Researchers found the tumor-fighting powers of the drug worked through a combination of ways. The drug appeared to inhibit extracellular signal-regulated kinase (ERK) phosphorylation, a key component in the molecular pathway that leads to the growth of new cells. In addition, the anti-cholesterol medication was shown to stop the progression of tumor cells that have already begun to grow while also inducing calcium-dependent cell death mechanisms in fibroid tumor cells.

"Taken together, this study has identified a novel pathway by which simvastatin induces the death of uterine fibroid tumor cells." said one of the authors, Darren Boehning, in a news release.

The anti-tumor properties of simvastatin will continued to be studied by the research team, with ongoing investigations focusing on testing the use of the drug to treat fibroid in animals, meaning human clinical application isn’t in the immediate future.

Still, the authors suggest that if the drug continues to prove its ability to fight non-cancerous uterine fibroids, the result could have a lasting impact on preventing hysterectomies.

The authors review the recent changes in diagnostic criteria of gestational diabetes mellitus (GDM),

describe problems with maintaining and monitoring adequate blood glucose, especially in type 1 diabetes, and provide a brief overview of the currently approved glucose–lowering therapies in pregnancy.

The HAPO study provides a very suggestive evidence for a strong, continuous association of maternal glucose levels with an increased risk of excessive foetal weight gain.

The new definition of GDM results in higher healthcare expenditure, but remains cost–effective.

The current therapeutic goals require careful revision to further reduce the risk of adverse outcomes.

New glucose–monitoring strategies and markers, and approval of new pharmacotherapies are needed.

The antiviral drug telbivudine prevents perinatal transmission of hepatitis B virus (HBV), according to a study in the June issue of Clinical Gastroenterology and Hepatology. “If we are to decrease the global burden of hepatitis B, we need to start by addressing mother–to–infant transmission, which is the primary pathway of HBV infection,” said study author Yuming Wang from Institute for Infectious Diseases, Southwest Hospital, Chongqing, China. “We found that telbivudine not only eliminated vertical transmission of HBV from pregnant women to theirs infants, but that it is also safe and well tolerated by women and infants.” Researchers performed a prospective study of 450 HBV–positive pregnant women with high viral load, or significant HBV in the blood, during the second or third trimester of pregnancy. Two hundred and seventy nine women received telbivudine (600 mg daily) during weeks 24 through 32 of gestation, and 171 women who were unwilling to take antiviral drugs participated as controls. At six months after birth, none of the infants whose mothers were given telbivudine tested positive for HBV, compared to 14.7 percent of infants in the control group. Levels of HBV also decreased for the moms: almost a quarter who received telbivudine had no HBV detectable in their system. Those not on the antiviral medication all tested positive for HBV.

A significantly higher proportion of women given telbivudine had undetectable levels of HBV DNA in cord blood (99.1 percent) than controls (61.5 percent). No severe adverse events or complications were observed in women or infants.

The long–term influence of using telbivudine, especially when compared to the other recommended oral antiviral drug, tenofovir, remains to be explored

5 - Factors associated with successful transabdominal sonography-guided dilation and curettage for early cesarean scar pregnancy

Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China

Objective

To investigate factors associated with successful transabdominal sonography-guided dilation and curettage for the treatment of cesarean scar pregnancy (CSP).

Methods

In a retrospective study, data were reviewed from patients who received transabdominal sonography-guided dilation and curettage (TASDC) as the primary treatment for early CSP at The Second Xiangya Hospital, Changsha, China, between 2009 and 2013.

Results

Among 232 patients, 185 (79.7%) women with CSP were successfully treated with TASDC. Among them, 81 (43.8%) required insertion of a Foley catheter into the lower uterine segment to stop bleeding. The complication rate was 37.9% (88/232) and the failure rate was 21.3% (47/232). Overall, 28 (12.1%), 5 (2.2%), and 4 (1.7%) patients with massive intraoperative uterine bleeding were treated with wedge resection of the uterus, hysterectomy, and uterine artery embolization as a secondary treatment, respectively. In binary logistic regression analysis, pregnancy of 7 weeks or less and pregnancy without missed abortion were associated with successful TASDC for patients with CSP (P < 0.001).

Conclusion

Pregnancy of 7 weeks or less and pregnancy without missed abortion were found to be important factors for successful TASDC among patients with CSP. Wedge resection was the main secondary treatment to preserve the uterus and remove gestational tissue among patients with massive bleeding.

OBJECTIVE To investigate if unexplained recurrent spontaneous abortions (RSA) are associated with increased rates of aneuploidy in spermatozoa of RSA partners ('RSA-men').

PATIENT(S) Patients enrolled at the Hormone and Fertility Center and controls at the Department of Urology (LMU-Munich).

INTERVENTION(S) Sperm samples of 11 partners of unexplained RSA cases evaluated for elevated diploidy and disomy levels of chromosomes 1-22, X, and Y by multicolor sperm fluorescence in situ hybridization (FISH).

MAIN OUTCOME MEASURE(S) Aneuploidy rates obtained in RSA-men compared with controls from the literature and internally; an increase of the aneuploidy rate was considered statistically significant, when it differed ≥2 standard deviations from the mean baseline level in controls.

RESULT(S) Our sperm FISH data on RSA men showed increased disomy rates for at least three chromosomes in more than 60% of patients but no statistically significant increase of the overall mean sperm disomy or diploidy rate. In particular, meiotic errors involving chromosome 16 contributed to increased sperm disomy in more than 60% of our patients.

CONCLUSION(S) These data suggest that among paternal meiotic errors nondisjunction of chromosome 16 might have similar relative influence on fetal aneuploidy compared with maternal chromosome 16 disomy.

OBJECTIVE Data regarding the association between isolated single umbilical artery (SUA) and pregnancy outcome are inconsistent and mainly address the risk of pregnancy complications. Thus, we aimed to focus on the association between isolated SUA, and labor and delivery.

METHODS We conducted a case-control study of all singleton pregnancies diagnosed with isolated SUA (no known chromosomal/structural anomalies/fetal growth restriction) attempting vaginal delivery. Obstetric and neonatal outcome was compared with that of a control group of pregnancies with a three-vessel cord in a 1:2 ratio matched by parity. Composite adverse outcome included the following: Cesarean section (CS) and/or operative delivery due to non-reassuring fetal heart rate (NRFHR), prolonged neonatal admission, low Apgar score and umbilical artery pH < 7.2.

RESULTS Out of 34 196 deliveries, 162 (0.5%) were diagnosed with SUA, and 91 (0.27%) were diagnosed with isolated SUA. Isolated SUA was associated with a higher rate of CS due to NRFHR (5.5% vs 1%, p = 0.02), small for gestational age (SGA) (14.3% vs 4.9%, p = 0.009), lower birth weight, and a higher rate of composite adverse outcome (20.9% vs 8.8%, p = 0.005). On multivariable analysis, isolated SUA was independently associated with an increased risk for composite adverse outcome (OR 2.34, 95% CI 1.05-5.21).

This findings could be interpreted to mean that at CS rates below this threshold, socio–economic development may be driving the ecologic association between CS rates and mortality. On the other hand, at rates higher than this threshold, there is no association between CS and mortality outcomes regardless of adjustment. The ecological association between CS rates and relevant morbidity outcomes needs to be evaluated before drawing more definite conclusions at population level.

Study at UB and UR is recruiting pregnant women with severe nausea and vomiting. Pregnant women with hyperemesis gravidarum may find relief from a medication prescribed for seizure patients.

The first randomized, double–blind, two–arm clinical trial to test gabapentin as a treatment for hyperemesis gravidarum, begins this summer, thanks to a four–year, $1.3 million National Institutes of Health grant to Thomas J. Guttuso Jr, MD, associate professor of neurology and obstetrics and gynecology at the University at Buffalo School of Medicine and Biomedical Sciences. The drug is normally prescribed to treat seizures, pain and restless legs syndrome.

11 - OCs & endometrial cancer

Oral contraceptive (OC) use reduces a woman’s risk of developing endometrial cancer in later life, but by how much and how long does the effect last? A Collaborative Group has published data about OC use in over 27 000 women with endometrial cancer over the last 20 years (Lancet Onc 2015;16:1061-70).

The mean age at diagnosis was 63 years and the longer women had used OCs the greater the reduction in their risk of uterine malignancy, with every 5 years associated with a risk ratio of 0.76 (CI 0.73 – 0.76). The reduction persisted for more than 30 years.

There was significant absolute risk reduction with a woman generally lowering her endometrial cancer risk from 2.3 to 1.3 per 100 women years. It is estimated since OCs were introduced 5 decades ago, nearly half a million cases of endometrial cancer have been prevented by their use.

12 - Hysteroscopic sterilisation

With the increasing caesarean section rate and improved fetal survival in our country –Egypt- the need for permanent contraception is gaining more acceptance. The vast majority of procedures are laparoscopic tubal occlusions but in the last 10 years the hysteroscopic approach has become more popular in western countries, rising from less than 1% of all sterilisations to over 25% now. Of these, most are Essure procedures where a coil is inserted into the lumen of each fallopian tube via the uterine cavity which causes fibrosis and tubal occlusion. Essure is approved in USA 2002(13years ago). This technique obviates the need for incisions, abdominal cavity entry and (theoretically) general anaesthesia but there is a remarkable lack of data available about its acceptability, efficacy and complications and actual cost in Egypt (Dhruva et al NEJM 2015 doi:10.1056/NEJMp1510514).

To fill this information gap, Mao et al (BMJ 2015;373:h5162) reviewed over 8 000 Essure insertions and outcomes carried out in the New York area over the last decade. They found the indications included women who were older, obese, had previous abdominal surgery or co-morbidities and half of the procedures were performed under general anaesthesia. In keeping with instructions, a hysterosalpingogram (HSG) was required 3 months post-insertion to check occlusion so there was an opportunity to collect data about side effects. It appears that although the long-term results of pregnancy prevention are similar to conventional tubal litigation (less than 0.5%) there were 10 times as many complications requiring re-operation with Essure.

This extra operative risk (absolute risk about 2%), the unexpectedly high anaesthetic rate, the HSG requirement plus the 3 month continuation of conventional contraception all add up in terms of cost and efficiency. Essure does provide a sterilisation option but at a price and those being offered the method need to be told of the real-world complexity rates. Although hysteroscopy has become a common procedure in many Egyptian clinics, still many do not have the sufficient training.
Prospective data need to be collected and the existing facts communicated and the Essure made available at an affordable price.

13 - Miscarriage diagnosis

Ultrasound is used to diagnose whether an early pregnancy is viable or not. There are two crucial measurements in deciding if a miscarriage diagnosis can be made and they are the mean sac diameter and the crown rump (CR) length. If there is an empty gestational sac of greater than 25 mm or a CR length of greater than 7 mm with no fetal heart, then the pregnancy is non-ongoing.
If the findings are equivocal then the scan should be repeated in 7 days’ time and specific criteria are available that offer very high certainty that the pregnancy is non-viable if not attained (Preisler et al BMJ 2015;373:h4579). These scientists tested the sonographic measurements in nearly 3000 pregnancies where the situation was uncertain and found their predetermined criteria to be reliable in all the cases they tested.
It is important for all potential parents to be reliably informed about the state of their early pregnancies and the data gathered by the study presented here give confidence to ultrasonographers that their images reflect the clinical situation.

Data suggest short–term use of over–the–counter drugs could negatively impact fertility.

The results of a study presented at the European League Against Rheumatism Annual Congress (EULAR 2015) show that diclofenac, naproxen and etoricoxib significantly inhibit ovulation in women with mild musculoskeletal pain.

Of the women receiving NSAIDs, only 6.3% (diclofenac), 25% (naproxen) and 27.3% (etoricoxib) ovulated, compared with 100% of the control group.

These findings suggest that readily available non–steroidal anti–inflammatory drugs (NSAIDs) could have a harmful effect on fertility, and should be used with caution in women wishing to start a family.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed class of drugs worldwide and are frequently used by women of childbearing age. The adverse gastrointestinal, cardiovascular, and renal effects of NSAIDs are well known. Similarly, most clinicians likely understand that using NSAIDs in near-term pregnancy may have adverse effects, including potential prolongation of labor, premature closure of the fetal ductus arteriosus, and increased risk for postpartum bleeding.^[1] However, the potential for NSAIDs to adversely affect ovulation has received much less attention, even though this potential complication was described in the medical literature over 2 decades ago.^[2-6]

NSAIDs are prostaglandin inhibitors that block cyclo-oxygenase (COX)-1 and COX-2 enzyme production. The COX enzyme system catalyzes the production of biologically important prostaglandins. One isoenzyme, namely COX-2, is active in the ovaries during follicular development. Inhibition of COX-2 by NSAIDs and COX-2 inhibitors (eg, celecoxib) is thought to potentially cause reversible luteinized unruptured follicle syndrome (LUFS) in a subset of patients.^[1,6] This syndrome is characterized by a failure of ovulation. While clinical signs of ovulation (eg, elevated body temperature and progesterone levels) do occur, follicular rupture and ovum release are absent.

COX-2 inhibitors may have further adverse effects on fertility. COX-2 expression is thought to occur not only in ovulation but also in fertilization, implantation, and maintenance of pregnancy.^[7] COX isoforms are important in the generation of prostaglandins that are essential for formation of proteolytic enzymes causing rupture of the egg follicles as well as prostaglandins crucial in angiogenesis for establishment of the placenta.^[6,7]

Sporadic case series reports of delayed ovulation and/or LUFS in association with NSAID use have appeared in the medical literature.^[4-6]

Prospective, randomized, controlled trials of small sample sizes have demonstrated that NSAIDs and COX-2 inhibitors produce a reversible delay in follicular rupture.^[8-10] The studies show a fairly consistent pattern of apparently insignificant differences in biological variables, such as menstrual cycle length or overall endocrine profiles of cycles in women receiving NSAIDs and COX-2 inhibitors vs placebo. However, unruptured follicles were more often observed in a significantly higher proportion of women using these agents, and this effect is reversible upon drug discontinuation.

On the contrary, at least two small randomized trials^[11,12] and one prospective observational cohort study^[13] seem to provide reassurance that delayed follicular rupture is unlikely to cause infertility.

The most recent data were presented at this year's European League Against Rheumatism (EULAR) Annual Congress by Salman and colleagues.^[14] This prospective trial randomly assigned 39 women of childbearing age with minor back pain to one of four groups, as follows:

Velkeniers B et al. – Previous meta–analyses of observational data indicate that pregnant women with subclinical hypothyroidism have an increased risk of adverse pregnancy outcome. Potential benefits of levothyroxine (LT4) supplementation remain unclear, and no systematic review or meta–analysis of trial findings is available in a setting of assisted reproduction technologies (ART). This meta–analyses provide evidence that LT4 supplementation should be recommended to improve clinical pregnancy outcome in women with subclinical hypothyroidism and/or thyroid autoimmunity undergoing ART. Further research is needed to determine pregnancy outcome after close monitoring of thyroid function to maintain thyroid–stimulating hormone and free T4 levels within the trimester–specific reference ranges for pregnancy.

Methods

Relevant trials published until August 2012 were identified by searching MEDLINE, EMBASE, Web of Knowledge, the Cochrane Controlled Trials Register databases and bibliographies of retrieved publications without language restrictions.

Results

From 630 articles retrieved, authors included three trials with data on 220 patients.
One of these three trials stated ‘live delivery’ as outcome.
LT4 treatment resulted in a significantly higher delivery rate, with a pooled relative risk (RR) of 2.76 (95% confidence limits 1.20–6.44; P = 0.018; I² = 70%), a pooled absolute risk difference (ARD) of 36.3% (3.5–69.0%: P = 0.030) and a summary number needed to treat (NNT) of 3 (1–28) in favour of LT4 supplementation.
LT4 treatment significantly lowered miscarriage rate with a pooled RR of 0.45 (0.24–0.82; P = 0.010; I² = 26%), a pooled ARD of –31.3% (–48.2 to –14.5%: P < 0.001) and a summary NNT of 3 (2–7) in favour of LT4 supplementation.
LT4 treatment had no effect on clinical pregnancy (RR 1.75; 0.90–3.38; P = 0.098; I² = 82%).
In an ART setting, no data are available on the effects of LT4 supplementation on premature delivery, arterial hypertension, placental abruption or pre–eclampsia.

CHICAGO -- February 24, 2014 -- Children of women who used the pain reliever acetaminophen (paracetamol) during pregnancy appear to be at higher risk for attention-deficit/hyperactivity disorder (ADHD)-like behavioural problems and hyperkinetic disorders (HKDs).

Acetaminophen is the most commonly used medication for pain and fever during pregnancy. But some recent studies have suggested that acetaminophen has effects on sex and other hormones, which can in turn affect neurodevelopment and cause behavioural dysfunction.

For the current study, Zeyan Liew, University of California Los Angeles, Los Angeles, California and colleagues studied 64,322 children and mothers in the Danish National Birth Cohort (1996-2002). Parents reported behavioural problems on a questionnaire, and HKD diagnoses and ADHD medication prescriptions were collected from Danish registries.

More than half of the mothers reported using acetaminophen while pregnant. The use of acetaminophen during pregnancy appeared to be associated with a higher risk of HKD diagnosis, of using ADHD medications or of having ADHD-like behaviours at age 7 years. The risk increased when mothers used acetaminophen in more than one trimester during pregnancy.

“Maternal acetaminophen use during pregnancy is associated with a higher risk for HKDs and ADHD-like behaviours in children,” the authors wrote. “Because the exposure and outcomes are frequent, these results are of public health relevance but further investigations are needed.”

19 - Urolithiasis in pregnancy: a cost-effectiveness analysis of ureteroscopic management vs ureteral stenting

Presented in poster format at the annual meeting of the American Urological Association, New Orleans, LA, May 15-18, 2015.

Objective

The purpose of this study was to determine the cost-effectiveness of serial stenting vs ureteroscopy for treatment of urolithiasis during pregnancy as a function of gestational age (GA) at diagnosis.

Study Design

We built decision analytic models for a hypothetical cohort of pregnant women who had received a diagnosis of symptomatic ureteral calculi and compared serial stenting to ureteroscopy. We assumed ureteral stent replacement every 4 weeks during pregnancy, intravenous sedation for stent placement, and spinal anesthetic for ureteroscopy. Outcomes were derived from the literature and included stent infection, migration, spontaneous kidney stone passage, ureteral injury, failed ureteroscopy, postoperative urinary tract infection, sepsis, and anesthetic complications. Four separate analyses were run based on the GA at diagnosis of urolithiasis. Using direct costs and quality-adjusted life years, we reported the incremental costs and effectiveness of each strategy based on GA at kidney stone diagnosis and calculated the net monetary benefit. We performed 1-way and Monte-Carlo sensitivity analyses to assess the strength of the model.

Results

Ureteroscopy was less costly and more effective for urolithiasis, irrespective of GA at diagnosis. The incremental cost of ureteroscopy increased from –$74,469 to –$7631, and the incremental effectiveness decreased from 0.49 to 0.05 quality-adjusted life years for a kidney stone diagnosed at 12 and 36 weeks of gestation, respectively. The net monetary benefit of ureteroscopy progressively decreased for kidney stones that were diagnosed later in pregnancy. The model was robust to all variables.

Conclusion

Ureteroscopy is less costly and more effective relative to serial stenting for urolithiasis, regardless of the GA at diagnosis. Ureteroscopy is most beneficial for women who received the diagnosis early during pregnancy.

OBJECTIVES to evaluate the application of a pocket-sized ultrasound machine (PUM) in a routine ante-natal third trimester scan compared to high specification ultrasound machines (HSUM).

METHODS An observational cohort study on 53 unselected patients, who came for their routine third trimester ultrasound scan. First scan was performed by an experienced ultra-sonographer (SB) on a HSUM for fetal growth, fetal well-being and placental location. A second experienced operator (SG) performed the measurements on the PUM. Both operators were blinded for the other one's findings and measurements results.

RESULTS Fifty-one patients were eligible and scanned at a median gestational age of 31 weeks +1 day (range 27w + 2d - 36w + 0d). Mean pre-gestational Body Mass Index (BMI) was 22.9 ± 3.1 kg/m(2) (range 17.6 - 35.7 kg/m(2) ). A perfect agreement was found for fetal position, fetal bladder and stomach visualization (all Kappa 1.0) and very good agreement for placental position (Kappa 0.86). Deepest Vertical Pocket (DVP) correlated moderately (ICC 0.38, 95% CI 0.12-0.59; Bland-Altman bias -2.43, 95%CI -22.65-27.51). For fetal growth measurements there was a very good agreement on BiParietal Diameter (BPD, ICC 0.93, 95% CI 0.88-0.96; Bland-Altman bias -1.06, 95%CI -5.07-2.95), and a good agreement for Femur Length (FL, ICC 0.66, 95% CI 0.48-0.79; Bland-Altman bias 0.56, 95%CI -5.97-7.08) and Trans Cerebellar Diameter (TCD, ICC 0.65, 95%CI 0.46-0.78; Bland-Altman bias -0.84, 95%CI -7.77-6.09).

CONCLUSION The use of a battery-driven PUM in third trimester obstetrics can be used for routine assessment of fetal growth (BPD, TCD and FL) and for assessment of fetal well-being

BACKGROUND Antiphospholipid syndrome (APS) is defined by the combination of thrombotic events and/or obstetrical morbidity in patients tested persistently positive for antiphospholipid antibodies (aPL). With good management, around 70% of pregnant women with APS will deliver a viable live infant. However, current management does not prevent all maternal, foetal and neonatal complications of APS.

OBJECTIVES This observational, retrospective, single-centre cohort study aimed to assess pregnancy outcome in women with aPL treated with hydroxychloroquine (HCQ) in addition to conventional treatment during pregnancy.

STUDY DESIGN One-hundred and seventy pregnancies in 96 women with persistent aPL were analysed: 51 pregnancies occurred in 31 women treated with HCQ for at least six months prior to pregnancy and continued throughout gestation (group A); 119 pregnancies occurred in 65 women with aPL not treated with HCQ were included as controls (group B).

RESULTS HCQ-treatment was associated with a higher rate of live births (67% group A vs. 57% group B, p=0.05) and a lower prevalence of aPL-related pregnancy morbidity (47% group A vs. 63% B, p=0.004). The association of HCQ with a lower rate of any complication in pregnancy was confirmed after multivariate analysis (OR 2.2; 95%CI 1.2-136; p=0.04). Fetal losses>10(th)weeks of gestation (2% vs. 11%, p=0.05) and placenta mediated complications (2% vs 11%,p=0.05) were less frequent in group A than B. Pregnancy duration was longer in group A than B(27.6 [6-40] vs. 21.5 [6-40]weeks, p=0.03). There was a higher rate of spontaneous vaginal labour in HCQ-treated women compared to group B (37.3% vs. 14.3%, p=0.01).

CONCLUSIONS Despite the heterogeneity in the two groups in terms of SLE prevalence and previous pregnancy history, our results support the concept that women with aPL may benefit from treatment with HCQ during pregnancy to improve pregnancy outcome. The addition of HCQ to conventional treatment is worthy of further assessment in a proper designed randomized controlled trial

Zainul Rashid MR, et al. – This study aims to determine whether dydrogesterone supplementation during the first trimester can reduce the incidence of GH among primigravidae. Dydrogesterone supplementation during the first trimester significantly reduced the incidence of GH and fetal distress in primigravidae.

Methods

A prospective cross–sectional comparative study was undertaken in 2010 on 116 primigravidae (study group) who conceived following ART or IUI and supplemented with dydrogesterone up to 16 weeks gestation.
They were matched for age and race at 16 weeks gestation with a control patient from the early pregnancy clinic who were primigravidae (n = 116) who conceived spontaneously without dydrogesterone supplementation.

Results

The incidence of GH in the study group was significantly lower than the control group (1.7% versus 12.9%, p = 0.001).
The incidence of fetal distress was also significantly lower in the study group compared to the control group (4.3% versus 18.1%, p = 0.001).

Women’s magazines influence whether women decide to have a more natural childbirth or not, with most of the messages biased towards promoting the benefits of medicalised birth. Researchers from Monash University and Queensland University of Technology have studied how popular media influences women’s choices for childbirth. The study, published in Women & Health, specifically aimed to assess the effect of communicating the benefits of more natural birth (e.g. no medical intervention such as epidurals or caesarean section).

In this meta–analysis study, authors explore the low–dose aspirin for preventing preeclampsia and its complications. he available evidence suggests that LDA is effective in preventing preeclampsia, preterm birth, and IUGR in high–risk pregnancies without posing a major safety risk to mothers or fetuses.

The objects of the present study were to review all of the prospective and retrospective studies reporting on women treated with metformin at least during the first trimester of their pregnancy and to estimate the overall rate of major birth defects. There is currently no evidence that metformin is associated with an increased risk of major birth defects in women affected by PCOS and treated during the first trimester. However larger ad hoc studies are warranted in order to definitely confirm the safety and efficacy of this drug in pregnancy.

Methods

Results

The new threshold for diabetes in pregnancy recently introduced by the UK’s National Institute for Health and Care Excellence (NICE) misses a significant number of women at risk of serious complications, a report published in the journal Diabetologia shows. A team of researchers from the University of Cambridge and Cambridge University Hospitals Foundation Trust has discovered that the proposed new NICE thresholds are less effective than international thresholds set by World Health Organization (WHO) at identifying women who are adversely affected by high blood sugar levels during pregnancy. In February 2015, NICE introduced new guidelines requiring two blood tests only (fasting and two hours after a sugary drink) and recommending a less strict fasting blood sugar threshold for the diagnosis of gestational diabetes. However, these criteria were identified based on cost effectiveness estimates alone, using old NHS hospital payment data, and have never been tested in clinical practice.

A never–before–seen childbirth technique could help a woman's body heal itself through temperature changes, according to a pilot study from Baylor Research Institute. In a finding that could someday decrease global maternal mortality, Baylor's team found that cooling a woman's uterus after a C–section can dramatically reduce postpartum blood loss. Led by a team of physicians and nurses in labor/delivery from Baylor University Medical Center at Dallas, the study explores "uterine cooling," an experimental method that showed significant results in early testing. The theory is based on biological fact: Cold temperatures make some smooth muscles contract. The research suggests that the uterus is among that group. Women in the control group had standard surgeries, which protect the exposed uterus with sponges soaked in a saline solution (called the Ecolab® ORS™ Hush Slush System) at 99 degrees Fahrenheit. Women in the test group had their uteruses covered with sponges soaked in the same solution, but they were cooled to 30 degrees Fahrenheit. The women who underwent the cooling technique bled an average of 32 percent less than women in the control group. Given those dramatic differences, the results could imply big changes in obstetric practice.

A group of noted obstetricians and gynecologists maintain that ultrasound is more cost–effective and safer than other imaging modalities for imaging the female pelvis and should be the first imaging modality used for patients with pelvic symptoms. Writing in the American Journal of Obstetrics & Gynecology and supporting an American Institute of Ultrasound in Medicine initiative, they urge practitioners to “put ultrasound first.

Researchers are a step closer to understanding the risk factors associated with endometriosis thanks to a new University of Adelaide study. Dr Jonathan McGuane, from the University’s Robinson Research Institute, says they discovered, for the first time, an association between contact with seminal fluid and the development of endometriosis. “In laboratory studies, our research found that seminal fluid (a major component of semen) enhances the survival and growth of endometriosis lesions,” says Dr McGuane, co–lead author on the paper. Associate Professor Louise Hull, also with the University’s Robinson Research Institute, says a lot remains unknown about what causes, and how to effectively prevent and treat, endometriosis; however, more is now known about what aggravates the condition. The research was published in The American Journal of Pathology.

Glyburide is widely used during pregnancy for the treatment of gestational diabetes mellitus, and has been considered to be safe. However, a retrospective cohort study published in JAMA Pediatrics has found that newborns from privately insured mothers who were treated with glyburide were more likely to experience adverse outcomes than those from mothers treated with insulin. These adverse events included increased risk for neonatal intensive care admission, respiratory distress, hypoglycemia, birth injury, and large size for gestational age.The authors emphasized that given the widespread use of glyburide, further investigation of these differences in pregnancy outcomes is a public health priority.

31 - CLINICAL SIGNIFICANCE OF NEONATAL MENSTRUATION

Past studies have clearly shown the existence of a spectrum of endometrial progesterone responses in neonatal endometrium, varying from proliferation to full decidualisation with menstrual-like shedding.

The bleedings represent, similar to what occurs in adult menstruation, a progesterone withdrawal bleeding.

Today, the bleeding is completely neglected and considered an uneventful episode of no clinical significance.

Yet, clinical studies have linked the risk of bleeding to a series of events indicating fetal distress.

The potential link between the progesterone response and major adolescent disorders requires to be investigated by prospective studies.

32 - Number of episodes of reduced fetal movement at term: association with adverse perinatal outcome

Objective

The aims of this study were evaluation of the association of reduced fetal movements (RFM) and small-for-gestational-age (SGA) birth at term and to explore if fetal and maternal outcomes are different with single vs repeated episodes of RFM and normal fetal assessment test results.

Study Design

This was a retrospective cohort study of all singleton pregnancies referred for RFMs at a tertiary fetal medicine unit from January 2008 through September 2014. Ultrasound and Doppler indices were obtained from a computerized ultrasound database and pregnancy outcome was collected from hospital records.

Results

Of the 21,944 women with a singleton pregnancy booked for maternity care during the study period, 1234 women (5.62%) reported RFMs >36+0 weeks. Of these, 1029 women (83.4%) reported a single episode of RFM and 205 (16.6%) had ≥2 presentations for RFM. Women with repeated RFMs had a significantly higher mean uterine artery pulsatility index in the second trimester. The prevalence of SGA baby at birth in women presenting with a single episode as compared to repeated episodes of RFM was 9.8% and 44.2%, respectively (odds ratio, 7.3; 95% confidence interval, 5.1–10.4; P < .05).

Conclusion

Repeated episodes of RFMs at term are more likely to occur in women with high second-trimester uterine artery Doppler resistance indices and are strongly associated with the birth of SGA infants.

Women presenting with repeated episodes of RFM should be treated as being at high risk of placental dysfunction irrespective of the results of prenatal ultrasound and Doppler assessment.

33 - Induction of labor at full term in uncomplicated singleton gestations

a systematic review and metaanalysis of randomized controlled trials

The aim of this study was to evaluate the risk of cesarean and any maternal and perinatal effects of a policy induction of labor in uncomplicated full-term singleton gestations. Searches were performed in an electronic database with the use of a combination of text words related to “induction” and “cesarean section” from inception of each database through December 2014. We included all randomized controlled trials of uncomplicated singleton gestations at full term (ie, between 39 weeks 0/7 days and 40 weeks 6/7 days) with intact membranes randomized to induction of labor or control (ie, expectant management). The primary outcome was the incidence of cesarean delivery. The summary measures were reported as risk ratio (RR) with 95% confidence interval (CI). Five randomized controlled trials, including 844 women, were analyzed. Full-term vertex singleton gestations receiving induction of labor had similar incidence of cesarean delivery compared to controls (9.7% vs 7.5%; RR, 1.25; 95% CI, 0.75–2.08). Rates of spontaneous (75.9% vs 80.2%; RR, 0.95; 95% CI, 0.87–1.02) and operative (13.1% vs 10.6%; RR, 1.22; 95% CI, 0.83–1.81) vaginal delivery were also similar. Induction was associated with similar rates of chorioamnionitis (9.6% vs 8.0%; RR, 1.17; 95% CI, 0.38–3.39), but statistically significantly less blood loss (mean difference –57.59 mL; 95% CI, –83.96 to –31.21) compared to controls. Regarding neonatal outcomes, induction was associated with a significantly lower rate of meconium-stained amniotic fluid (4.0% vs 13.5%; RR, 0.32; 95% CI, 0.18–0.57) and significantly lower mean birthweight (mean difference –135.51 g; 95% CI, –205.24 to –65.77) compared to control group. Induction of labor at full term in uncomplicated singleton gestations is not associated with increased risk of cesarean delivery and has overall similar outcomes compared to expectant management.

34 - Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study

36 - Efficacy and safety of repeated postoperative administration of intramuscular diclofenac sodium in the treatment of post-cesarean section pain

a double-blind study.

37 - Pregnancy and viral hepatitis B and C

Sogni P; La Presse Medicale (May 2015)

The serovaccination failures are related to high maternal viral load (HBV-DNA>7 log IU/mL).

In this case, a treatment with analogue (tenofovir) associated with serovaccination could be performed during the last trimester of pregnancy.

The risk of mother-to-child transmission of virus C is around 3 to 5% in case of HCV-RNA positive without co-infection with HIV.

Breast-feeding is not contra-indicated in case of maternal HBV or HCV infection.

Migraine affects up to 25% of women of reproductive age. This review summarizes current evidence of the safety of the most common antimigraine medications during pregnancy and breastfeeding, and provides treatment recommendations for use in clinical practice.

39 - New drug compounds show promise against endometriosis

Endometriosis afflicts as many as 15 percent of reproductive-age women in the U.S. and millions of women around the world. The disorder can lead to scarring of the ovaries, fallopian tubes and other tissues; infertility; inflammation and chronic pain.

"The usual treatments for endometriosis are aimed at suppressing estrogen production because it's an estrogen-driven disease," said University of Illinois molecular and integrative physiology professor Benita Katzenellenbogen, who led the new study with chemistry professor John Katzenellenbogen. "We thought that a better approach might be to interfere with both of the main aspects of endometriosis: the growth-promoting actions and also the inflammatory aspects -- both of which involve the estrogen receptor," she said.

Current pharmaceutical treatments can suppress endometriosis, but often fail to reduce the pain and inflammation that are hallmarks of the disorder, said John Katzenellenbogen, whose laboratory developed the new compounds.

"Current treatments also have side effects on other tissues through which estrogens work, and so they can't be taken forever," he said. "There also is unfortunately a high rate of recurrence of the disease."

The new compounds, OBHS (oxabicycloheptene sulfonate) and CLI (chloroindazole), interact with two types of estrogen receptors (ER-alpha and ER-beta, respectively). Each drug reduced the size of endometriotic tissue or prevented its growth outside the uterus in mice. Each also reduced inflammation and suppressed the development of new neurons and blood vessels that support the misplaced tissue. The treatments did not reduce fertility or the health of young pups born to mouse mothers that had undergone the therapies.

The compounds had similar positive effects in human endometriotic cells that were grown in culture with human immune cells, called macrophages, which can contribute to the inflammation and growth of endometriotic tissue.

The research team also found that adding either of the new compounds to a common endometriosis treatment, letrazole, did a better job of suppressing endometriosis than letrazole alone.

"Inflammation is a driver of endometriosis," Benita Katzenellenbogen said. "At some point you've got to turn it off, and these compounds turn it off by working through the estrogen receptors."

In a previous study published in the Proceedings of the National Academy of Sciences, researchers found that CLI suppressed -- and even reversed -- the loss of brain neuron structure and function in a mouse model of MS.

While many more years of work must be done to test these new compounds in other models and, eventually, in human patients, the work demonstrates a new approach to treating endometriosis and other disorders tied to estrogen signaling and inflammation, the researchers said.

Journal of the Academy of Nutrition and Dietetics, 06/26/2015 Farland LV, et al.

In this study, authors want to examined relationships of pregnancy cravings with dietary intake and risk of developing isolated hyperglycemia (IH), impaired glucose tolerance (IGT), or gestational diabetes (GDM) later in pregnancy. New cravings in the first trimester of pregnancy were associated with dietary intake. Craving salty foods may predict reduced risk of developing GDM, whereas craving sweet food does not appear to alter one’s risk.

Methods

Results

Kamat S, et al. – The aim of this study was to compare the efficacy and safety of nifedipine and progesterone for maintenance tocolysis after arrested preterm labour, in prolonging pregnancy and preventing recurrence of preterm labour. The authors conclude that when compared with nifedipine, progesterone significantly prolongs pregnancy in women with arrested preterm labour with better neonatal outcomes and fewer side–effects.

This study was a randomised comparative study conducted on 110 pregnant women with arrested preterm labour, randomised to receive either nifedipine 20 mg Q 8–hourly or progesterone 400 mg daily for maintenance tocolysis.
Other than demographic parameters, obstetric parameters like previous history of abortions or preterm deliveries, gestational age, cervical dilatation and effacement, ultrasound measured cervical length at admission, were noted.
Outcome measures studied were mean prolongation of pregnancy, mode of delivery, neonatal outcome and side–effects of both the drugs.
Authors found that there was no significant difference in the demographic profile, parity, number of abortions, previous preterm deliveries, gestational age, cervical dilatation and effacement at admission between the two groups.
A total of 10% of the patients in the nifedipine group and 61% of the patients in the progesterone group delivered at term (p value 0.000).
The mean prolongation of pregnancy in the nifedipine group was 16.63 days and 40.14 days in the progesterone group which was significant (p = 0.000).
Neonates in the progesterone group had better birth weight, better Apgar scores at 1 and 5 min, lesser need for ventilation and significantly lesser composite morbidity.
Nifedipine was associated significantly with side–effects.

Poskus T, et al. – In this study, authors want to identify the incidence and risk factors of haemorrhoids and fissures during pregnancy and after childbirth. They reveals haemorrhoids and fissures are common during the last trimester of pregnancy and 1 month after delivery, with constipation, personal history of haemorrhoids or fissures, birthweight of newborn >3800 g, straining during delivery for more than 20 minutes being independently associated risk factors.

Methods

A prospective observational cohort study.
University hospital and outpatient clinics in Lithuania.
A total of 280 pregnant women followed up until 1 month after delivery.
Women were examined four times through pregnancy and after delivery; those that developed peri–anal diseases were compared with those that did not.
Incidence, time and risk factors of haemorrhoids and fissures.

Results

In all, 123 (43.9%) women developed peri–anal disease: 1.6% in the first trimester, 61% during the third trimester, 34.1% after delivery and 3.3% 1 month after delivery; 114 (40.7%) women were diagnosed with haemorrhoids, seven (2.5%) with haemorrhoids and anal fissure and two (0.71%) with anal fissure.
Ninety–nine (80.5%) women had vaginal delivery and 24 (19.5%) women had undergone caesarean section.
Multivariate analysis identified personal history of peri–anal diseases (odds ratio [OR] 11.93; 95% confidence interval [95% CI] 2.18–65.30), constipation (OR 18.98; 95% CI 7.13–50.54), straining during delivery for more than 20 minutes (OR 29.75; 95% CI 4.00–221.23) and birthweight of newborn >3800 g (OR 17.99; 95% CI 3.29–98.49) as significant predictors of haemorrhoids and anal fissures during pregnancy and perinatal period.

HERSHEY, Pa -- July 9, 2014 -- The drug letrozole results in higher birth rates in women with polycystic ovary syndrome (PCOS) than the current standard treatment, according to a study published in the New England Journal of Medicine.

“Clomiphene has its drawbacks,” said lead author Richard Legro, MD, Penn State College of Medicine, Hershey, Pennsylvania. “It’s only 22% successful with up to 6 cycles of treatment in producing a successful birth, it has a high multiple-pregnancy rate in comparison to unassisted conception, and it has side effects including hot flashes and mood changes.”

To compare the 2 drugs, researchers studied 750 infertile women aged 18 to 40 years with PCOS who wanted to conceive. Women were randomised to either clomiphene or letrozole and took the medications for up to 5 cycles, with increasing dosage each cycle.

The group of women who received letrozole had a higher rate of live births (27.5%) than those on clomiphene (19.1%). In addition, ovulation rates were significantly higher with letrozole than with clomiphene at each monthly visit.

Fewer twin pregnancies occurred among the women who took letrozole (3.9%) compared with those on clomiphene (6.9%).

Clomiphene was associated with a significantly higher incidence of hot flashes and letrozole was associated with a significantly higher incidence of fatigue and dizziness.

Birth defects were rare and rates were similar between the 2 medications, comparable with those from studies of women who conceive without treatment.

Further research is needed with a larger number of infants to clarify the safety of letrozole.

Bodnar LM et al. – This study aimed to assess whether there was an independent association between maternal 25–hydroxyvitamin D concentrations at 24–28 weeks of gestation and preterm birth in a multicenter U.S. cohort of twin pregnancies. Late second–trimester maternal 25–hydroxyvitamin D concentrations less than 75 nmol/L are associated with an increase in the risk of preterm birth in this cohort of twin pregnancies.

Methods

Serum samples from women who participated in a clinical trial of 17 α–hydroxyprogesterone caproate for the prevention of preterm birth in twin gestations (2004–2006) were assayed for 25–hydroxyvitamin D concentrations using liquid chromatography tandem mass spectrometry (n=211).
Gestational age was determined early in pregnancy using a rigorous algorithm.
Preterm birth was defined as delivery of the first twin or death of either twin at less than 35 weeks of gestation.

Results

The mean serum 25–hydroxyvitamin D concentration was 82.7 nmol/L (standard deviation 31.5); 40.3% of women had concentrations less than 75 nmol/L.
Preterm birth at less than 35 weeks of gestation occurred in 49.4% of women with 25–hydroxyvitamin D concentrations less than 75 nmol/L compared with 26.2% among those with concentrations of 75 nmol/L or more (P<.001).
After adjustment for maternal race and ethnicity, study site, parity, prepregnancy body mass index, season, marital status, education, gestational age at blood sampling, smoking status, and 17 α–hydroxyprogesterone caproate treatment, maternal 25–hydroxyvitamin D concentration of 75 nmol/L or more was associated with a 60% reduction in the odds of preterm birth compared with concentrations less than 75 nmol/L (adjusted odds ratio [OR] 0.4, 95% confidence interval [CI] 0.2–0.8).
A similar protective association was observed when studying preterm birth at less than 32 weeks of gestation (OR 0.2, 95% CI 0.1–0.6) and after confounder adjustment.

Javadian P, et al. – The possible effect of iron supplementation has been investigated in the normal population and patients with gestational diabetes mellitus (GDM). The findings indicate the concentration of serum ferritin levels was significantly higher in The GDM group.

Methods

This case control study conducted on 52 pregnant women with GDM (25 women with type Al and 27 women with Type A2 of GDM).
The control group randomly selected 50 normoglycemic women.
Venous blood sampling was done between 24 and 28 weeks of pregnancy for measuring of ferritin, lipoproteins, uric acid and malondialdehyde serum levels.
Under study variables including age, gestational age, weight and BMI were gathered.
All the women were followed up until the time of delivery and pregnancy outcome were gathered.

Results

The serum ferritin levels in GDM group was 31.22+15.44, which is significantly higher than 24.76+8.94, in the control group with (P=0.012).
Plasma hemogulobin in the control group was 12.2+0.1 compared to 12.9+0.1 in GDM group which was significantly lower (P=0.005).
Triglycerides was significantly higher in GDM group in contrast with the control group, 275.08+143.17 and 192.30+92.13 (P=0.001), respectively.

Yao Z, et al. – The authors performed a meta–analysis of clinical trials of pregabalin to evaluate its ability to control acute postoperative pain after gynecologic surgery. They found that pregabalin has an analgesic and opioid–sparing effect and does not increase the frequency of adverse effects in acute postoperative pain management after gynecologic surgery.

Catalano PM, et al. – In this study, authors sought to evaluate inadequate gestational weight gain and fetal growth among overweight and obese women. In overweight and obese women weight loss or gain ≤5 kg is associated with increased risk of Small for gestational age (SGA) and decreased neonatal fat mass, lean mass, and head circumference.

Methods

Authors conducted an analysis of prospective singleton term pregnancies in which 1053 overweight and obese women gained >5 kg (14.4 ± 6.2 kg) or 188 who either lost or gained ≤5 kg (1.1 ± 4.4 kg).
Birthweight, fat mass, and lean mass were assessed using anthropometry.
Small for gestational age (SGA) was defined as ≤10th percentile of a standard US population.
Univariable and multivariable analysis evaluated the association between weight change and neonatal morphometry.

Results

There was no significant difference in age, race, smoking, parity, or gestational age between groups.
Weight loss or gain ≤5 kg was associated with SGA, 18/188 (9.6%) vs 51/1053 (4.9%); (adjusted odds ratio, 2.6; 95% confidence interval, 1.4–4.7; P = .003).
Neonates of women who lost or gained ≤5 kg had lower birthweight (3258 ± 443 vs 3467 ± 492 g, P < .0001), fat mass (403 ± 175 vs 471 ± 193 g, P < .0001), and lean mass (2855 ± 321 vs 2995 ± 347 g, P < .0001), and smaller length, percent fat mass, and head circumference.
Adjusting for diabetic status, prepregnancy body mass index, smoking, parity, study site, gestational age, and sex, neonates of women who gained ≤5 kg had significantly lower birthweight, lean body mass, fat mass, percent fat mass, head circumference, and length.
There were no significant differences in neonatal outcomes between those who lost weight and those who gained ≤5 kg.

48 - Women having babies later in life more likely to live longer

The North American Menopause Society News, 06/26/2014

Nested, case–control study confirms association between older maternal age at birth of last child and exceptional longevity. Women who had their children later in life will be happy to learn that a new study suggests an association between older maternal age at birth of the last child and greater odds for surviving to an unusually old age. That’s according to a nested case–control study published online in Menopause. In this study which used Long Life Family Study data, 311 women who survived past the oldest fifth percentile of survival (according to birth cohort–matched life tables) were identified as cases, along with 151 women who died at ages younger than the top fifth percentile of survival who were identified as controls. Looking at the cases of all 462 women, the study found a significant association for older maternal age, whereby women who had their last child beyond age 33 years had twice the odds for survival to the top fifth percentile of survival for their birth cohorts compared with women who had their last child by age 29 years. More specifically, women between the ages of 33 and 37 having their last child had an odds ratio of 2.08. The odds ratio for older women was 1.92.

Dood RL, et al. – In this study, authors want to investigate whether endometrial ablation is associated with increased risk or delayed diagnosis of endometrial cancer compared with medical management of abnormal uterine bleeding. They reveals no difference was observed in endometrial cancer rates, and there was no delay in diagnosis when comparing endometrial ablation vs medical management. Further studies are needed to investigate the effect of previous ablation exposure on histology or cancer stage at manifestation of endometrial cancer.

Though the 11 most popular hospital urine pregnancy tests perform well in the first month after conception, a new study published in Clinical Chemistry, the journal of AACC, reveals the alarming statistic that nine of these tests become significantly more likely to produce false–negative results after the 5th to 7th week of pregnancy. Around the 5th to 7th week of gestation, however, urine concentrations of an hCG variant known as the hCG beta core fragment rise dramatically, interfering with hCG detection and causing false–negative test results. In a hospital setting, this failure to detect pregnancy can lead to major consequences such as administration of medications that cause birth defects, fetal radiation exposure, or failure to diagnose ectopic pregnancy, which is the leading cause of first–trimester pregnancy–related maternal death.

A service that creates digital embryos by virtually mixing two people's DNA will give a clearer glimpse of their possible child's health, and perhaps much more – before it has been conceived. The Matchright technology will be available in two US fertility clinics later this month, allowing people to screen out sperm donors who, when their genes are combined with those of the intended mother, could increase the risk of a child inheriting genetic diseases. The company that markets the technology, GenePeeks, hopes to expand worldwide. But the technology's patent also includes a list of traits that aren't necessarily related to health – such as eye and skin pigmentation, height and waist size – raising concerns that it could be used to select embryos on the basis of more superficial characteristics. "It covers any disease or any trait that has a genetic influence," says Lee Silver at Princeton University, who co–founded GenePeeks – even those where the genetic basis has yet to be discovered.

Vajaranant TS, et al. – Because early estrogen deficiency may increase the susceptibility of the optic nerve to glaucoma, the authors studied the association of early bilateral oophorectomy with glaucoma. Bilateral oophorectomy before the age of 43 years may increase the risk of glaucoma, and estrogen treatment does not seem to attenuate the risk.

Kamel A, et al. – Postpartum episiotomy dehiscence is a rare complication of vaginal delivery. Infection rates in episiotomy wounds are surprisingly low; however, it remains the most common cause of wound dehiscence, which may lead to major physical, psychological and social problems if left untreated. Most dehisced perineal wounds are left to heal naturally by secondary intention. This approach often results in a protracted period of significant morbidity for women. There is emerging evidence that early re–suturing closure of broken–down perineal wounds may have a better outcome, but randomised controlled trials are needed to yield evidence–based guidance for this management approach.

Procedure poses risk of spreading undetected cancerous tissue in women with unsuspected cancer. In a safety communication notice issued today, the U.S. Food and Drug Administration discouraged the use of laparoscopic power morcellation for the removal of the uterus (hysterectomy) or uterine fibroids (myomectomy) in women because, based on an analysis of currently available data, it poses a risk of spreading unsuspected cancerous tissue, notably uterine sarcomas, beyond the uterus. A number of additional treatment options are available for women with symptomatic uterine fibroids, including traditional surgical hysterectomy (performed either vaginally or abdominally) and myomectomy, and laparoscopic hysterectomy and myomectomy without morcellation, as well as other non–surgical options. The FDA will convene a public meeting of the Obstetrics and Gynecological Medical Devices Panel to discuss information related to laparoscopic power morcellation. In the interim, the agency has instructed manufacturers of power morcellators used during laparoscopic hysterectomy and myomectomy to review their current product labeling for accurate risk information for patients and health care professionals.

Researchers at the Wellcome Trust Sanger Institute have discovered interacting proteins on the surface of the sperm and the egg essential to begin mammalian life. These proteins, which allow the sperm and egg to recognize one another, offer new paths towards improved fertility treatments and the development of new contraceptives.

Fertilization occurs when an egg and a sperm recognize each other and fuse together to form an embryo.

"The Izumo–Juno pairing is the first known essential interaction for sperm–egg recognition in any organism," says Dr Enrica Bianchi, first author from the Wellcome Trust Sanger Institute. "The binding of the two proteins is very weak, which probably explains why this has remained a mystery until now. The team found that after the initial fertilization step, there is a sudden loss of the Juno protein from the surface of the egg, becoming virtually undetectable after just 40 minutes. This may explain why the egg, once fertilized by the first sperm cell, shuts down its ability to recognize further sperm.

56 - Vascular stent as a treatment for refractory cervical stenosis

Chinese Medical Journal, 03/18/2014

Jie Y, et al. – Authors experience with these two patients gave us some insights that may be useful for others who are considering this procedure. The long–term side effects of treatment, especially in terms of cervical function in subsequent pregnancies, need to be examined further. A specially designed self–expanding vascular stent may offer hope to these patients.

57 - Premedication with midazolam prior to caesarean section has no neonatal adverse effects

Revista Brasileira de Anestesiologia, 03/19/2014 Clinical Article

Can Senel A, et al. – Like all surgical patients, obstetric patients also feel operative stress and anxiety. The literature contains few studies concerning preoperative midazolam use in Caesarian section (C/S) patients. The aim in this study was to help patients undergoing C/S surgery. Midazolam can therefore safely be used as a premedicative agent in C/S surgery.

58 - A randomised controlled trial of expectant management versus surgical evacuation of early pregnancy loss

European Journal of Obstetrics & Gynecology and Reproductive Biology, 03/18/2014 Clinical Article

Nadarajah R, et al. – In this randomized controlled trial comparing expectant versus surgical management of early pregnancy loss over a 1–year period, researchers found that there was no statistically significant difference in the success rate between the groups and between the different types of miscarriage.

Methods

From 1st January to 31st December 2009 at Sultanah Aminah Hospital, Johor Bahru, pregnant women with missed or incomplete miscarriages at gestations up to 14 weeks were recruited in this study.
The success rate in the surgical group was measured as curettage performed without any complications during or after the procedure, while the success rate in the expectant group was defined as complete spontaneous expulsion of products of conception within 6 weeks without any complication.
A total of 360 women were recruited and randomised to expectant or surgical management, with 180 women in each group.

Results

With expectant management, 131 (74%) patients had a complete spontaneous expulsion of products of conception, of whom 106 (83%) women miscarried within 7 days.
The rates of unplanned admissions (18.1%) and unplanned surgical evacuations (17.5%) in the expectant group were significantly higher than the rates (7.4% and 8% respectively) in the surgical group.
The complications in both groups were similar.

59 -Vitamin D and pre-eclampsia

Original data, systematic review and meta-analysis

Annals of Nutrition and Metabolism, 03/18/2014 Evidence Based Medicine Review Article

Hypponen E, et al. – This study aims to evaluate the role of vitamin D in the development of pre–eclampsia, authors conducted a systematic review and meta–analysis including novel data from 2 large–scale epidemiological studies. This study suggests that low maternal serum 25(OH)D concentrations increase pre–eclampsia risk and that vitamin D supplementation lowers this risk. The quality of evidence is insufficient to determine a causal association, which highlights the need for adequately powered clinical trials.

Methods

PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for prospective observational studies of association between vitamin D supplementation or status (measured by maternal 25–hydroxyvitamin D, 25(OH)D) with a subsequent risk of pre–eclampsia, or randomised controlled trials using vitamin D supplementation to prevent pre–eclampsia.
The Hungarian Case–Control Surveillance of Congenital Abnormalities (HCCSCA) and the Avon Longitudinal Study of Parents and Children (ALSPAC) were included in meta–analyses with published studies.

Results

Mothers receiving vitamin D supplementation earlier in pregnancy had lower odds of pre–eclampsia [pooled odds ratios (OR) 0.81 and 95% confidence interval (CI) 0.75–0.87, p = 2.4 × 10–8, 2 studies] in the meta–analysis of published studies with HCCSCA.
The meta–analysis of published studies with ALSPAC suggested an association between higher serum 25(OH)D levels and a reduced risk of pre–eclampsia (pooled OR 0.52 and 95% CI 0.30–0.89, p = 0.02, 6 studies).
Randomised trials of supplementation were suggestive of protective association (pooled OR 0.66 and 95% CI 0.52–0.83, p = 0.001, 4 studies).

60 - Doctors' groups warn against underwater births

HealthDay, 03/24/2014

Approach might help with early labor but can pose danger to newborns, ob/gyns and pediatricians say. Using a birthing pool during the early stages of labor can provide some benefits to women. However, giving birth underwater may put newborns at risk for serious health problems, according to a statement issued by two major medical organizations. The joint opinion from the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) is based on a review of available literature, the groups said. "Many labor and delivery units are equipped with tubs to be used by laboring women, and immersion in water for relaxation and pain relief is appealing to some," Dr. Jeffrey Ecker, chairman of the ACOG committee that developed the opinion, said in a college news release. Underwater delivery should be performed only in properly designed clinical trials and with the parents' informed consent, according to the opinion, which was released online March 20 and appears in the April print issue of the journal Obstetrics & Gynecology.

61 -Stress may diminish a woman's fertility, study suggests

HealthDay, 03/25/2014

First U.S. review to show a possible link between stress and how long it takes to get pregnant. The authors looked at levels of an enzyme linked with stress in the saliva of women who were trying to get pregnant. They also tracked the women's ability to conceive over a 12–month period. "Women with higher levels of the stress biomarker had a two–fold increased risk of infertility," said study author Courtney Lynch. The enzyme they measured is called salivary alpha–amylase. "Alpha–amylase is an enzyme that is secreted into the mouth that helps the body start to digest carbohydrates," said Lynch, director of reproductive epidemiology at the Ohio State University College of Medicine. "It is also linked to the fight–or–flight part of the stress system." For the study, Lynch and her colleagues collected data from about 500 couples who were recruited from targeted counties in Texas and Michigan. After adjusting for age, race, income and the use of alcohol, caffeine and cigarettes, the researchers found that the women with the highest alpha–amylase levels had a 29 percent lower probability of pregnancy compared to the women who had the lowest levels of the enzyme. The study results were published in the March 24 issue of the journal Human Reproduction.

62 - The practical utility of routine post-partum hemoglobin assessment

American Journal of Obstetrics and Gynecology, 03/19/2014 Clinical Article

Steele HB, et al. – This study aims to evaluate a policy of routine versus selective postpartum complete blood count (CBC). Targeted CBC testing results in fewer transfusions, lower costs and improved quality of patient care.

Methods

Historic case control design with matched subjects from one year periods bracketing the policy change (n=800).
This primary outcome was postpartum transfusion rate.
Univariable and multivariable analyses were performed.
Total hospital costs were estimated.

Results

Eliminating routine postpartum CBC testing was associated with decreased transfusion rates (5.5% vs. 1.8%, p=0.007) despite similar transfusion risks.
CBC utilization decreased from 59% to 22.2% (p<0.0001).
No adverse bleeding outcomes occurred.
Multivariable modeling suggested that the occurrence of postpartum hemorrhage was the best clinical predictors of transfusion risk.
Tachycardia, oliguria and symptoms were also effective at identifying transfusion candidates.
Elimination of routine CBCs was independently associated with a reduced risk of transfusion (OR 0.30, 95% CI 0.12–0.72).
Annual cost savings were estimated at $58,000.

63 - Pregnant women may be more vulnerable to potentially dangerous infection

HealthDay, 03/20/2014

Screening for H. influenzae not recommended for now, expert says. Mothers–to–be may be more susceptible to an infection associated with poor pregnancy outcomes, a new study suggests. Haemophilus influenzae can be dangerous to the fetus of a pregnant woman who develops an invasive infection, say the authors of a new study in the March 19 Journal of the American Medical Association. Ladhani said the health of a woman's baby appeared to be influenced by when during pregnancy the mother developed the serious infection, which can cause blood poisoning. The invasive form of H. influenzae infection during the first 24 weeks of pregnancy was associated with fetal loss in nearly 94 percent of cases, and extremely premature birth in about 6 percent, the study found. During the second half of pregnancy, infection was linked with premature birth in nearly 29 percent and stillbirth in about 7 percent of 28 cases, according to the study.

64 - Don't order fetal ultrasound videos as souvenirs

FDA - HealthDay, 03/21/2014

In addition, agency says, leave Doppler fetal heartbeat monitors to health professionals. Expectant mothers should not get fetal ultrasound videos as keepsakes and should not use over–the–counter Doppler ultrasound heartbeat monitors, according to the U.S. Food and Drug Administration. Although both products are generally considered safe, they are approved for use only with a prescription. The increasing use of these devices for nonmedical reasons is raising concerns among health officials. "Although there are no known risks of ultrasound imaging and heartbeat monitors, the radiation associated with them can produce effects on the body," Robert Phillips, a physicist with the FDA's Center for Devices and Radiological Health, said in an agency news release. "When ultrasound enters the body, it heats the tissues slightly," Phillips said. "In some cases, it can also produce small pockets of gas in body fluids or tissues." The long–term impact of these effects is not known, Phillips said

65 - Women with circumcised partners less likely to have HIV, no less likely to use condoms

AIDSmap news, 03/20/2014

A study from Orange Farm near Johannesburg in South Africa, the area that hosted the first–ever randomised controlled trial of male circumcision for HIV prevention, which concluded in 2005, has found evidence that women who are partners of circumcised men are less likely to have HIV themselves. A 2009 meta–analysis (Weiss) of the benefits to women of circumcising men found no evidence that having sex with a circumcised, rather than an uncircumcised, man reduced the risk of HIV infection to women, though there have been studies that show that male circumcision reduces the risk of human papillomavirus (HPV) and genital herpes (HSV2) in women. But this is the first study to provide convincing evidence that male circumcision offers a degree of protection to their female partners too – although the benefit is quite small, in the order of a 15% reduction in prevalence in women who only have sex with circumcised men.

66 - Consumer understanding of the benefits and risks of fish consumption during pregnancy

American Journal of Lifestyle Medicine, 02/07/2014 Clinical Article

Lando AM, et al. – Fish consumption during pregnancy is one important area of dietary advice. The challenge for policy makers, public health officials, and clinicians is to determine how best to communicate with pregnant women about both the benefits and risks associated with fish consumption.

There are potential benefits for pregnant women and their babies from a diet that contains sufficient amounts of fish.
However, methylmercury, which is in most fish in at least trace amounts, can have adverse effects on the cognitive development of fetuses and can have neurological effects on children and adults in high amounts.
The Federal government first issued national consumption advice in order to minimize the risk to the developing fetus from methylmercury in fish in the 1990s.
This advice was updated in 2001 and again in 2004.
Most recently, the US Dietary Guidelines for Americans, 2010 recommends a consumption target for pregnant and nursing women of 8 to 12 oz/wk of a variety of fish lower in methyl-mercury—to take advantage of the potential benefits that fish could provide to children’s development— while avoiding the 4 fish species highest in methylmercury that are named in joint 2004 Food and Drug Administration/Environmental Protection Agency advice (tilefish, shark, swordfish, and king mackerel)

67 - Efficacy of Mefloquine Intermittent Preventive Treatment in Pregnancy Against Schistosoma haematobium Infection in Gabon

A Nested Randomized Controlled Assessor-Blinded Clinical Trial
Clinical Infectious Diseases, Clinical Article

Basra A et al. – In this study the authors evaluated the efficacy of mefloquine intermittent preventive treatment against malaria in pregnancy (IPTp) against Schistosoma haematobium infection in pregnant women. When used as IPTp for the prevention of malaria, mefloquine shows promising activity against concomitant S. haematobium infection leading to an important reduction of egg excretion in pregnant women. Provided that further studies confirm these findings, the use of mefloquine may transform future IPTp programs into a 2–pronged intervention addressing 2 of the most virulent parasitic infections in pregnant women in sub–Saharan Africa.

Methods

Pregnant women with S. haematobium infection presenting at 2 antenatal health care centers in rural Gabon were invited to participate in this nested randomized controlled, assessor–blinded clinical trial comparing sulfadoxine–pyrimethamine with mefloquine IPTp.
Study drugs were administered twice during pregnancy with a 1– month interval after completion of the first trimester.

Results

Sixty–five pregnant women were included in this study.
Schistosoma haematobium egg excretion rates showed a median reduction of 98% (interquartile range [IQR], 70%–100%) in the mefloquine group compared to an increase of 20% (IQR, –186% to 75%) in the comparator group.
More than 80% of patients showed at least 50% reduction of egg excretion and overall cure rate was 47% (IQR, 36%–70%) 6 weeks after the second administration of mefloquine IPTp.

68 - Calculating length of gestation from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database versus vital records may alter reported rates of prematurity

Fertility and Sterility, 03/13/2014 Clinical Article

Stern JE, et al. – The study aims to compare length of gestation after assisted reproductive technology (ART) as calculated by three methods from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) and vital records (birth and fetal death) in the Massachusetts Pregnancy to Early Life Longitudinal Data System (PELL). Estimates of preterm birth in ART vary depending on source of data and method of calculation. Some estimates may overestimate preterm birth rates for ART conceptions.

Methods

Historical cohort study.
ART deliveries were linked to live birth or fetal death certificates.
Length of gestation in 7,171 deliveries from fresh autologous ART cycles (2004–2008) was calculated and compared with that of SART CORS with the use of methods: M1 = outcome date - cycle start date; M2 = outcome date - transfer date + 17 days; and M3 = outcome date - transfer date + 14days + day of transfer.
Generalized estimating equation models were used to compare methods.

Results

Singleton and multiple deliveries were included.
Overall prematurity (delivery <37 weeks) varied by method of calculation: M1 29.1%; M2 25.6%; M3 25.2%; and PELL 27.2%.
The SART methods, M1–M3, varied from those of PELL by ≥ 3 days in >45% of deliveries and by more than 1 week in >22% of deliveries.
Each method differed from each other.

69 - Clinical opinion published on use of maternal oxygen during labor

EurekAlert!, 02/24/2014

Article published in American Journal of Obstetrics and Gynecology. When a fetal heartbeat pattern becomes irregular during labor, many practitioners give oxygen to the mother. But questions remain whether this oxygen supplementation benefits the fetus or may actually be potentially harmful. A clinical opinion written by third year resident Maureen Hamel, MD, along with maternal–fetal medicine specialists Brenna Anderson, MD and Dwight Rouse, MD, of the Department of Obstetrics and Gynecology at Women & Infants Hospital of Rhode Island and The Warren Alpert Medical School of Brown University, has been published in the January 10, 2014 online edition of the American Journal of Obstetrics & Gynecology. The manuscript, entitled "Oxygen for intrauterine resuscitation: Of unproved benefit and potentially harmful," aimed to make recommendations about the safety of the use of maternal oxygen supplementation in laboring women. Based on their research, the team concludes that until it is studied properly in a randomized clinical trial, maternal oxygen supplementation in labor should be reserved for maternal hypoxia (lack of oxygen) and should not be considered an indicated intervention for non–reassuring fetal status.

70 - Acute pyelonephritis in pregnancy

an 18-year retrospective analysis

Presented as a poster at the 58th annual meeting of the Society for Gynecologic Investigation, Miami, FL, March 16-19, 2011.

Objective

We sought to describe the incidence of acute pyelonephritis in pregnancy, and to assess its association with perinatal outcomes in an integrated health care system.

Study Design

A retrospective cohort study was performed using medical records on 546,092 singleton pregnancies delivered in all Kaiser Permanente Southern California hospitals from 1993 through 2010. These medical records include the perinatal service system along with inpatient and outpatient encounter files. Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) were used to estimate associations.

Results

The incidence of acute antepartum pyelonephritis was 0.5% (2894/543,430). Women with pyelonephritis in pregnancy were more likely to be black or Hispanic, young, less educated, nulliparous, initiate prenatal care late, and smoke during pregnancy. Pregnancies of women with pyelonephritis compared to those without were more likely to be complicated by anemia (26.3% vs 11.4%; OR, 2.6; 95% CI, 2.4–2.9), septicemia (1.9% vs 0.03%; OR, 56.5; 95% CI, 41.3–77.4), acute pulmonary insufficiency (0.5% vs 0.04%; OR, 12.5; 95% CI, 7.2–21.6), acute renal dysfunction (0.4% vs 0.03%; OR, 16.5; 95% CI, 8.8–30.7), and spontaneous preterm birth (10.3% vs 7.9%; OR, 1.3; 95% CI, 1.2–1.5). Most of the preterm births occurred between 33-36 weeks (9.1%).

Conclusion

We characterize the incidence of pyelonephritis in an integrated health care system where routine prenatal screening for asymptomatic bacteriuria is employed. Maternal complications are commonly encountered and the risk of preterm birth is higher than the baseline obstetric population.

71 - Patterns of recurrence of postpartum hemorrhage in a large population-based cohort

Presented in part at the 45th annual meeting of the Society of Epidemiological Research, Minneapolis, MN, June 27-30, 2012, and the 44th annual meeting of the Society for Obstetric Anesthesia and Perinatology, Monterey, CA, May 2-5, 2012.

Objective

Although a history of postpartum hemorrhage (PPH) is a recognized risk factor for PPH in subsequent pregnancies, little is known about how the risk accumulates over multiple pregnancies, how recurrence varies by PPH subtype, and whether recurrence can be explained by chronic maternal conditions.

Study Design

Risks of PPH were assessed according to a history of PPH, severity, and subtype (atony, retained placenta, or lacerations) in 538,332 primiparous women whose data were included in the Swedish Medical Birth Register from 1997-2009. The role of stable maternal risk factors was evaluated in regression models that predicted probability of recurrent PPH in second and third pregnancy.

Results

Women with a history of PPH had a 3-fold increased risk of PPH in their second pregnancy compared with unaffected women (15.0% vs 5.0%, respectively). Adjustment for stable maternal risk factors did not attenuate this risk significantly (adjusted relative risk, 3.0; 95% confidence interval, 2.9–3.1). In a third pregnancy, the risk of PPH was 26.6% after 2 previously affected pregnancies, compared with 4.4% in women with no previous PPH. A history of a specific type of PPH predicted recurrence of PPH in the second pregnancy, not only of the same type but other causes as well.

Conclusion

PPH risk is highest among women with >1 previously affected delivery and in those with a previous severe PPH. Chronic conditions that are known to be risk factors for PPH do not explain the recurrence risks. The recurrence patterns across PPH subtypes may point to shared pathologic mechanisms underlying the varying PPH causes.

72 - Fertility prospects following ectopic pregnancy

EurekAlert!, 03/06/2014

Preserving a fallopian tube following an ectopic pregnancy seems like it would favor a woman's fertility prospects, right? A new study from Wake Forest Baptist Medical Center looked at pregnancy outcomes in regards to the two surgical treatments for ectopic pregnancy – salpingectomy, in which the affected fallopian tube is removed, or salpingotomy, in which the tube is preserved. "In women with a tubal pregnancy and a healthy opposite tube, salpingotomy does not significantly improve fertility prospects compared with salpingectomy," Yalcinkaya said. "We have pondered what we should do, but it's never been studied. This study provides an answer – saving the fallopian tube does not show any improved benefit." The research was published last month in The Lancet.

The study found that ongoing pregnancy by natural conception was

about 61 percent after salpingotomy

and 56 percent after salpingectomy. If the opposite tube is normal,

doctors can now just remove the tube out which is a quicker procedure, less complex and invasive and eliminates the persistence of another occurring ectopic pregnancy, Yalcinkaya said. Persistent growth of pregnancy tissue occurred more frequently in the salpingotomy group than in the salpingectomy group, the study reports.

73 - Delivery by caesarean section and childhood cancer: A nationwide follow-up study in three countries

BJOG: An International Journal of Obstetrics and Gynaecology, 02/26/2014 Clinical Article

Momen NC, et al. – This study aims to investigate the association between delivery by caesarean section and risk of childhood cancer. The evidence does not suggest that caesarean section is a risk factor for the overall risk of childhood cancer and possibly not for subtypes of childhood cancer either.

Methods

A population–based, follow–up study using register data from three countries.
Denmark, Sweden and Finland.
Children born in Denmark (1973–2007), Sweden (1973–2006) and Finland (randomly selected sample of 90%, 1987–2007; n = 7 029 843).
Exposure was delivery by caesarean section and the outcome was childhood cancer diagnosis.
Follow–up started from birth and ended at the first of the following dates: cancer diagnosis, death, emigration, day before 15th birthday or end of follow–up.
Cox regression was used to obtain hazard ratios.

Results

A total of 882 907 (12.6%) children were delivered by caesarean section.
Of these, 30.3% were elective (n = 267 603), 35.9% unplanned (n = 316 536) and 33.8% had no information on planning (n = 298 768).
Altogether, 11 181 children received a cancer diagnosis.
No evidence of an increased risk of childhood cancer was found for children born by caesarean section (hazard ratio, 1.05; 95% confidence interval, 0.99, 1.11).
No association was found for any major type of childhood cancer, or when split by the type of caesarean section (elective/unplanned).

74 - Administration of oral and vaginal prebiotic lactoferrin for a woman with a refractory vaginitis recurring preterm
delivery

Appearance of lactobacillus in vaginal flora
followed by term delivery

J. Obstet. Gynaecol. Res. Vol. 40, No. 2: 583–585, February 2014

Katsufumi Otsuki, Mayumi Tokunaka, Tomohiro Oba, Masamitsu Nakamura,
Nahoko Shirato and Takashi Okai
Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan

Abstract
Lactoferrin (LF) is one of the prebiotics present in the human body. A 38-year-old multiparous woman with
poor obstetrical histories, three consecutive preterm premature rupture of membrane at the 19th, 23rd and
25th week of pregnancy, was referred to our hospital. She was diagnosed as having refractory vaginitis.
Although estriol vaginal tablets were used for 4 months, the vaginitis was not cured.We administrated vaginal
tablets and oral agents of prebiotic LF, resulting in a Lactobacillus predominant vaginal flora. When she was
pregnant, she continued to use the LF, and the Lactobacillus in the vaginal flora was continuously observed
during pregnancy. An elective cesarean section was performed at the 38th week of pregnancy. When the
administration of LF was discontinued after the delivery, Lactobacillus in the vaginal flora was disappeared.
Key words: bacterial vaginosis, Lactobacillus, lactoferrin, preterm delivery

The hydroxychloroquine tablet was used to to suppress Kelly Moseley’s immune system.

A 37–year–old woman who had 20 miscarriages has spoken of her “dream come true” after she had a baby boy following pioneering treatment with an anti–malaria pill that costs just 25p.

Kelly Moseley’s son Tyler, who is now nine months old, is the first child in the world as a result of a mother taking the pill, the Daily Mirror reported. Hassan Shehata, a consultant obstetrician and gynaecologist at Epsom and St Helier University Hospitals NHS Trust, discovered she had a high level of natural killer cells in her immune system.

In some women these are so active that they attack the foetus. He used the malaria tablet, hydroxychloroquine, to suppress her immune system.

Though most home births are safe, the risk of long–term disability has not been “adequately addressed”, scientists say. The risk of having a baby at home is comparable to driving without a seatbelt on a child’s car seat, two leading experts have claimed, arguing that the danger of long–term disability in the event of complications has been underestimated. In an intervention that reopens the debate over the safety of home births, the authors of a paper published today in the Journal of Medical Ethics, said that the “avoidable, foreseeable disability” that could be caused, in particular by delays in access to emergency care for new–borns, should “weigh heavily” on parents’ decision about whether to give birth at home or not.

Perez–Delboy A, et al. – Abnromalities of placentation, including placenta accreta, represent a major source of morbidity and mortality among women. Traditional management consists of peripartum hysterectomy at the time of delivery, although more conservative treatments have also been developed recently. In this review authors describe the available literature describing the operative approach and considerations for management of women with placenta accreta

Caffeine is the most widely used drug, but little is known about helping those who depend on it. "I'm a zombie without my morning coffee." But a recent study coauthored by American University psychology professor Laura Juliano indicates that more people are dependent on caffeine to the point that they suffer withdrawal symptoms and are unable to reduce caffeine consumption even if they have another condition that may be impacted by caffeine – such as a pregnancy, a heart condition, or a bleeding disorder. Based on current research, Juliano advises that healthy adults should limit caffeine consumption to no more than 400 mg per day – the equivalent of about two to three 8–oz cups of coffee. Pregnant women should consume less than 200 mg per day and people who regularly experience anxiety or insomnia – as well as those with high blood pressure, heart problems, or urinary incontinence – should also limit caffeine.

Next step: implanting embryos. A team of doctors in Sweden has successfully transplanted wombs into nine women, who will try and make medical history by becoming pregnant. The women, mostly in their 30s, who were either born without a uterus or had it removed because of cancer, are part of the first major experiment to see if a woman with a transplanted uterus can become pregnant and give birth to the child. The women received wombs donated from relatives. Women from two previous womb transplant attempts – in Turkey and Saudi Arabia–both failed to carry a baby. Scientists in several countries are working on similar operations, but the Swedish group is the most advanced, the AP reports. Dr. Mats Brannstrom, chair of the obstetrics and gynecology department at the University of Gothenburg, will hold a workshop next month on how to perform womb transplants and publish their findings.

Schneeberger C et al. – This study aimed to estimate and compare contamination rates of three different urine–sampling methods in pregnant women to assess bacteriuria. In pregnant women, the contamination rate of midstream samples is comparable with the contamination rates of morning and clean–catch samples. The quantity of contaminants varied among the three samples collected by one woman. These results show that more complex, unpractical, and time–consuming morning and clean–catch samples are not superior. Therefore, authors recommend a midstream sample to assess bacteriuria in pregnant women.

Methods

In this cross–sectional study, 113 pregnant women collected three different midstream urine samples consecutively: morning (first void); midstream (void without further instructions); and clean–catch sample (void after cleaning).
The following end points were considered contaminants: epithelial cells, Gram–positive rods or mixed bacteria in the Gram stain, and mixed growth or skin flora in the urine culture.
Intraindividual variability in contaminants was quantified with Fleiss–Cohen’s weighted κ statistic.
Differences between samples were assessed using generalized estimating equations.

Results

Mainly low numbers of Gram–positive rods were more likely to be present in Gram stains of midstream samples compared with clean–catch samples (77.7% compared with 66.7%, P=.022).
Morning samples showed more mixed growth compared with midstream samples (6.2% compared with 0.9%, P=.050).
No consistency in quantity of contaminants was found in midstream samples compared with morning and clean–catch samples.
No differences were found between the other end points in all three urine samples (P>.05).
The study could detect an odds ratios of 2.0 for differences in urine–sampling methods with 80% power and 5% significance for most end points.

Nilsen RM, et al. – The authors examined how the prevalence of preconception folic acid use for a given pregnancy in Norwegian women varied according to the time interval from the previous pregnancy. The finding of a lower preconception folic acid use in women with both short and long interpregnancy intervals might help identifying those with higher risk of folate deficiency and preventing unwanted pregnancy outcomes.

Methods

Analysis was based on 48855 pairs of pregnancies with the second pregnancy included in the Norwegian Mother and Child Cohort Study (birth years 1999–2009).
Interpregnancy interval was defined as the time from birth of a child to the conception of the subsequent sibling.
Preconception folic acid use was defined as any use of folic acid–containing supplements within the last 4 weeks before the second pregnancy

Results

The prevalence of preconception folic acid use was 31%.
Among women with a term birth (≥37 weeks) in the previous pregnancy (92%), those with interpregnancy intervals ≤12 and ≥49 months were associated with up to 35% lower prevalence of preconception folic acid use for the second pregnancy, relative to the reference group (13–24 months).
The low use in short intervals was mainly attributable to lower proportion of planned pregnancies and fewer women with higher education.
Among women with a preterm birth (<37 weeks) in the previous pregnancy (8%), preconception folic acid use significantly decreased with increasing pregnancy spacing.

Methods

In this cross–sectional study, 113 pregnant women collected three different midstream urine samples consecutively: morning (first void); midstream (void without further instructions); and clean–catch sample (void after cleaning).
The following end points were considered contaminants: epithelial cells, Gram–positive rods or mixed bacteria in the Gram stain, and mixed growth or skin flora in the urine culture.
Intraindividual variability in contaminants was quantified with Fleiss–Cohen’s weighted κ statistic.
Differences between samples were assessed using generalized estimating equations.

Results

Mainly low numbers of Gram–positive rods were more likely to be present in Gram stains of midstream samples compared with clean–catch samples (77.7% compared with 66.7%, P=.022).
Morning samples showed more mixed growth compared with midstream samples (6.2% compared with 0.9%, P=.050).
No consistency in quantity of contaminants was found in midstream samples compared with morning and clean–catch samples.
No differences were found between the other end points in all three urine samples (P>.05).
The study could detect an odds ratios of 2.0 for differences in urine–sampling methods with 80% power and 5% significance for most end points.

Chiossi G. et al. – To compare the maternal and neonatal risks of elective repeat cesarean delivery compared with pregnancy continuation at different gestational ages, starting from 37 weeks.In women with prior cesarean delivery, 39 weeks of gestation is the optimal time for repeat cesarean delivery for both mother and neonate.

Methods

We analyzed the composite maternal and neonatal outcomes of repeat cesarean deliveries studied prospectively over 4 years at 19 U.S. centers.
Maternal outcome was a composite of pulmonary edema, cesarean hysterectomy, pelvic abscess, thromboembolism, pneumonia, transfusion, or death.
Composite neonatal outcome consisted of respiratory distress, transient tachypnea, necrotizing enterocolitis, sepsis, ventilation, seizure, hypoxic–ischemic encephalopathy, neonatal intensive care unit admission, 5–minute Apgar of 3 or lower, or death.
Outcomes after elective repeat cesarean delivery without labor at each specific gestational age were compared with outcomes for all who were delivered later as a result of labor onset, specific obstetric indications, or both.

Results

Twenty–three thousand seven hundred ninety–four repeat cesarean deliveries were included.
Elective delivery at 37 weeks of gestation had significantly higher risks of adverse maternal outcome (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.06–2.31), whereas elective delivery at 39 weeks of gestation was associated with better maternal outcome when compared with pregnancy continuation (OR 0.51, 95% CI 0.36–0.72).
Elective repeat cesarean deliveries at 37 and 38 weeks of gestation had significantly higher risks of adverse neonatal outcome (37 weeks OR 2.02, 95% CI 1.73–2.36; 38 weeks OR 1.39 95% CI 1.24–1.56), whereas delivery at 39 and 40 weeks of gestation presented better neonatal outcome as opposed to pregnancy continuation (39 weeks OR 0.79, 95% CI 0.68–0.92; 40 weeks OR 0.57, 95% CI 0.43–0.75).

SOUTHAMPTON, United Kingdom -- January 3, 2014 -- Children are likely to have stronger muscles if their mothers had a higher level of vitamin D in their body during pregnancy, according to a study published in the January 2014 edition of the Journal of Clinical Endocrinology and Metabolism.

Low vitamin D status has been linked to reduced muscle strength in adults and children, but little is known about how variation in a mother’s status during pregnancy affects her child.

Low vitamin D concentrations are common among young women in the UK, and although women are recommended to take an additional 10mcg/day of vitamin D in pregnancy, supplementation is often not taken up.

In the study, vitamin D levels were measured in 678 mothers in the later stages of pregnancy. When the children were aged 4 years, grip strength and muscle mass were measured.

Results showed that the higher the levels of vitamin D in the mother, the higher the grip strength of the child, with an additional, but less pronounced association between mother’s vitamin D and child’s muscle mass.

“These associations between maternal vitamin D and offspring muscle strength may well have consequences for later health; muscle strength peaks in young adulthood before declining in older age and low grip strength in adulthood has been associated with poor health outcomes including diabetes, falls and fractures,” said Nicholas Harvey, Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.

“It is likely that the greater muscle strength observed at age 4 years in children born to mothers with higher vitamin D levels will track into adulthood, and so potentially help to reduce the burden of illness associated with loss of muscle mass in old age,” he said.

The 678 women who took part in the study are part of the Southampton Women’s Survey -- one of the largest and best characterised such studies globally.

The latest study in JAMA Psychiatry investigated how advanced paternal age can affect rates of mental illness and school performance in children. After a groundbreaking genetic analysis in 2012 highlighted the surprising number of spontaneous mutations that can occur in the sperm of older men, scientists have been delving into the relationship to better quantify and describe the risk. While some studies confirmed the connection, others failed to find a link. In the latest research, Brian D’Onofrio, associate professor of psychological and brain sciences at Indiana University, and his colleagues attempted to address one of the biggest problems with studying the trend. Most of the previous investigations compared younger fathers and their children to different older fathers and their offspring. This team turned to birth registry data from Sweden and compared children born to the same fathers, evaluating the siblings on various mental health and academic measures. D’Onofrio’s group found that the increased risk for children of fathers older than 45 years soared to 3.5 times compared to that of younger fathers. Children of older fathers also showed a 13 fold higher risk of developing attention deficit–hyperactivity disorder (ADHD), a 25 times greater chance of getting bipolar disorder, and twice the risk of developing a psychosis. These kids also had doubled risk of having a substance abuse problem and a 60% higher likelihood of getting failing grades in school compared with those with younger fathers.

ARLINGTON HEIGHTS, Ill -- February 3, 2014 -- According to a new study published today, the more common colds and viral infections a woman has during pregnancy, the higher the risk her baby will have asthma.

The study, published in the February issue of Annals of Allergy, Asthma and Immunology, found a mother’s infections and bacterial exposure during pregnancy affect the in utero environment, thus increasing a baby’s risk of developing allergy and asthma in childhood.

“In addition, these same children that had early exposure to allergens, such as house dust and pet dander, had increased odds of becoming sensitised by age 5,” said allergist Mitch Grayson, MD, American College of Allergy, Asthma and Immunology (ACAAI), Arlington Heights, Illinois. “When dust mites from the mother and child’s mattresses were examined, children with high dust mite exposure yet low bacteria exposure were more likely to be allergic to dust mites than those with low mite exposure and high bacteria contact.”

Researchers studied 513 pregnant women in Germany, and their 526 children. Questionnaires were completed during pregnancy, when the children were 3 and 12 months old, and every year up to 5-years-old. Of the families, 61% had a parent with asthma, hay fever or atopic dermatitis.

According to the ACAAI, asthma and allergy can be hereditary. If both of a child’s parents have allergies, the child has a 75% chance of being allergic. If 1 of the parents is allergic, or if a close relative has allergies, the child has a 30% to 40% chance of having some form of allergy. If neither parent has allergy, the chance is only 10% to 15%.

“We know that allergy and asthma can develop in the womb since genetics play a factor in both diseases,” said allergist Michael Foggs, MD, ACAAI. “But this study sheds light about how a mother’s environment during pregnancy can begin affecting the child before birth.”

Asthma is the most common potentially serious medical condition to complicate pregnancy, according to the ACAAI. In fact, asthma affects approximately 8% of women in their childbearing years. When women with asthma become pregnant, 1-third of the patients improve, 1-third worsen and 1-third remain unchanged.

1 -Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery International Journal of Gynecology & Obstetrics, 09/09/2014 Clinical Article

2 - A Statin's Role in Uterine Fibroid Treatment

3 - Diabetic pregnancy: An overview of current guidelines and clinical practice

4 - Drug prevents passage of HBV during pregnancy

5 - Factors associated with successful transabdominal sonography-guided dilation and curettage for early cesarean scar pregnancy

Objective

Methods

Results

Conclusion

6 - Increased chromosome 16 disomy rates in human spermatozoa and recurrent spontaneous abortions;

Neusser M, Rogenhofer N, Dürl S, Ochsenkühn R, Trottmann M, Jurinovic V, Steinlein O, von Schönfeldt V, Müller S, Thaler C; Fertility and Sterility (Aug 2015)

7 - The impact of isolated single umbilical artery on labor and delivery outcome;

Ashwal E, Melamed N, Hiersch L, Edel S, Bardin R, Wiznitzer A, Yogev Y; Prenatal Diagnosis 34 (6), 581-5 (Jun 2014)

8 - What is the optimal rate of caesarean section at population level?

A systematic review of ecologic studies

9 - Vitamin D status is inversely associated with anemia and serum erythropoietin during pregnancy;

Thomas C, Guillet R, Queenan R, Cooper E, Kent T, Pressman E, Vermeylen F, Roberson M, O'Brien K; American Journal of Clinical Nutrition 102 (5), 1088-95 (Nov 2015)

10 - Drug combating severe nausea in pregnancy begins clinical trial University at Buffalo Health and Medicine News, 06/20/2014

14 - Non-steroidal anti-inflammatory drugs inhibit ovulation after just ten days

16 - Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction technologies

Systematic review and meta-analysis of RCTs Human Reproduction Update, Evidence Based Medicine Review Article Clinical Article

17 - The cervix as a natural tamponade in postpartum hemorrhage caused by placenta previa and placenta previa accreta: a prospective study.

Abstract

18 - Use of Acetaminophen During Pregnancy Linked to Higher Risk for Behaviour Problems in Kids

19 - Urolithiasis in pregnancy: a cost-effectiveness analysis of ureteroscopic management vs ureteral stenting

Objective

Study Design

Results

Conclusion

20 - The use of a pocked-sized ultrasound machine (PUM) for routine examinations in the third trimester of pregnancy;

Galjaard S, Baeck S, Ameye L, Bourne T, Timmerman D, Devlieger R; Ultrasound in Obstetrics and Gynecology (Dec 2013)

21 - The impact of hydroxychloroquine treatment on pregnancy outcome in women with antiphospholipid antibodies;

Sciascia S, Hunt B, Talavera-Garcia E, Lliso G, Khamashta M, Cuadrado M; American Journal of Obstetrics and Gynecology (Sep 2015)

22 - A pilot study to determine whether progestogen supplementation using dydrogesterone during the first trimester will reduce the incidence of gestational hypertension in primigravidae Gynecological Endocrinology, 03/17/2014

23 - Popular media influences choice of childbirth

24 - Low-dose aspirin for preventing preeclampsia and its complications: A meta-analysis

25 - First-trimester exposure to metformin and risk of birth defects: A systematic review and meta-analysis

Methods

Results

26 - New NICE thresholds could miss up to 4,000 women per year at risk from diabetes in pregnancy

27 - Baylor Research Institute study reveals that uterine cooling can reduce C-section blood loss

28 - Ob/Gyn experts recommend "ultrasound first" for imaging the female pelvis

29 - How your sex life may influence endometriosis

30 - Association of adverse pregnancy outcomes with glyburide ( doanil ) vs insulin in women with gestational diabetes

31 - CLINICAL SIGNIFICANCE OF NEONATAL MENSTRUATION

32 - Number of episodes of reduced fetal movement at term: association with adverse perinatal outcome

Objective

Study Design

Results

Conclusion

33 - Induction of labor at full term in uncomplicated singleton gestations

a systematic review and metaanalysis of randomized controlled trials

34 - Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study

Objective

Study Design

Results

Conclusion

35 - A randomized placebo-controlled trial of preoperative tranexamic acid among women undergoing elective cesarean delivery

Objective

Methods

Results

Conclusion

36 - Efficacy and safety of repeated postoperative administration of intramuscular diclofenac sodium in the treatment of post-cesarean section pain

a double-blind study.

BACKGROUND:

METHODS:

RESULTS:

CONCLUSIONS:

37 - Pregnancy and viral hepatitis B and C

Sogni P; La Presse Medicale (May 2015)

38 -Pharmacological treatment of migraine during pregnancy and breastfeeding

39 - New drug compounds show promise against endometriosis

40 - Early pregnancy cravings, dietary intake, and development of abnormal glucose tolerance

Methods

Results

41 - Comparison of nifedipine and progesterone for maintenance tocolysis after arrested preterm labour Journal of Obstetrics & Gynaecology, 06/06/2014 Clinical Article

42 - Haemorrhoids and anal fissures during pregnancy and after childbirth

A prospective cohort study BJOG: An International Journal of Obstetrics and Gynaecology, 06/05/2014 Clinical Article

43 - Letrozole Results in Higher Birth Rates Than Clomiphene in Women With PCOS

44 - Maternal 25-hydroxyvitamin D and preterm birth in twin gestations Obstetrics and Gynecology, Clinical Article

1 -Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery
International Journal of Gynecology & Obstetrics, 09/09/2014 Clinical Article

10 - Drug combating severe nausea in pregnancy begins clinical trial
University at Buffalo Health and Medicine News, 06/20/2014

Systematic review and meta-analysis of RCTs
Human Reproduction Update, Evidence Based Medicine Review Article Clinical Article

22 - A pilot study to determine whether progestogen supplementation using dydrogesterone during the first trimester will reduce the incidence of gestational hypertension in primigravidae
Gynecological Endocrinology, 03/17/2014

41 - Comparison of nifedipine and progesterone for maintenance tocolysis after arrested preterm labour
Journal of Obstetrics & Gynaecology, 06/06/2014 Clinical Article

A prospective cohort study
BJOG: An International Journal of Obstetrics and Gynaecology, 06/05/2014 Clinical Article

44 - Maternal 25-hydroxyvitamin D and preterm birth in twin gestations
Obstetrics and Gynecology, Clinical Article

45 - Gestational diabetes mellitus and iron supplement; Effects on pregnancy outcome
Acta Medica Iranica, 06/18/2014 Clinical Article

47 - Inadequate weight gain in overweight and obese pregnant women: What is the effect on fetal growth?
American Journal of Obstetrics and Gynecology, 06/20/2014 Clinical Article

50 - Most hospital pregnancy tests found to be unreliable after first few weeks of pregnancy
ScienceDaily, 04/10/2014

51 - Meet your unborn child - before it's even conceived
New Scientist, 04/11/2014

52 - Risk of glaucoma after early bilateral oophorectomy
Menopause,

A Nested Randomized Controlled Assessor-Blinded Clinical Trial
Clinical Infectious Diseases, Clinical Article

To leave or To remove the placenta?
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