1/41. Twin delivery after myomectomy, in vitro fertilization, and embryo reduction in an infertile woman.A 28-year-old patient had metroplasty performed because of necrosis of a uterine fibroid. During follow-up, the left adnexa were removed because of a recurrent left ovarian cyst. The triplet gestation achieved by in vitro fertilization was reduced to twins. The living premature newborns were delivered abdominally.- - - - - - - - - - ranking = 1keywords = fertilization (Clic here for more details about this article) |
2/41. Repetitive complete hydatidiform mole can be biparental in origin and either male or female.Complete hydatidiform mole (CHM) is an abnormality in pregnancy due to a diploid conception which is generally androgenetic in origin, i. e. all 46 chromosomes are paternally derived. We have examined the genetic origin of repetitive hydatidiform moles in a patient having three CHM by two different partners, and no normal pregnancies. Using fluorescent microsatellite genotyping, we have shown all three CHM to be biparental, rather than androgenetic, in origin. Examination of informative markers for each homologous pair of chromosomes, in two of the CHM, failed to reveal any evidence of unipaternal disomy, suggesting that the molar phenotype might result from disruption of normal imprinting patterns due to a defect in the maternal genome. It has been suggested that intracytoplasmic sperm injection (ICSI), followed by selection of male embryos, can prevent repetitive CHM; but examination of sex chromosome-specific sequences in the three CHM described here, showed that, while two were female, the first CHM was male. Selection of male embryos is therefore unlikely to prevent repetitive CHM in this patient. Our results suggest that the genetic origin of repetitive CHM should be determined prior to in-vitro fertilization (IVF) and that current strategies for the prevention of repetitive CHM may not be appropriate where the CHM are of biparental origin.- - - - - - - - - - ranking = 0.21747832772263keywords = fertilization, conception (Clic here for more details about this article) |
3/41. One-step hysteroscopic removal of sinking submucous myoma in two infertile patients.OBJECTIVE: To report one-step resectoscopic removal of submucous myomas that were pushed back into the muscular layer by increased intrauterine pressure during hysteroscopic procedures. DESIGN: Case report. SETTING: Kawasaki Municipal Hospital, Kawasaki, japan. PATIENT(S): Two infertile women presenting with menorrhagia in whom submucous myoma with a broad base was diagnosed. INTERVENTION(S): One patient was pretreated with GnRH agonist for 4 months; the other patient did not receive this treatment. Resectoscopic myomectomies were performed under close sonographic monitoring. MAIN OUTCOME MEASURE(S): Clinical symptoms and conception status. RESULT(S): Tumor sinking occurred during the hysteroscopic procedures, but complete resectoscopic removal of the submucous myomas was achieved under sonographic and hysteroscopic visualization. One patient experienced hyponatremia but recovered after conservative treatment. Both patients conceived after myoma removal. CONCLUSION(S): Sinking myomas, which may cause infertility, can be removed with a one-step hysteroscopic procedure. Sinking of submucous myomas during hysteroscopy might be caused by pretreatment with GnRH agonist and by increased intrauterine pressure during hysteroscopy. We recommend that intrauterine pressure be <45 mmHg, equivalent to hanging a bag of fluid under gravity control 70 cm above the patient's uterus, at the beginning of operations for sinking myomas.- - - - - - - - - - ranking = 0.017478327722631keywords = conception (Clic here for more details about this article) |
4/41. Ovarian conservation in a woman of reproductive age with mullerian adenosarcoma.BACKGROUND: Total abdominal hysterectomy with bilateral salpingo-oophorectomy is generally considered optimal therapy for patients with uterine sarcomas. Local resection of the tumor or hysterectomy with ovarian conservation has been used in only a small number of patients. recurrence risk in women undergoing ovarian-sparing surgery for mullerian adenosarcomas can be difficult to evaluate due to the paucity of literature in this area. We present a reproductive-age woman with a mullerian adenosarcoma and review the literature on conservative surgical management of this class of tumors. CASE: A 25-year-old nulligravida was diagnosed with a uterine adenosarcoma and the question of conservative surgical therapy arose. Following a literature review, discussion with the patient led to the decision for ovarian preservation at the time of hysterectomy. The pelvis and abdomen were grossly free of metastatic disease at laparotomy and all tumor was confined to the uterus on pathologic examination. She is free of disease 36 months postoperatively and is now considering in vitro fertilization using a surrogate. CONCLUSION: Ovarian conservation can probably be offered safely in carefully selected women of reproductive age with mullerian adenosarcomas.- - - - - - - - - - ranking = 0.2keywords = fertilization (Clic here for more details about this article) |
5/41. Molecular analysis of a gestation consisting of a complete hydatidiform mole and normal dizygotic twin.OBJECTIVE: To identify a twin pregnancy consisting of a complete mole and coexistent fetus by means of molecular cytogenetics and dna polymorphisms. STUDY DESIGN: Seven highly polymorphic dna markers were used to establish the androgenetic origin of a complete hydatidiform mole that coexisted with a normal 46,XY fetus. cytogenetic analysis of mole nuclei was performed with centromeric probes, demonstrating a 46,XX constitution. RESULTS: molar tissue was diploid with two X chromosomes, possibly due to chromosome doubling after monospermic fertilization of an ovum with inactivated or absent nucleus. CONCLUSION: Although contamination with maternal tissue may be difficult to avoid, molecular markers provide the possibility of distinguishing between a complete hydatidiform mole and coexisting normal fetus versus a partial mole, with methods that can be performed antenatally. This distinction is important since in the first case up to 24% of fetuses described in the literature have been viable, and the risk of subsequent development of persistent trophoblastic tumor in patients with a complete mole and a coexisting fetus is considerably higher than in patients with a single, complete hydatidiform mole.- - - - - - - - - - ranking = 0.2keywords = fertilization (Clic here for more details about this article) |
6/41. Red degeneration of a leiomyoma masquerading as retained products of conception.BACKGROUND: The incidence of leiomyomas in pregnancy is approximately 1%. Their presence has been linked to spontaneous abortion, premature labor, soft tissue dystocia, uterine inertia, fetopelvic disproportion, malposition of the fetus, retention of the placenta, and postpartum hemorrhage. CASE: This case report documents a seldom-described event of a submucous leiomyoma masquerading as retained products of conception. The patient presented 4 weeks postpartum with complaints of urinary retention and heavy bleeding with cramping. Examination revealed a large mass resembling placental tissue filling the vaginal vault. The necrotic mass was removed with blunt and sharp dissection. The final pathology report revealed a degenerating leiomyoma. CONCLUSION: Complicating factors associated with this fibroid included a history of spontaneous abortion and preterm labor, as well as fetal malpresentation and carneous degeneration of the leiomyoma. Gestational myomas, although rare, can have an unusual appearance that may be misinterpreted.- - - - - - - - - - ranking = 0.087391638613153keywords = conception (Clic here for more details about this article) |
7/41. A case of twin pregnancy with complete hydatidiform mole and coexisting fetus following IVF-ET.Twin pregnancy consisting of complete hydatidiform mole (H-mole) and a coexisting fetus occurs with an estimated incidence of 1 per 22,000-100,000 pregnancies. The incidence of this unusual twin pregnancy with complete H-mole and a coexisting fetus after in vitro fertilization and embryo transfer (IVF-ET) is not thought to be greater than that of general population. We present an unusual twin pregnancy with complete H-mole and a coexisting fetus that occurred following IVF-ET, which was terminated at 21 weeks of gestation and developed into nonmetastatic gestational trophoblastic tumor.- - - - - - - - - - ranking = 0.2keywords = fertilization (Clic here for more details about this article) |
8/41. Brief psychotic disorder associated with bereavement in a patient with terminal-stage uterine cervical cancer: a case report and review of the literature.We report here a terminally ill patient with uterine cervical cancer who developed a brief psychotic disorder after bereavement following the loss of three close friends also suffering from gynecological cancer. A 49-year-old housewife, who was diagnosed as having uterine cervical cancer and was receiving palliative care was referred for psychiatric consultation because of an abrupt onset of delusions, bizarre behavior, disorganized speech, and catatonic behavior. On psychiatric examination, she showed delusional thought and catatonic behavior. Laboratory data were unremarkable, as was brain MRI. She had no history of psychiatric illness or drug or alcohol abuse. After receiving haloperidol, psychiatric symptoms disappeared, and she returned to the previous level of functioning after 3 days. The patient explained that the death of three of her friend due to gynecological cancer was shocking event for her. She focused her attention on her own fears of dying from the same disease. Brief psychotic disorder in cancer patients is rare in the literature. However, our report of brief psychotic disorder associated with bereavement may highlight possible precipitating factors, which have not been adequately emphasized in the literature to date. From a clinical perspective, it would be informative for liaison psychiatrists to inquire about the patient's experience of loss of significant others with the same disease. This may provide useful information helpful to understanding the patient's conception of the disease process. Cancer patients' bereaving friends who had cancer is not rare in clinical settings. Therefore, medical staff should be mindful of interpersonal relationships between patients and bereavement arising from these relationships.- - - - - - - - - - ranking = 0.017478327722631keywords = conception (Clic here for more details about this article) |
9/41. Serial hCG and ultrasound measurements for predicting malignant potential in multiple pregnancies associated with complete hydatidiform mole: a report of 2 cases.BACKGROUND: Multiple pregnancy complicated by the presence of a complete hydatidiform mole (CHM) is a rare clinical entity. However, there are enough accumulated data to assist the clinician in the management of such a patient. CASES: Case 1 presented in the first trimester with a twin pregnancy associated with a CHM. In the absence of other complications, the pregnancy was monitored with serial beta-human chorionic gonadotropin (beta-hCG) and ultrasound measurements. A reduction in molar volume suggested regression of the CHM. The pregnancy was successfully carried to term with no progress of the CHM. Beta-hCG levels regressed after delivery. Case 2 had a triplet pregnancy resulting from in vitro fertilization with a CHM detected in the first trimester. Similar measurements were applied. The pregnancy was complicated by episodes of antepartum hemorrhage (APH). Further, the molar volume continued to increase. Because of recurrent APH, delivery was by cesarean section. After delivery, after an initial decline, the beta-hCG level rose, and pulmonary metastases were detected. The patient was treated with single-agent chemotherapy, with complete resolution. CONCLUSION: The combination of serial ultrasound molar volume measurements with serial beta-hCG estimation may assist the clinician in predicting which of these rare complicated pregnancies will result in the development of trophoblastic neoplasia.- - - - - - - - - - ranking = 0.2keywords = fertilization (Clic here for more details about this article) |
10/41. Intramural molar pregnancy: a case report.BACKGROUND: Intramural pregnancy is a rare but potentially life-threatening condition. The condition remains unknown to many clinicians and sonographers. With the ever-increasing use of high-resolution ultrasound scanning, early diagnosis of the condition is now possible, provided that the condition is thought of. To our knowledge, this is the first reported case of intramural pregnancy treated with suction evacuation under laparoscopic guidance. CASE: A 28-year-old woman presented with history of vaginal bleeding early in her fourth pregnancy, having had 2 previous suction terminations of pregnancy and evacuation of retained products of conception for incomplete miscarriage at 8 weeks' gestation 2 months earlier. An ultrasound scan showed a complex mass in the left fundal region of the uterus, and the serum beta-human chorionic gonadotropin levels were grossly elevated. The patient was found to have an intramural hyperplastic pregnancy, treated with suction evacuation under laparoscopic guidance and systemic methotrexate therapy. CONCLUSION: A macroscopic ostium led into the uterine cavity and made guided suction evacuation of the uterus possible. early diagnosis can prevent a life-threatening situation and conserve reproductive function.- - - - - - - - - - ranking = 0.017478327722631keywords = conception (Clic here for more details about this article) |
| | Next -> |