Fetal reduction for hyperreactio luteinalis.

OBJECTIVE: To present an unusual case of hyperreactio luteinalis and a comprehensive review of the recent literature. Hyperreactio luteinalis is a benign ovarian condition of pregnancy that at times becomes life threatening. The medical literature provides only case reports. DESIGN: Case report and systematic review of the literature. SETTING: University Center. PATIENT(S): A multiparous woman with polycystic ovary syndrome who underwent ovarian stimulation with oral and injectable medications and conceived triplets. She presented at 10 weeks of pregnancy with hyperreactio luteinalis. INTERVENTION(S): Fetal reduction to singleton. MAIN OUTCOME MEASURE(S): Resolution of condition. RESULT(S): The condition resolved 6 weeks after fetal reduction. The patient delivered at term without further complications. CONCLUSION(S): Our review showed that many unnecessary surgeries are performed to treat hyperreactio luteinalis. When feasible, fetal reduction may improve outcome and represents an effective approach that does not compromise maternal well-being or future fertility.

Who should be tested for fragile X carriership? A review of 1 center's pedigrees.

OBJECTIVE: To determine whether following American College of Obstetricians and Gynecologists and American College of Medical Genetics recommendations would have detected carriers in pedigrees of patients diagnosed with fragile X. STUDY DESIGN: Using a database of patients referred to the UT genetics clinic for evaluation of fragile X, pedigrees of cases of fragile X syndrome were analyzed. RESULTS: Eight of 17 cases identified had a family history of unexplained mental retardation (MR) or fragile X MR and would have been diagnosed using current guidelines. Other findings noted in the pedigrees included autism, speech or hearing problems, attention deficit hyperactivity syndrome and behavioural disorders. No risk factors were found in 4 cases. CONCLUSION: Using current guidelines, less than one half of fragile X carriers would have been identified during a prenatal assessment. Using other risk factors in screening would likely increase carrier detection rate.

Job satisfaction among obstetrician-gynecologists: a comparison between private practice physicians and academic physicians.

OBJECTIVE: Physician job satisfaction has been the subject of much research. However, no studies have been conducted comparing academic and private practice physician satisfaction in obstetrics and gynecology. This study was undertaken to measure satisfaction levels for academic and private practice obstetrician-gynecologists and compare different aspects of their practice that contributed to their satisfaction. STUDY DESIGN: A survey was mailed to randomly selected obstetrician-gynecologists in Memphis, TN; Birmingham, AL; Little Rock, AR; and Jackson, MS. Physicians were asked to respond to questions concerning demographics and career satisfaction. They were also asked to assess the contribution of 13 different aspects of their practice in contributing to their job selection and satisfaction using a Likert scale. A score of 1 meant the physician completely disagreed with a statement regarding a factor's contribution or was completely dissatisfied; a score of 5 meant the physician completely agreed with a factor's contribution or was completely satisfied. Simple descriptive statistics, as well as the 2-sample t test, were used. Likert scale values were assumed to be interval measurements. RESULTS: Of the 297 questionnaires mailed, 129 (43%) physicians responded. Ninety-five (74%) respondents rated their overall satisfaction as 4 or 5. No significant difference was found between academic and private physicians when comparing overall job satisfaction (P = .25). When compared to private practice physicians, the aspects most likely contributing to overall job satisfaction for academic physicians were the ability to teach, conduct research, and practice variety (P = .0001, P = .0001, and P = .007, respectively). When compared with academic physicians, the aspects most likely contributing to job satisfaction for private practice physicians were autonomy, physician-patient relationship, and insurance reimbursement (P = .0058, P = .0001, and P = .0098, respectively). When choosing a practice setting, academic physicians found variety, teaching, and research to be more important (P = .0027, P = .0001, and P = .0001, respectively). In contrast, private practice physicians found autonomy, physician-patient relationship, coworkers, and geographic location to be more important (P = .0005, P = .0001, P = .0035, and P = .0016, respectively). CONCLUSION: Academic and private practice physicians are equally satisfied with their careers. However, teaching, research and variety contribute more to academic satisfaction, whereas autonomy, physician-patient relationship, and coworkers contribute more to satisfaction for the physician in private practice. This study may be used when counseling residents concerning their career options.

Venous thromboembolism in the pregnant woman.

The incidence of venous thromboembolism (vein thrombosis [DVT] and pulmonary embolism [PE]) increases sharply in pregnant women. The 3 primary contributing factors in VTE--hypercoagulability, stasis and endothelial injury--can all occur in association with pregnancy. Symptoms that may suggest VTE are often inherent in pregnancy, such as leg pain and shortness of breath, making clinical diagnosis problematic. The use of objective diagnostic testing for VTE is complicated in pregnancy because many of the tests commonly used present a potential risk to the fetus. Heparin does not cross the placenta and is not teratogenic, making it the first-line treatment for VTE. Low-molecular-weight heparins are typically the drug of choice for prophylaxis and treatment of VTE in pregnant women.

Live birth after treatment of a heterotopic cornual pregnancy with fetal intrathoracic KCI. A case report.

BACKGROUND: Heterotopic pregnancy, in which an ectopic gestation coexists with an intrauterine one, occurs more frequently following in vitro fertilization than with spontaneous conception. However, it is rare to find an ectopic gestation in the interstitial (or cornual) portion of the fallopian tube. This scenario poses challenges in diagnosis as well as difficulties in managing the cornual pregnancy while maintaining the viability of the intrauterine gestation. CASE: A 29-year-old nulligravida with stage IV endometriosis completed in vitro fertilization for primary infertility. A heterotopic pregnancy involving the right interstitial portion of the fallopian tube as well as a viable singleton intrauterine pregnancy was diagnosed using serial ultrasound. Successful termination of the cornual pregnancy was accomplished by transabdominal fetal intrathoracic injection of KCl under ultrasound guidance. CONCLUSION: Pregnancy reduction of a heterotopic cornual gestation using KCl is a treatment alternative for this uncommon but potentially devastating complication of in vitro fertilization.