Serum ferritin levels and polycystic ovary syndrome in obese and nonobese women.

OBJECTIVE: The aim of this study is to evaluate serum ferritin levels and polycystic ovary syndrome (PCOS)-related complications in obese and nonobese women. MATERIALS AND METHODS: This retrospective study included 539 (286 with PCOS and 253 without PCOS). RESULTS: Serum ferritin correlated with menstrual cycle length, sex hormone-binding globulin, total testosterone, androstenedione, triglyceride, and total cholesterol in both obese and nonobese women. Obese women with high ferritin levels exhibited higher insulin resistance, impaired glucose tolerance, and liver enzymes (glutamic oxaloacetic transaminase, glutamic pyruvic transaminase) than obese women with low ferritin levels. However, among nonobese women, insulin resistance and risk of diabetes were not significantly different between the high and low ferritin groups. Independent of obesity, hypertriglyceridemia was the major metabolic disturbance observed in women with elevated serum ferritin levels. CONCLUSION: Elevated serum ferritin levels are associated with increased insulin resistance and risk of diabetes in obese women but not in nonobese women. However, higher serum ferritin levels were correlated with a greater risk of hyperglyceridemia in both obese and nonobese women. Therefore, hypertriglyceridemia in women with PCOS might be associated with iron metabolism.

Twenty-one years of experience with ovarian ectopic pregnancy at one institution in Taiwan.

OBJECTIVE: To review the experience with patients with ovarian ectopic pregnancy (OEP) at Chang Gung Memorial Hospital, Lin-Kou Medical Center, Tao-Yuan, Taiwan, between 1989 and 2009. METHODS: A retrospective review of the presentation, prevalence, diagnosis, and trends in treatment of patients with OEP, and the use of assisted reproductive technology (ART) procedures and intrauterine devices (IUD). The incidence rate ratios (IRR) of ectopic pregnancies (EPs) per live births, OEPs per EPs, and OEPs per live births were analyzed. RESULTS: The 110 OEPs diagnosed comprised 2.0% of all EPs (n=5408) and 1:1543 of all live births, leading to a mean OEP per year of 5.24. Seventy-eight patients were managed with laparoscopy and 32 underwent laparotomy. Twenty-six (23.6%) patients used an IUD and 12 (10.9%) had undergone ART. OEP associated with ART increased in the last 10 years of the study period. The IRR of EPs per live births, OEPs per EPs, and OEPs per live births all increased between 1989 and 2009. Management of OEP tended to favor laparoscopy in the later years. CONCLUSION: There was a trend toward better management of OEP with laparoscopy. ART has become a risk factor for OEP. The IRR of EPs per live births, OEPs per EPs, and OEPs per live births all increased over the 21-year period.

Intrauterine contraceptive device migration to the lower urinary tract: report of 2 cases.

Several instances of migration of intrauterine contraceptive devices (IUDs) into the bladder have been reported. Non-contrast-enhanced computed tomography enables excellent visualization of the sites of migrated IUDs. Herein are reported 2 cases of IUDs that migrated to the lower urinary tract. In the first case, the IUD migrated to the bladder. The site of the migrated IUD was accurately determined using 3-dimensional ultrasound. In the second case, the IUD migrated through the bladder to the opening of the urethra. Both cases were managed endoscopically, with excellent outcome. Three-dimensional ultrasound is an alternative method for localization of the site of a migrated IUD. We present the first case of an IUD migrating through the bladder to the opening of the urethra. Endoscopic retrieval is feasible and safe in cases with an intravesically migrated IUD.

Six cases of tubal stump pregnancy: complication of assisted reproductive technology?

OBJECTIVE: To present six cases of tubal stump pregnancy and discuss possible etiologies. DESIGN: Case series. SETTING: Department of Obstetrics and Gynecology at a tertiary referring medical center. PATIENT(S): Six women with tubal stump pregnancy diagnosed and treated in the department from 2004 to 2010 according to electronic files and histological reports. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Assisted reproductive technology (ART) before tubal stump pregnancies. RESULT(S): From 2004 to 2010, this study diagnosed six tubal stump pregnancies among 1,466 ectopic pregnancies, an incidence of 0.4%. Of the six cases, two conceived spontaneously after ovulation induction. Four of them conceived after IVF-ET programs. CONCLUSION(S): Tubal stump pregnancies may be one of the complications of ART. In view of the risk of early rupture in a tubal stump pregnancy, early diagnosis is warranted to avoid maternal morbidity.

Use of a pessary in treatment of pelvic organ prolapse: quality of life, compliance, and failure at 1-year follow-up.

STUDY OBJECTIVES: To estimate the effect of pessary use on symptom improvement and quality of life in women with pelvic organ prolapse, to examine factors that influence patient choice and continued use of a pessary, and to determine reasons associated with discontinuation of pessary use. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Outpatient urogynecologic clinic of a university hospital. PATIENTS: Seventy-two patients with symptomatic pelvic organ prolapse were evaluated for pessary insertion between March 2006 and August 2008. INTERVENTIONS: Insertion of a Gellhorn pessary. MEASUREMENTS AND MAIN RESULTS: Urinary symptoms and quality of life were assessed using the Urinary Distress Inventory incontinence questionnaire (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) at baseline and postinsertionally at 2 months and at 1 year. Frequency of choosing pessary use or surgery and rate of continuous use of a pessary was compared between groups. Compared with baseline findings, at 1 year, UDI-6 and IIQ-7 demonstrated significant improvement in frequency of micturition, stress incontinence, voiding function, and bowel evacuation. Substantially more older or menopausal women opted for a pessary rather than surgery, and significantly more sexually active women preferred surgery. Women with diabetes mellitus or occult stress urinary incontinence and those without family support are more likely to discontinue pessary use. CONCLUSIONS: Use of a pessary in treatment of pelvic organ prolapse is associated with good compliance, and results in significant improvement in quality of life and urinary and bowel symptoms. Women with diabetes or occult stress urinary incontinence and those without family support should receive intensive counseling before placement of a pessary.

Delayed onset advanced pelvic organ prolapse after pelvic trauma in a nulliparous young female: case report.

Reports have shown that high-energy pelvic trauma might be associated with advanced pelvic organ prolapse in conjunction with other causes. We report the case of a 21-year-old nulliparous, premenopausal, non-overweight woman with no predisposing factors for prolapse who developed stage IV massive pelvic organ prolapse and stress urinary incontinence 4 years after a severe pelvic traumatic accident. Most likely, the pelvic trauma, as a single factor, was the causative factor for the massive procidentia. The onset on the prolapse was delayed until 4 years after the pelvic accident. The patient was managed with sacrospinous ligament hysteropexy along with anterior and posterior vaginal wall repair and perineorrhaphy. Despite satisfactory surgical management, long-term regular follow-up is still required.

A randomized controlled trial of antenatal pelvic floor exercises to prevent and treat urinary incontinence.

INTRODUCTION AND HYPOTHESIS: the aim of the study was to evaluate the effect of antenatal pelvic floor muscle exercise (PFME) in the prevention and treatment of urinary incontinence during pregnancy and postpartum period. METHODS: three hundred women were randomly assigned to the PFME group and control group. Urinary symptoms were measured by Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and question of self-reported urinary incontinence. Questionnaire scores of the PFME and the control groups were compared and analyzed. RESULTS: during late pregnancy and the postpartum period, the PFME group had significantly lower total UDI-6 and IIQ-7 scores; their self-report rate of urinary incontinence was also less than the control group. Additionally, we found whether in PFME or control, women who delivered vaginally were more likely to develop postpartum urinary leakage than women who delivered by cesarean section. CONCLUSIONS: PFME applied in pregnancy is effective in the treatment and prevention of urinary incontinence during pregnancy, and this effect may persist to postpartum period.

Triplet pregnancy complicated with one hydatidiform mole and preeclampsia in a 46,XY female with gonadal dysgenesis.

OBJECTIVE: We present a case of triplet pregnancy with a complete hydatidiform mole, a condition carrying a significant risk to both mother and fetuses and, therefore, raising an important issue on prenatal care. CASE REPORT: A 36-year-old patient with gonadal dysgenesis and a 46,XY karyotype successfully conceived a triplet pregnancy after oocyte donation and in vitro fertilization. At mid-trimester, the pregnancy was seen harboring a hydatidiform mole along with two other fetuses by ultrasound. Fetal karyotyping of both fetuses revealed normal results. Serum human chorionic gonadotropin levels were followed up throughout the remainder of pregnancy. At 33 weeks of gestation, preeclampsia ensued with worsening of maternal renal function and high blood pressure, so cesarean section was arranged to deliver a set of two surviving twins. Prophylactic bilateral gonadectomy was done at the same time to curtail the possibility of future malignancy development. Upon pathologic examination of the placentae, hydropic chorionic villi with central cistern formation and nonpolar trophoblastic hyperplasia with atypia and necrosis were found, compatible with complete hydatidiform mole. The gonads showed streaks of fibrous tissue, which resembled ovarian stroma and hilus cells, and an unremarkable tube. Maternal serum human chorionic gonadotropin levels declined gradually to normal level at two months after delivery. CONCLUSION: This is the first report of triplet pregnancy complicated with one complete hydatidiform mole and preeclampsia in a 46,XY female with gonadal dysgenesis. Our case demonstrated that prolonged gestation with both surviving fetuses was possible by applying intensive monitoring of the whole pregnancy.