Impact of updated international diagnostic criteria for the diagnosis of polycystic ovary syndrome.

Objective: To study whether application of the new 2018 guidelines for the diagnosis of polycystic ovary syndrome (PCOS) would decrease the diagnosis of PCOS. Second, to compare the metabolic profiles of women included and excluded in this new definition. Design: Retrospective cross-sectional chart review. Setting: University-affiliated hospital system. Patients: Women, ages 12-50, with the International Classification of Diseases code "Polycystic Ovary Syndrome" in 2017. Interventions: Application of the new 2018 guidelines for the diagnosis of PCOS. Main Outcome Measures: The primary outcome was the retention of PCOS diagnosis after applying the new 2018 guidelines. Secondary outcomes included the comparison of metabolic risk factors. Analysis was performed using chi-square tests for categorical variables and unpaired t tests for continuous variables, with a P value of <.05 determined to be significant. Results: Of 258 women with PCOS based on Rotterdam criteria, only 195 (76%) met the criteria based on the new 2018 guidelines. Those women who only met Rotterdam criteria (n = 63) had significantly lower body mass index (32.7 vs. 35.8), lower total cholesterol levels (151 vs. 176 mg/dL), lower triglyceride levels (96 vs. 124 mg/dL), lower total (33.2 vs. 52.3 ng/dL) and free testosterone levels (4.7 vs. 8.3), lower antimüllerian hormone levels (3.1 vs. 7.7 ng/mL), and were more likely to be multiparous (50% vs. 29%) than women who met 2018 criteria. Conclusions: Increasing the minimum antral follicle count to ≥20 antral follicles significantly decreases the number of women with the diagnosis of PCOS. Furthermore, the women that meet the new criteria have more health risks for metabolic syndrome than those who only meet the Rotterdam criteria.

Immediate Repair of a Complete Uterine Transection After Motor Vehicle Collision.

BACKGROUND: Traumatic separation of the cervix from the uterine corpus is rare. We describe a case in which this injury was identified and surgically repaired at initial presentation to preserve fertility. CASE: An 18-year-old woman presented with a pelvic crush injury after a motor vehicle accident. Imaging revealed pelvic fractures and bladder rupture. Complete transection of the uterine corpus at the level of the internal os was identified at laparotomy. The gynecology service was consulted and circumferentially reattached the corpus to the cervix. CONCLUSION: Uterine integrity should be confirmed in female patients with pelvic crush injuries who undergo exploratory laparotomy given the unknown extent of intra-abdominal trauma. Immediate surgical correction of uterine transection at the time of injury with restoration of the genital outflow tract is feasible and may allow preservation of fertility.

Pulmonary arterial venous malformations as primary manifestation of gestational trophoblastic neoplasia.

•A unique initial presentation of GTN as pulmonary arteriovenous malformations.•Metastatic GTN presenting as multiple visceral AVMs in the brain, liver, and lungs.•Management of metastatic GTN with brain metastases with induction chemotherapy.

Prewash total motile count is a poor predictor of live birth in intrauterine insemination cycles.

OBJECTIVE: To determine whether there is a relationship between prewash total motile count and live births in couples undergoing IUI. DESIGN: Retrospective review in a single academic center. SETTING: Not applicable. PATIENT(S): Couples with infertility undergoing ovulation induction with IUI between 2010 and 2014. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Live births. RESULT(S): Our cohort included 310 women who underwent 655 IUI cycles with a cumulative live birth rate (LBR) per couple of 20% and an LBR per cycle of 10%. A analysis yielded no correlation between prewash total motile count (TMC) and live births. No live births occurred with TMC <2 million sperms. Age had a significant negative relationship to LBR. A receiver operating characteristic analysis comparing age and live births indicated a significant decline in live births for women >37 years (90% sensitivity, 70% specificity). The LBR per couple was decreased to 7% in women >37 years compared with 25% in women <37 years. CONCLUSION(S): Prewash TMC is a poor predictor of live birth. There were no live births with prewash TMC <2 million sperms. The LBR for women >37 years with IUI was significantly lower than women <37 years.

Adjuvant Use of Rifampin for Refractory Intrahepatic Cholestasis of Pregnancy.

BACKGROUND: Intrahepatic cholestasis of pregnancy is an incompletely understood disease that poses significant fetal risks, including stillbirth. Treatment of intrahepatic cholestasis of pregnancy is aimed at relieving maternal symptoms and improving fetal outcomes. CASE: A 21-year-old gravid woman, 3 para 0111, presented at 27 2/7 weeks of gestation with severe intrahepatic cholestasis of pregnancy. Her clinical course was refractory to first-line therapy with ursodiol, and she was started on rifampin with rapid improvement of symptoms and transaminitis. Despite maternal improvement, she was delivered at 31 weeks of gestation for persistent nonreassuring fetal status. CONCLUSION: Rifampin may be an effective adjunctive therapy for intrahepatic cholestasis of pregnancy refractory to ursodiol alone. Additional research is needed to assess short-term and long-term maternal and newborn outcomes, because fetal deterioration still occurred in spite of maternal improvement.