Fulminant sepsis after second-trimester amniocentesis in pregnant women by in vitro fertilization and embryo transfer.

Second-trimester amniocentesis is a common procedure for prenatal diagnosis. Sepsis is a rare complication after amniocentesis and may rapidly deteriorate if prompt treatment, including broad-spectrum antibiotics and removal of the infected abortus, is delayed. In vitro fertilization and embryo transfer (IVF-ET) is a standard final treatment for infertile women. Transvaginal oocyte retrieval is necessary for such women; this procedure potentially causes Escherichia coli attaching and effacing in the abdominal cavity. Here we report that two pregnant women by IVF-ET developed sepsis after second-trimester amniocentesis. The cause of sepsis after amniocentesis is still unknown. We provided the possibility of the causation of the E. coli infection associated with the previous intra-abdominal procedure, but it needs more evidence to prove it.

Obturator hematoma after the transobturator suburethral tape procedure.

BACKGROUND: Herein we report a case of obturator hematoma formation which occurred during our 25th case involving the transobturator suburethral tape procedure with the inside-to-out approach. CASE: A case of an obturator hematoma forming after a transobturator suburethral tape procedure is reported. The patient did not become infected and was managed conservatively. The hematoma spontaneously resorbed after 11 weeks and the patient was cured of her incontinence. CONCLUSION: The transobturator approach for suburethral tape placement may be associated with vascular complications.

The detection of ureteral injuries after hysterectomy.

STUDY OBJECTIVE: To identify the incidence and outcomes of ureteral injuries in patients undergoing hysterectomy, and to evaluate the effect of intraoperative cystoscopy and early postoperative ureteral jet ultrasonography. DESIGN: Retrospective comparative study (Canadian Task Force classification II-2). SETTING: Tertiary medical center. PATIENTS: Fifteen patients who experienced ureteral injuries while undergoing hysterectomy out of 4950 total patients during a 6-year period. INTERVENTIONS: All patients underwent hysterectomy, and intraoperative cystoscopy or early postoperative ureteral jet ultrasonography were used to evaluate ureteral integrity. MEASUREMENTS AND MAIN RESULTS: The incidence of ureteral injury recognized after hysterectomy was 0.32%, and all ureteral injuries occurred during laparoscopic hysterectomy. The initial detection of ureteral injury resulted from intraoperative cystoscopy in five patients, early postoperative ureteral jet ultrasonography in two patients, and signs and symptoms in eight patients. The patients whose injuries were detected by either intraoperative cystoscopy or early postoperative ureteral jet ultrasonography were diagnosed earlier (1.7 and 19.9 postoperative days, respectively; p<.01) and tended toward more conservative treatment (p=.119; OR=10; 95% CI 0.78-128.78) than those who were diagnosed based on signs and symptoms alone. CONCLUSIONS: Use of intraoperative cystoscopy or early postoperative ureteral jet ultrasonography leads to earlier diagnosis of posthysterectomy ureteral injury, thereby allowing for more conservative treatment.

Are there any predictors for failed Burch colposuspension?

OBJECTIVE: To investigate early postoperative complications of Burch colposuspension and the risk factors that may be associated with failure. METHODS: We retrospectively reviewed the chart records of all patients who underwent Burch colposuspension from October 1997 to September 2002. Indications for colposuspension included urodynamic stress incontinence with bladder neck hypermobility and adequate vaginal capacity. The occurrence of early postoperative complications related to the operation was documented. Subjective failure of the operation was defined as patient dissatisfaction and/or persistent urinary leakage. Chi-square test or Fisher's exact test was used to determine the association among risk factors, early postoperative complications, and the failure rate of Burch colposuspension. RESULTS: A total of 258 patients (92.5%) reported satisfaction with the surgical outcome. The age, parity, menopausal status, use of hormone replacement therapy, previous hysterectomy, and occurrence of early postoperative complications did not significantly influence the failure rate. CONCLUSION: Our results demonstrate that Burch colposuspension is an effective and, according to our patients, highly satisfactory procedure for the treatment of urodynamic stress incontinence.

Relationship between sex hormone-binding globulin and pregnancy outcome in women undergoing controlled ovarian hyperstimulation for assisted reproduction.

The purpose of this study was to determine whether the changes of sex hormone-binding globulin (SHBG) affect the pregnancy outcome in women undergoing controlled ovarian hyperstimulation (COH) for assisted reproduction. Forty-five infertile women who were undergoing pituitary desensitization and COH for in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) and 19 women with normal menstrual cycles participated in the study. Fasting blood samples of the follicular and luteal phases, including follicular fluid during oocyte retrieval, were obtained for determination of estradiol (E(2)), progesterone (P(4)), testosterone (T), and SHBG concentrations. The SHBG levels increased progressively during the course of COH, but remained constant throughout normal menstrual cycles. A positive correlation existed between E(2) and SHBG levels in both the follicular and luteal phases. The mean plasma SHBG concentration and E(2)/T ratio were significantly higher, while the level of T and the free androgen index were significantly lower, in the luteal phase of women who conceived than in those who did not conceive following COH. The changes of follicular fluid SHBG level and E(2)/T ratio were similar to those in plasma. We concluded, therefore, that increases in SHBG in the follicular and luteal phases may be a reflection of the functional state of ovarian stimulation, and further that such elevations may influence the pregnancy outcome through the modulation of circulating estrogen and androgen balance during down-regulated COH cycles for IVF/ICSI.

Simultaneous increases of leptin and gonadotropin-releasing hormone following exogenous estrogen administration in women with normally menstrual cycle.

The aim of this study was to investigate whether administration of exogenous estrogen affects the changes of leptin and GnRH levels in women with normal menstrual cycle. A total of 18 women received a bolus intravenous injection of 20 mg conjugated estrogen (premarin group) at 0800 during the fifth day of menstrual cycle, while another 18 women were administered 20 mL of normal saline as the control group. Fasting blood samples were collected at 0, 4, 8, 24, 28, 32, 48, 56, 72 and 96 hours after injection for analyses of leptin, GnRH, estrone (E(1)), estradiol (E(2)), LH and FSH. Both the mean plasma levels of E(1) and E(2) were significantly increased from 4 hours and significantly sustained elevated levels up to 72 hours after injection of premarin. Simultaneous significant increases of leptin and GnRH levels were observed at 28, 32 and 48 hours after injection, while the controls remained constant. The mean LH and FSH levels were initially suppressed and then significantly increased at 56 and 72 hours after premarin administration. Leptin appears to be involved in the regulation of positive feedback mechanism of estrogen by conveyance of metabolic signal to affect the release of GnRH in hypothalamus, while its participation in the modulation of negative feedback remains unknown.

Prevalence of lower urinary tract symptoms during pregnancy in Taiwan.

BACKGROUND AND PURPOSE: Women often complain of symptoms related to urination during their pregnancy, but data are limited on the clinical profile and lower urinary tract symptoms (LUTS) of pregnant women in Taiwan. This study assessed the prevalence and predisposing factors of LUTS in Taiwanese women during pregnancy. METHODS: A cross-sectional survey was designed to collect data on the prevalence of LUTS during pregnancy. Women attending the antenatal clinic of a medical center in central Taiwan were recruited and asked to complete a LUTS questionnaire including 12 questions on symptoms related to urination. RESULTS: 799 normal pregnant women were included in this study. The most common LUTS were nocturia (60.2%) and stress urinary incontinence (SUI; 46.1%), followed by urgency (34.1%), frequency (27.8%), incomplete emptying (26.2%), a bearing-down sensation (23.8%), and voiding difficulty (12.6%). The prevalence of nocturia, SUI, urgency, and frequency generally increased as gestational age advanced. There was a significantly higher prevalence of SUI in multiparous women than in nulliparous women; however, the prevalence of urgency, frequency, incomplete emptying, bearing-down sensation, and straining was significantly higher in nulliparous women than in multiparous women. High parity, high body weight before pregnancy and advanced gestational age were the predisposing factors of SUI during pregnancy. Only 6.5% of the pregnant women studied complained that SUI caused a social or hygienic problem based on the International Continence Society (ICS) criteria. CONCLUSIONS: This study provides a profile of LUTS in Taiwanese women during pregnancy. Nocturia was the most common lower urinary tract symptom. Nocturia, SUI, urgency, and frequency increased as gestational age advanced. Parity was a predisposing factor for LUTS during pregnancy, with multiparous women experiencing significantly more SUI while nulliparous women had higher prevalence of other LUTS.

Is an indwelling catheter necessary for bladder drainage after modified Burch colposuspension?

Catheterization is considered to be a mandatory procedure for adequate bladder drainage following an anti-incontinence operation until the recovery of normal voiding function occurs. We conducted this prospective study to challenge this practice. A total of 86 patients with genuine stress incontinence who underwent a modified Burch coplosuspension were randomized into two groups based on the day of operation. The study group consisted of 42 patients who had the transurethral Foley catheter removed postoperatively the next morning (Group A). The control group was composed of 43 patients who had the transurethral indwelling catheter left in place until the fifth postoperative day (Group B). The percentages of immediate voiding difficulties in Groups A and B were 7.1% and 0%, respectively ( P>0.05). The postoperative urinary tract infection rates of Groups A and B were 16.6% and 23.3%, respectively ( P>0.05). The success rates of our patients were not compromised after our modified operative procedures (78.6% with dry results and 19.0% with improved symptoms in Group A vs. 74.4% with dry results and 20.9% with improved symptoms in Group B, P >0.05). Our results imply that it is not necessary that an indwelling catheter, for bladder drainage, be left in place until the fifth postoperative day to prevent immediate voiding difficulties.