Conservative management of placenta increta: case report and literature review

Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and beta-hCG assessment. Serum beta-hCG levels were undetectable after 8 weeks of therapy. A scan at 6 months showed complete involution of the uterus. Review of the literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with placenta increta

Predicting the risk of preterm laborby second trimester measurement of maternal alpha-fetoprotein levels and a risk factor scoring system

Preterm labor [delivery after 20 weeks and before 37 weeks of gestation] is the leading cause of prenatal mortality in developed countries. Many women who have preterm labor have abnormally high plasma levels of a-fetoprotein in early pregnancy.This study was designed to evaluate the ability of this biochemical test and a clinical risk factor scoring system to prospectively discriminate pregnancies at high risk for preterm delivery. In nested case control study six-hundred women were studied prospectively from the early second trimester until delivery. There were sixty women in the study group [those with preterm delivery] and sixty women in the control group [those with term delivery]. A plasma level sample was collected during the second trimester, between 17 and 30 week's gestation. Then a-fetoprotein was determined in both groups.The mean AFP level was 196.75 +/- 151.48 IU/mL in the study group and85.98 +/- 55.90 IU/mL in the control group, both of which were statistically significant [p<0.001']. The mean infants age was 33.11 +/- 3.40 weeks in the study group and 38.83 +/- 0.86 weeks in the control group [p<0.001] and mean of birth weight was 1988 +/- 672.33 gr in the study group and 3241.50 +/- 405.98 gr in the control group [p<0.001]. The risk factor scoring system was >10 in 17% of women in the study group and in 8% of women in the control group. The sensitivity, specificity, PPV and NPV of this test was 78%, 65%, 69.10 and 75% respectively. The accuracy of the test, LR+ and LR- were 71%, 2.24 and 0.333 respectively.The combination of measurement of maternal serum AFP in the second trimester associated with a risk factor scoring system provides a more accurate indicator of the risk of preterm delivery and therefore may be of use in targeting prevention strategies

Human papillomavirus genotype as a major determinant of the course of cervical cancer

Introduction: Certain types of human papillomavrus [HPV] are associated with cervical intraepithelial neoplasia [CIN] and squamous cell carcinoma [SCC]. The aim of the observations reported here was to determine whether the prognosis for invasive cancers of the uterine cervix is related to the type of human papillomavirus asociated with the tumor

Material and Methods: Twenty Patients with invasive cervical cancer were prospectively registered from 2000 to 2001. HPV typing was performed by insitu hybridization [ISH] on DNA extracted from frozen, formal in-fixed, paraffin-embedded tumor specimens. The specimens mostly represented classifications SCC Stage 1 and Stage 2 of the International Federation of Gynecology and Obstetrics [Table 1]. HPV- DNA was detected by insitu hybridization, using three different DNA Probes: types 6/11, 16/18 and 31/33/51

Results: HPV DNA was detected in the nuclei of SCC tumor cells in 13[65%] of 20 cases. Of the 13 HPV-DNA positive cases three reacted only with the HPV 31/33/51 probe, two reacted only with the 16/18 probe, three showed strong hybridization for both 31/33/51 and 6/11probes, four showed 6/11 and 16/18 genotypes and one case reacted with 31/33/51,6/11 and 16/18 probes

Conclusion: The prognosis for invasive cancers of the uterine cervix is dependent on the oncogenic potential of the associated HPV type. HPV typing may provide a prognostic indicator for individual patients and is of potential use in defining specific therapies against HPV harboring tumor cells. These findings are consistent with the hypothesis that HPV infection is the primary cause of cervical neoplasia. Furthermore, they support HPV vaccine research to prevent cervical cancer and efforts to develop HPV DNA diagnostic tests