Monochorionic diamniotic twin cervical ectopic pregnancy following assisted conception: a case report.

BACKGROUND: Ectopic pregnancy is a leading cause of maternal mortality. Its incidence has progressively increased in recent years. Assisted conception techniques are associated with a significantly higher rate of ectopic pregnancies. Cervical ectopic pregnancies are very rare, accounting for < 1% of all ectopic pregnancies. CASE: A 41-year-old, Caucasian woman presented for routine transvaginal scan at 6 weeks' gestation following a single embryo transfer as part of in vitro fertilization (IVF) follow-up. This revealed a monochorionic diamniotic twin pregnancy within the cervix. Serum beta-hCG concentration was 18,470 IU/L, and she reported only a mild brown-stained vaginal discharge. She was counseled regarding the risks of this pregnancy and was managed medically, receiving oral mifepristone and systemic methotrexate. She was subsequently monitored with serial serum beta-hCG measurements and transvaginal ultrasonography. After 6 weeks, due to the slow serum beta-hCG decline and lack of spontaneous menstruation, she was counseled regarding the potential risks of the persistent pregnancy and underwent suction evacuation. CONCLUSION: This case is an example of a complication of LVF. To the best of our knowledge and following a search of the Medline database, this is the only case of monochorionic twin pregnancy located within the cervical canal.

Do South Asian women with PCOS have poorer health-related quality of life than Caucasian women with PCOS? A comparative cross-sectional study.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common chronic endocrine disorder affecting women of reproductive age. This study aimed to compare the HRQoL of South Asian and white Caucasian women with PCOS, given that it is particularly common among women of South Asian origin and they have been shown to have more severe symptoms. METHODS: The Polycystic Ovary Syndrome Questionnaire (PCOSQ) and the Short Form-36 (SF-36) were administered in a cross-sectional survey to 42 South Asian and 129 Caucasian women diagnosed with PCOS recruited from the gynaecology outpatient clinics of two university teaching hospitals in Sheffield and Leeds. Additional clinical data was abstracted from medical notes. Normative data, collected as part of the Oxford Health and Lifestyles II survey, was obtained to compare SF-36 results with ethnically matched women from the general UK population. Using the SF-36, normative HRQoL scores for women of South Asian origin were lower than for Caucasian women. Given this lower baseline we tested whether the same relationship holds true among those with PCOS. RESULTS: Although HRQoL scores for women with PCOS were lower than normative data for both groups, South Asian women with PCOS did not have poorer HRQoL than their Caucasian counterparts. For both the SF-36 and PCOSQ, mean scores were broadly the same for both Asian and Caucasian women. For both groups, the worst two HRQoL domains as measured on the PCOSQ were 'infertility' and 'weight', with respective scores of 35.3 and 42.3 for Asian women with PCOS compared to 38.6 and 35.4 for Caucasian women with PCOS. The highest scoring domain for South Asian women with PCOS was 'menstrual problems' (55.3), indicating best health, and was the only statistically significant difference from Caucasian women (p = 0.01). On the SF-36, the lowest scoring domain was 'Energy & Vitality' for Caucasian women with PCOS, but this was significantly higher for Asian women with PCOS (p = 0.01). The best health status for both groups was 'physical functioning', although this was significantly lower for South Asian women with PCOS (p = 0.005). Interestingly, only two domains differed significantly from the normative data for the Asian women with PCOS, while seven domains were significantly different for the Caucasian women with PCOS compared to their normative counterparts. CONCLUSIONS: The HRQoL differences that exist between South Asian and Caucasian women in the general population do not appear to be replicated amongst women with PCOS. PCOS reduces HRQoL to broadly similar levels, regardless of ethnicity and differences in the normative baseline HRQoL of these groups.

Endometriosis: associations with menopause, hormone replacement therapy and cancer.

Endometriosis is an estrogen-dependent condition and is characterized by the presence of ectopic endometrial tissue. The pathogenesis of this condition remains an enigma. Endometriosis has well known associations with menopause both in terms of secondary outcomes from medical and surgical therapy in premenopausal women, as well as a natural occurrence/recurrence of the disease in women going through menopause naturally. This review article aims to discuss the current day modalities of management of endometriosis with their pros and cons especially in the context of menopause and cancer.

Ethnic variations in the distribution of obesity and biochemical metabolic abnormalities in fertility clinic attendees.

OBJECTIVE: To assess ethnic variations in the distribution of obesity and the associated biochemical, metabolic abnormalities in young women of reproductive age. STUDY DESIGN: Baseline anthropometric, biochemical and endocrine parameters were compared between 30 South Asian (SA) and 41 Caucasian (CA) women attending a fertility clinic. RESULTS: The CA were significantly more obese (BMI > 30 kg/m2) than the SA (p = 0.001); however, there was no difference in waist circumference. The SA were significantly more hyperinsulinemic (p = 0.04) and had lower levels of plasma high density lipoprotein-c (p = 0.02) than the CA. Metabolic abnormalities increased in the SA with a BMI > 25 kg/m2, and the group showed a 4.6-fold greater prevalence of metabolic syndrome (MS) than did the CA. CONCLUSION: SAs have a higher prevalence of MS than CAs, and the risk is even higher in the SA polycystic ovary syndrome subgroup. MS criteria need to be redefined in terms of obesity in SA, and the role of community-based preventive measures in young women needs to be emphasized.

Peripartum group A streptococcal sepsis: a case report.

BACKGROUND: Infections of the upper respiratory tract and skin are commonly attributed to group A Streptococcus (GAS). The organism can be found in the female genital tract and can cause peripartum sepsis in rare cases. CASE: A case of GAS peripartum sepsis did not respond to conservative measures despite early initiation of intravenous antibiotics. Radical surgical intervention improved the condition. CONCLUSION: A GAS uterine infection should be suspected at an early stage in cases of puerperal pyrexis that do not respond to broad-spectrum antibiotics.

Epidemiology of abnormal uterine bleeding.

Menstrual dysfunction is a common cause of referral to the gynaecology clinic, and the problem has a considerable impact on the health status and the quality of life of women. The aetiology is varied and the burden on the healthcare system continues to grow. There is an urgent need for clinicians to develop effective preventive strategies and treatment modalities that can be available to women in the community.

Impact of microwave endometrial ablation in the management of subsequent unplanned pregnancy.

Microwave endometrial ablation is a safe and effective global procedure in the management of menorrhagia. Pregnancy and its associated complications after endometrial ablation are well recognized in the literature. Little information is available pertaining to difficulties one may encounter during procedures such as termination of pregnancies after endometrial ablation, and this is highlighted in this case. In addition to short-term sequelae, long-term implications of a procedure should be discussed. Preprocedure counseling is a very important step in patient management.

An observational study of Yasmin in the management of women with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the commonest endocrine disturbance affecting women in the reproductive age group and encompasses signs of hyperandrogenism, menstrual cycle disturbances and obesity. Some of the symptoms of PCOS may be ameliorated by the combined oral contraceptive pill (COCP). METHODS: A pilot observational study was carried out in a university teaching hospital setting to determine whether the clinical and biochemical features of PCOS are ameliorated by a new COCP, Yasmin, which contains a new progestogen, drosperinone. Treatment with Yasmin was given for 6 months to 17 patients. RESULTS: Thirteen patients (76%) completed 6 months of therapy. Good cycle control was achieved in all patients. Percentage body fat increased, with no overall change in body mass index. Fasting insulin and triglyceride concentrations rose significantly. Serum total testosterone concentrations fell with a concomitant rise in sex hormone binding globulin levels. Hirsutism scores did not change significantly in the 12 women who were clinically hirsute. There was, however, a significant improvement in the acne scores. Four of the 17 patients dropped out of the trial between Cycles 3 and 5 due to side effects. CONCLUSIONS: Yasmin provides good cycle control for women with PCOS, with an improvement in acne over 6 months but not in other symptoms of the syndrome.