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Pregnancy of unknown location

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https://www.readbyqxmd.com/read/27873370/the-magnitude-of-change-in-the-fetal-cerebroplacental-ratio-in-the-third-trimester-and-the-risk-of-adverse-pregnancy-outcome
#1
Christopher Flatley, Ristan M Greer, Sailesh Kumar
OBJECTIVE: The primary aim of this study was to evaluate if the magnitude of change in the cerebro-placental ratio (CPR) after 30 weeks gestation was better predictive of adverse pregnancy outcome compared to a single measurement at 35-37 weeks. A secondary aim was to evaluate whether the utility of CPR measured at 35-37 weeks was enhanced after adjusting for the gestational change. METHODS: This was a retrospective cohort study of women who had had at least two ultrasound scans between 30-37 weeks gestation with the final scan taking place at 35-37 weeks...
November 22, 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27854392/association-between-three-dimensional-transvaginal-sonographic-markers-and-outcome-of-pregnancy-of-unknown-location-a-pilot-study
#2
S Reid, B Nadim, T Bignardi, C Lu, W P Martins, G Condous
OBJECTIVE: To assess the accuracy of three-dimensional (3D) transvaginal sonographic (TVS) parameters in predicting the evolution of a pregnancy of unknown location (PUL). METHODS: This was a prospective observational study performed at the early pregnancy unit of a university hospital from September 2008 to June 2012. Women with a positive pregnancy test without any signs of intra- or extrauterine pregnancy at their first TVS examination were considered eligible and a 3D dataset containing the entire uterus was acquired...
November 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27819282/characterization-of-t-follicular-helper-cells-in-allogeneic-normal-pregnancy-and-pdl1-blockage-induced-abortion
#3
Weihong Zeng, Zhicui Liu, Siming Zhang, Jiabin Ren, Xiaoling Ma, Chuanmei Qin, Fuju Tian, Yan Zhang, Yi Lin
A deeper understanding of the immunological events during pregnancy will provide novel insights into the pathogenesis of pregnancy complications. The fundamental function of T follicular helper (Tfh) cells is to provide cognate help to B cells. Dysregulations of Tfh-cell function and/or development can result in various immunological diseases. However, the role and characteristics of Tfh cells during pregnancy remain unknown. Herein, an allogeneic-normal-pregnant mouse model was used, and we found that the CD4(+) T cells residing at the uterus and placenta (UP) displayed a Tfh-like phenotype; and the UP-derived CD4(+)CXCR5(hi)PD-1(hi) and CD4(+)CXCR5(hi)ICOS(hi) Tfh cells, which showed a memory/activation phenotype, reached their peak at mid-pregnancy...
November 7, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27818118/-medical-induced-abortion
#4
K Bettahar, A Pinton, T Boisramé, V Cavillon, S Wylomanski, I Nisand, D Hassoun
OBJECTIVE: Updated clinical recommendations for medical induced abortion procedure. METHODS: A systematic review of French and English literature, reviewing the evidence relating to the provision of medical induced abortion was carried out on PubMed, Cochrane Library and international scientific societies recommendations. RESULTS: The effectiveness of medical abortion is higher than 95% when the protocols are adjusted to gestational age (EL1)...
November 3, 2016: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
https://www.readbyqxmd.com/read/27814980/-role-of-ultrasound-in-elective-abortions
#5
S Wylomanski, N Winer
Ultrasound plays a fundamental role in the management of elective abortions. Although it can improve the quality of post-abortion care, it must not be an obstacle to abortion access. We thus studied the role of ultrasound in pregnancy dating and possible alternatives and analyzed the literature to determine the role of ultrasound in post-abortion follow-up. During an ultrasound scan, the date of conception is estimated by measurement of the crown-rump length (CRL), defined by Robinson, or of the biparietal diameter (BPD), as defined by the French Center for Fetal Ultrasound (CFEF) after 11 weeks of gestation (Robinson and CFEF curves) (grade B)...
November 1, 2016: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
https://www.readbyqxmd.com/read/27810130/-surgical-methods-of-abortion
#6
T Linet
OBJECTIVE: A state of the art of surgical method of abortion focusing on safety and practical aspects. MATERIAL AND METHODS: A systematic review of French-speaking or English-speaking evidence-based literature about surgical methods of abortion was performed using Pubmed, Cochrane and international recommendations. RESULTS: Surgical abortion is efficient and safe regardless of gestational age, even before 7 weeks gestation (EL2). A systematic prophylactic antibiotics should be preferred to a targeted antibiotic prophylaxis (grade A)...
October 31, 2016: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
https://www.readbyqxmd.com/read/27793386/imelda-transvaginal-approach-to-ectopic-pregnancy-diagnosis-by-transvaginal-hydrolaparoscopy-and-treatment-by-transvaginal-natural-orifice-transluminal-endoscopic-surgery
#7
Jan Baekelandt, Jona Vercammen
OBJECTIVE: To demonstrate a new minimally invasive approach for the diagnosis and treatment of ectopic pregnancy. DESIGN: Stepwise explanation of the technique using original video footage. SETTING: Hospital. PATIENT(S): Since 2014, 15 patients were treated transvaginally for ectopic pregnancy and pregnancy of unknown location (PUL). INTERVENTION(S): In case of a diagnosis of ectopic pregnancy on ultrasound, a 2...
October 25, 2016: Fertility and Sterility
https://www.readbyqxmd.com/read/27780537/bone-mesenchymal-stem-cells-improve-pregnancy-outcome-by-inducing-maternal-tolerance-to-the-allogeneic-fetus-in-abortion-prone-matings-in-mouse
#8
Yu-Han Meng, Xiao-Hui Zhu, Li-Ying Yan, Yan Zhang, Hong-Yan Jin, Xi Xia, Rong Li, Jie Qiao
INTRODUCTION: The successful pregnancy depends on maternal immune tolerance against the fetus. It has been reported that MSCs (mesenchymal stem cells) could play a regulatory role on immune cells such as CD4(+)T cells, macrophages and NK cells, but their effect on recurrent miscarriage is unknown. STUDY DESIGN: In a prospective study, the abortion-prone (CBA/J × DBA/2) H-2(d) × H-2(k) mice were utilized. Female CBA/J mice (8-10 weeks old) were injected with vehicle or MSCs via tail vein or uterine horns, and 14 days later, they were mated with DBA/2 males for the following experiments...
November 2016: Placenta
https://www.readbyqxmd.com/read/27779816/key-concepts-in-pregnancy-of-unknown-location-identifying-ectopic-pregnancy-and-providing-patient-centered-care
#9
REVIEW
Loren Fields, Alison Hathaway
Pregnancy of unknown location (PUL) is a descriptive term for when a woman with a positive pregnancy test has a transvaginal ultrasound that cannot determine the site of the pregnancy. While the majority of women with PUL are subsequently diagnosed with a spontaneous abortion or viable intrauterine pregnancy, 7% to 20% of these women have an ectopic pregnancy. The potential for morbidity and mortality related to an ectopic pregnancy means that considerable care is necessary in the evaluation and management of women with PUL...
October 25, 2016: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/27745839/structural-chromosomal-rearrangements-require-nucleotide-level-resolution-lessons-from-next-generation-sequencing-in-prenatal-diagnosis
#10
Zehra Ordulu, Tammy Kammin, Harrison Brand, Vamsee Pillalamarri, Claire E Redin, Ryan L Collins, Ian Blumenthal, Carrie Hanscom, Shahrin Pereira, India Bradley, Barbara F Crandall, Pamela Gerrol, Mark A Hayden, Naveed Hussain, Bibi Kanengisser-Pines, Sibel Kantarci, Brynn Levy, Michael J Macera, Fabiola Quintero-Rivera, Erica Spiegel, Blair Stevens, Janet E Ulm, Dorothy Warburton, Louise E Wilkins-Haug, Naomi Yachelevich, James F Gusella, Michael E Talkowski, Cynthia C Morton
In this exciting era of "next-gen cytogenetics," integrating genomic sequencing into the prenatal diagnostic setting is possible within an actionable time frame and can provide precise delineation of balanced chromosomal rearrangements at the nucleotide level. Given the increased risk of congenital abnormalities in newborns with de novo balanced chromosomal rearrangements, comprehensive interpretation of breakpoints could substantially improve prediction of phenotypic outcomes and support perinatal medical care...
November 3, 2016: American Journal of Human Genetics
https://www.readbyqxmd.com/read/27646869/ep25-03-external-validation-of-risk-prediction-model-m4-rationalising-management-of-pregnancies-of-unknown-location
#11
B Nadim, C Lu, B Shakeri, S Reid, G Condous
No abstract text is available yet for this article.
September 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27580995/classification-of-pregnancies-of-unknown-location-according-to-four-different-hcg-based-protocols
#12
J Fistouris, C Bergh, A Strandell
STUDY QUESTION: How do four protocols based on serial human chorionic gonadotropin (hCG) measurements perform when classifying pregnancies of unknown location (PULs) as low or high risk of being an ectopic pregnancy (EP)? SUMMARY ANSWER: The use of cut-offs in hCG level changes published by NICE, and a logistic regression model, M4, correctly classify more PULs as high risk, compared with two other protocols. WHAT IS KNOWN ALREADY: A logistic regression model, M4, based on the mean of two consecutive hCG values and the hCG ratio (hCG 48 h/hCG 0 h) that classify PULs into low- and high-risk groups for triage purposes, identifies more EPs than a protocol using the cut-offs between a 13% decline and a 66% rise in hCG levels over 48 h...
October 2016: Human Reproduction
https://www.readbyqxmd.com/read/27572300/overview-and-guidelines-of-off-label-use-of-methotrexate-in-ectopic-pregnancy-report-by-cngof
#13
REVIEW
Henri Marret, Arnaud Fauconnier, Gil Dubernard, Hélène Misme, Laurence Lagarce, Magali Lesavre, Hervé Fernandez, Camille Mimoun, Claire Tourette, Sandra Curinier, Benoit Rabishong, Aubert Agostini
Our objective is to describe off-label use of methotrexate in ectopic pregnancy treatment using evidence based medicine. The patient group includes all women with a pregnancy outside the usual endometrium, or of unknown location. Method used was a Medline search on ectopic pregnancy managed using methotrexate treatment; evidence synthesis was done based on this current literature analysis. Level of evidence (LE) were given according to the centre for evidence base medicine rules. Grade was proposed for guidelines but no recommendation was possible as misoprostol is off label use for all the indications studied...
October 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/27542587/hormone-receptor-expression-in-patients-with-dermatofibrosarcoma-protuberans
#14
Kathryn L Kreicher, Kord S Honda, David E Kurlander, Jeremy S Bordeaux
BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma for which the exact etiology is unknown. Case reports exist of DFSP appearing and growing rapidly during pregnancy, suggesting a hormonal role. OBJECTIVE: Our goal was to determine the expression of estrogen receptors (ERs) and progesterone receptors (PRs) in patients with DFSP. METHODS: Archived formalin-fixed, paraffin-embedded tissue from patients with DFSP in the past 20 years at a single institution were analyzed for ER and PR using immunohistochemistry...
December 2016: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/27541142/a-family-based-study-of-gene-variants-and-maternal-folate-and-choline-in-neuroblastoma-a-report-from-the-children-s-oncology-group
#15
Angela L Mazul, Anna Maria Siega-Riz, Clarice R Weinberg, Stephanie M Engel, Fei Zou, Kathryn S Carrier, Patricia V Basta, Zalman Vaksman, John M Maris, Sharon J Diskin, Charlene Maxen, Arlene Naranjo, Andrew F Olshan
PURPOSE: Neuroblastoma is a childhood cancer of the sympathetic nervous system with embryonic origins. Previous epidemiologic studies suggest maternal vitamin supplementation during pregnancy reduces the risk of neuroblastoma. We hypothesized offspring and maternal genetic variants in folate-related and choline-related genes are associated with neuroblastoma and modify the effects of maternal intake of folate, choline, and folic acid. METHODS: The Neuroblastoma Epidemiology in North America (NENA) study recruited 563 affected children and their parents through the Children's Oncology Group's Childhood Cancer Research Network...
October 2016: Cancer Causes & Control: CCC
https://www.readbyqxmd.com/read/27500326/differences-in-serum-human-chorionic-gonadotropin-rise-in-early-pregnancy-by-race-and-value-at-presentation
#16
Kurt T Barnhart, Wensheng Guo, Mark S Cary, Christopher B Morse, Karine Chung, Peter Takacs, Suneeta Senapati, Mary D Sammel
OBJECTIVE: To assess whether variation in serum human chorionic gonadotropin (hCG) measures, used to assess early gestation viability, are associated with differences in clinical presentation and patient factors. METHOD: This retrospective cohort study included 285 women with first-trimester pain and bleeding and a pregnancy of unknown location for whom a normal intrauterine pregnancy was ultimately confirmed. Serial samples were collected at three U.S. sites and hCG changes were analyzed for differences by race, ethnicity, and clinical factors...
September 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27484256/anxiety-associated-with-diagnostic-uncertainties-in-early-pregnancy
#17
A Richardson, N Raine-Fenning, S Deb, B Campbell, K Vedhara
OBJECTIVES: To determine anxiety levels of women presenting to Early Pregnancy Assessment Units (EPAU) with abdominal pain and/or vaginal bleeding and assess how these change over time and according to ultrasonographic diagnosis. METHODS: We undertook a prospective cohort study in a EPAU in a large UK teaching hospital. Women with abdominal pain and/or vaginal bleeding in early pregnancy (less than 12 weeks gestation) presenting for the first time were eligible for inclusion in the study...
August 3, 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27477774/developmental-neuropathology-of-brainstem-respiratory-centers-in-unexplained-stillbirth-what-s-the-meaning
#18
Anna M Lavezzi, Stefano Ferrero, Luigi Matturri, Luca Roncati, Teresa Pusiol
Stillbirth is one of the most stressful life events affecting over 3 million pregnancies per year throughout the world. An accurate autopsy of the stillborn fetus, including the placenta and umbilical cord examination, should be performed promptly after delivery. A thorough maternal history also should be taken, including exposures to risk factors. In many cases a death cause, attributable to fetal, maternal, or placental pathology, is clearly identified. However, in 50% or more of cases the cause remains unknown...
October 2016: International Journal of Developmental Neuroscience
https://www.readbyqxmd.com/read/27457397/-use-of-methotrexate-in-the-ectopic-pregnancy-and%C3%A2-pregnancy-of-unknown-location
#19
J Racková, D Driák, H Neumannová, K Hurt, B Sehnal, M Halaška
OBJECTIVE: There are only a few gynaecological departments in the Czech Republic that use medical treatment of the ectopic pregnancy (EP) or persistent pregnancy of unknown location (PUL). We have started using this method in 2008 at our clinic. The aim of this study was to assess the success rate of conservative medical treatment with methotrexate (MTX) in the dose of 1 mg/kg intramuscularly in patients with ectopic pregnancy or persistent pregnancy of unknown location and to compare the results of clinical history, clinical finding and laboratory results in a group of successful and a group of unsuccessful treatment...
April 2016: Ceská Gynekologie
https://www.readbyqxmd.com/read/27453740/velamentous-insertion-of-umbilical-cord-with-vasa-praevia-case-series-and-literature-review
#20
REVIEW
R E Bohîlțea, M M Cîrstoiu, A I Ciuvica, O Munteanu, O Bodean, D Voicu, C A Ionescu
A velamentous umbilical cord is characterized by membranous umbilical vessels at the placental insertion site that are prone to compression and rupture, especially when they are located in the membranes covering the cervical os (vasa praevia). The velamentous insertion of the umbilical cord, with a reported incidence of 1% in singleton pregnancies and 15% in monochorionic twin gestations, has been associated with obstetric complications: fetal growth restriction, prematurity, congenital anomalies, low Apgar scores, fetal bleeding with acute fetal distress and placental retention...
April 2016: Journal of Medicine and Life
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