Expression of androgen receptor in human placentas from normal and preeclamptic pregnancies.

OBJECTIVE: To elucidate the expression of androgen receptor (AR) in human placenta from normal and preeclamptic (PE) pregnancies. MATERIALS AND METHODS: This study was performed at the Division of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Academic Medical Center. Forty normal pregnant women at 37.0 +/- 0.89 weeks' gestation and 40 women with preeclampsia at 35.9 +/- 1.33 weeks' gestation were included in this study. Serum testosterone was measured before delivery. Immunochemical methodology was employed in formalin-fixed, paraffin-embedded sections from the placentas of all subjects. AR expression was evaluated in placentas collected from 15 normal pregnant women and 12 PE women. RESULTS: Women with preeclampsia had an elevated serum testosterone level (0.52 +/- 0.13 vs. 0.34 +/- 0.11 ng/mL; p < 0.01). The expression of AR in both placentas was confirmed using immunohistochemistry and was primarily present in the nucleus and cytoplasm of syncytiotrophoblasts and stromal cells. There was a significant increase in AR mRNA expression in PE placentas compared with normal placentas. CONCLUSION: These data suggest that the increased AR expression may alter AR-mediated function on syncytiotrophoblasts and stromal cells in PE placentas, and be a possible mechanism for its association with preeclampsia.

Twin pregnancy with gastroschisis in both twins.

OBJECTIVE: Gastroschisis is a congenital malformation characterized by an abdominal wall defect located laterally to a normal umbilicus. The cause of gastroschisis is unknown, but most authors consider it exogenous. We describe the case of a woman with a twin pregnancy in which both twins had gastroschisis. CASE REPORT: A 17-year-old primiparous female was referred to our institution because of a twin pregnancy, with one twin diagnosed with gastroschisis at 34 weeks of gestation. Unfortunately, gastroschisis was noted in both twins, but no other anomalies were observed under level II sonographic evaluation. The twins were delivered by cesarean section at 36+ weeks of gestation because of preterm labor and breech presentation of one fetus. Both twins presented with a 3-cm abdominal wall defect located to the right side of the umbilicus and a large portion of the bowel protruding that was not covered by membrane. Histopathology of the placenta revealed that the twins were diamniotic monochorionic. Chromosomal analysis of cord blood showed normal karyotype (46,XX) in both newborns. CONCLUSION: The cause of gastroschisis is unknown, although possible exogenous causes have been studied. The diagnosis of gastroschisis in twin pregnancy is always in late gestation. Therefore, maternal serum alpha fetoprotein screening and a detailed prenatal ultrasound evaluation are recommended in multifetal pregnancies.

Postpartum hemoperitoneum due to avulsion of pelvic uterine adhesion band.

A 31-year-old nulliparous woman presented in labor with preterm rupture of membranes at 35 weeks of gestation. The ensuing intrapartum course was uneventful, and she delivered a healthy infant (birth weight, 2,850 g) vaginally. Four hours after delivery, the patient had a syncopal episode due to hypovolemic shock. At laparotomy, a fibrous band between the right fallopian tube and uterus was found to be avulsed and actively bleeding, confirming preoperative findings obtained with multidetector row computed tomographic angiography.