Does vaginal bleeding influence first-trimester markers for Down syndrome?

OBJECTIVES: To examine the effect of early vaginal bleeding on first-trimester screening markers for Down syndrome. METHODS: A retrospective study was conducted on 1755 normal singleton fetuses that underwent first-trimester combined screening for Down syndrome on the basis of ultrasound and maternal serum markers. Fetal delta-nuchal translucency (NT), maternal serum pregnancy-associated plasma protein A (PAPP-A) and free beta-hCG were compared between pregnancies with (n = 252) and without (n = 1503) an episode of vaginal bleeding. Subgroup analysis for the intensity of bleeding (spotting n = 191; light n = 32; heavy n = 29) was performed. RESULTS: The median +/- SD (log(10)) for delta-NT, multiple of medians (MoM) PAPP-A and MoM free beta-hCG (corrected for maternal weight, smoking and ethnicity) was - 0.17 +/- 0.62, 1.10 +/- 0.28, 1.1 +/- 0.28 and - 0.15 +/- 0.51, 0.98 +/- 0.26, 0.94 +/- 0.3 in pregnancies with and without a history of early vaginal bleeding, which were not significantly different. Exclusion of patients with spotting from the vaginal bleeding group revealed significantly higher maternal serum free beta-hCG MoM values (median +/- SD (log(10))) compared to patients without bleeding, 1.29 +/- 0.27 vs 0.96 +/- 0.3(p = 0.011). Screen-positive (cut off of 1:350) rate after combined first-trimester screening was 28.1% in patients with light vaginal bleeding and 8.4% in patients without bleeding (p = 0.001). CONCLUSIONS: Light vaginal bleeding before first-trimester combined screening for Down syndrome leads to a higher screen-positive rate after combined first trimester screening, without a significant difference in serum levels of the screening markers.

[Leiomyosarcoma of the uterus in young identical twins]. / Leiomyosarkome des Uterus bei jugendlichen eineiigen Zwillingsschwestern.

The authors describe the occurrence of a confirmed leiomyosarcoma and a tumor suspected of being a leiomyosarcoma in 23-year-old twin sisters. In one of them the tumor had caused clinical symptoms; in the second it was detected at the presymptomatic stage as a result of increased attention after detection of the first tumor. In the first case treatment consisted in an extended abdominal hysterectomy, sparing one ovary, with bilateral interiliac lymph node extirpation; in the second case, in an extended abdominal hysterectomy with both adnexae and bilateral interiliac lymph node extirpation. So far - 13 and 10 months after the initial treatment, respectively - there are no signs of continued tumor growth in either case.

[Endometrial carcino-sarcoma in a young woman with Turner syndrome (author's transl)]. / Karzinosarkom des Endometriums bei einer jungen Frau mit Turner-Syndrom. Kasuistischer Beitrag und Literaturübersicht.

Endometrial carcino-sarcoma is a rare rapidly growing mixed muellerian tumor. The pathogenesis of this tumor is not definitely known. However, the current explanation favors the theory of the growth of this tumor from pluripotential sub-epithelial cells. The incidence of the tumor is increased in post-menopausal women. Many of these women have a history of radiotherapy of the genital organs for benign gynaecological disease. A causal relationship between occurence of carcino-sarcoma and estrogen treatment as in carcinoma of the endometrium is not mentioned in the literature. The clinical signs and symptoms are non-specific as in many other malignant tumors of the uterine body. The prognosis is very bad. The average survival from the onset of the first symptoms is only a few months. The treatment of choice appears to be total abdominal hysterectomy and bilateral salpingo-oophorectomy. Radical operations and ancillary radiotherapy and chemotherapy do not appear to improve the survival rate. The extremely rare coincidence of a carcino-sarcoma in a young woman with Turner Syndrome gonadal dysgenesis after five years of treatment with estrogen led to the present case report.