Ensayos Clínicos como Asunto , Dinoprostona/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Inyecciones Intralesiones , Inyecciones Intramusculares , Laparoscopía , Fragmentos de Péptidos/sangre , Embarazo , Estudios ProspectivosRESUMEN
Because of the atypical symptomatology, which can mimic an EPH-gestosis, the physiological elevation of serum aldosterone in the third trimester and restricted diagnostic possibilities, the diagnosis of primary hyperaldosteronism during pregnancy is difficult. A case of an adrenal adenoma during pregnancy is reported.
Asunto(s)
Hiperaldosteronismo/diagnóstico , Complicaciones del Embarazo/diagnóstico , Adenoma/diagnóstico , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Hiperaldosteronismo/genética , Preeclampsia/diagnóstico , Embarazo , Complicaciones Neoplásicas del Embarazo/diagnósticoAsunto(s)
Rotura Prematura de Membranas Fetales/tratamiento farmacológico , Madurez de los Órganos Fetales/efectos de los fármacos , Recién Nacido de Bajo Peso , Pulmón/embriología , Trabajo de Parto Prematuro/tratamiento farmacológico , Tocólisis , Antibacterianos/administración & dosificación , Cortisona/administración & dosificación , Femenino , Humanos , Recién Nacido , Embarazo , Síndrome de Dificultad Respiratoria del Recién Nacido/prevención & controlRESUMEN
6 infertile women with primary or secondary amenorrhoea or anovulation, who failed to ovulate after clomiphene and HMG/HCG treatment, underwent 11 treatment cycles with pulsatile GnRH therapy using a portable pump. Normal ovulation occurred in 9 out of 11 treatment cycles; the luteal phase was normal in 6 cycles. One woman conceived in the second treatment cycle.