Subsequent placenta accreta after previous mifepristone-induced abortion: A case report.

BACKGROUND: Mifepristone-induced abortion (MIA) has been used worldwide to terminate pregnancies. However, the association between placenta accrete (PA) and MIA has seldom been reported. CASE SUMMARY: A 26-year-old pregnant woman presented with painless vaginal bleeding at 35 wk of gestation. She had a medical abortion (mifepristone followed by misoprostol) 1 year ago at the sixth week of gestation. Her personal history for previous surgery was negative. Abdominal ultrasonography showed a normal foetus with complete placenta previa. The foetal membrane ruptured with massive vaginal bleeding and severe abdominal pain. An emergency Caesarean section was performed, and the newborn was delivered. The placenta failed to expel and manual extraction was carried out. A large defect was noted in the uterine fundus and repair of the uterine rupture was conducted immediately. The postoperative pathology report showed placenta accreta. CONCLUSION: The evidence suggests a possible etiologic role of MIA in PA, as the incidence of PA after MIA is much higher than general population. Millions of pregnancies are complicated by PA each year, some of which result in fatality. To prevent subsequent placental complications after MIA, hormonal supplementation might be a promising therapeutic options. However, further studies are needed to identify the high-risk factors and to confirm the effectiveness of estrogen supplement therapy.

Expectant management of heterotopic cesarean scar pregnancy.

BACKGROUND: Heterotopic cesarean scar pregnancy (HCSP) is a very rare but life-threatening entity and there is no optimal management strategy. Here we report a successfully managed case of HCSP with expectant treatment in a tertiary referral hospital. METHODS: A woman with HCSP after in vitro fertilization-embryo transfer opted for expectant treatment after five days of mild bleeding and ultrasound demonstrated cardiac activity disappearance of the scar pregnancy at 8(+4) weeks of gestation. RESULTS: The patient had mild to moderate bleeding during close monitoring. Three days later, speculum examination revealed the gestational mass was partly protruding at the os of the cervix and it was removed with forceps without massive hemorrhage. A healthy male baby was delivered by cesarean section at gestational age of 36(+4) weeks. CONCLUSIONS: The expectant method might be an alternative option for a HCSP with loss of cardiac activity of the scar pregnancy, when applied under supportive management and with available emergency surgery facilities.

[Expression and significance of chemokine CXC receptor 3, 4 and their ligands at the early pregnancy decidua and villi].

OBJECTIVE: To explore the expression and significance of chemokine CXC receptor (CXCR) 3 and CXCR4 and their ligands (CXCL) at the early pregnancy decidua and villi. METHODS: Decidual mononuclear cells were isolated from the normal decidua of 5 - 8 weeks pregnant women by lymphocyte separation medium in vitro. CD(56)(+) natural killer (NK) cells were purified by dynabeads cell sorter kit. Purity and phenotype of CD(56)(+) decidua NK cells were analyzed by fluorescence-activated cell sorter (FACS). Gene expression of CXCR3 and CXCR4 in decidua NK cells and CXCL9, CXCL10 and CXCL12 in early pregnancy decidua and villi was assessed by RT-PCR. Protein expression of CXCL9, CXCL10 in normal endometrium and early pregnancy decidua was characterized and quantified by streptavidin-biotin peroxidase chain reaction (SP) immunohistochemistry and computered image analysis system. Correlations between the gray degree of CXCL9 and CXCL10 and the number of CD(56)(+)NK cells in upper tissue were analyzed by Spearman's correlation coefficient rank test. RESULTS: The phenotype of 98.7% decidua NK cells was CD(56)(bright). The genes of CXCR3 and CXCR4 were expressed in decidua NK cells and that of CXCL9 and CXCL10 were expressed in early pregnancy decidua and CXCL12 in early pregnancy villi. CXCL9 and CXCL10 were expressed in the cytoplasm of surface epithelia, glandular epithelia and stromal cells of early pregnancy decidua and were not expressed in villi by immunohistochemistry. The gray degree of CXCL9 and CXCL10 in the secretory phase endometrium (56 +/- 43, 59 +/- 47) was stronger than that in the proliferative phase (16 +/- 18, 8 +/- 14, P < 0.05) and reached the highest (143 +/- 35, 158 +/- 29, P < 0.05) in the early pregnancy decidua. The number of CD(56)(+) NK cell in the secretory phase endometrium (60 +/- 20) was more than that in the proliferative phase endometrium (23 +/- 4, P < 0.05) and was the most in the early pregnancy decidua (114 +/- 15, P < 0.05). The gray degree of CXCL9 in upper tissue had a positive correlation with the number of CD(56)(+) cells (r = 0.88, P < 0.05) and that of CXCL10 had a similar pattern to CXCL9 (r = 0.86, P < 0.05). CONCLUSION: The interactions between CXCL9, CXCL10 and CXCL12 expressed in decidua and villi and CXCR3, CXCR4 expressed in CD(56)(+) decidua NK cells may influence the CD(56)(+)NK cell recruitment at the maternal-fetal interface.

[Effect of estradiol benzoate on the heat shock protein 70, 90 expressions in endometrial glandular epithelial cell].

OBJECTIVE: To explore the effect of estradiol benzoate on the expressions of heat shock protein (HSP) 70, 90 in endometrial glandular epithelial cell. METHODS: Normal endometrial glandular epithelial cells were isolated, and cultured by enzymolysis method and identified by electron microscopy and immunohistochemical analysis. The normal endometrial glandular epithelial cells were treated with culture medium only, estradiol benzoate (10(-9), 10(-8), 10(-7) or 10(-6) mol/L), estradiol benzoate (10(-9), 10(-8), 10(-7) or 10(-6) mol/L) and antiestrogen ICI 182780 (fulvestrant, faslodex, 1 micromol/L) and ICI 182780 only for 6, 12, 18, 24 hours respectively. The dose- and time-related effect of estradiol benzoate and ICI 182780 on the cell growth was measured by mononuclear cell direct cytotoxicity assay (methyl thiazolyl tetrazolium assay), and that on the expression of HSP70 and HSP90 in normal endometrial glandular epithelial cell in vitro was measured by immunohistochemical analysis and computerized image analysis system. RESULTS: Estradiol benzoate stimulated cell growth in a time- and dose-dependent manner and the effect was attenuated by the antiestrogen ICI 182780. The average cell growth rates of 10(-9), 10(-8), 10(-7), 10(-6) mol/L estradiol benzoate for 24 hours were (170 +/- 9)%, (207 +/- 11)%, (231 +/- 12)%, (257 +/- 10)%, which were significantly higher than those of 6 hours [(117 +/- 13)%, (129 +/- 10)%, (146 +/- 10)%, (176 +/- 6)%, P < 0.05] and that those estradiol + ICI 182780 for 24 hours [(137 +/- 4)%, (145 +/- 10)%, (151 +/- 9)%, (167 +/- 3)%, P < 0.05]. Estradiol benzoate treatment resulted in a time- and dose-dependent increase of the expression of HSP90 and decrease of HSP70 in human endometrial glandular epithelial cell. The expression of HSP90 in 10(-9), 10(-8), 10(-7), 10(-6) mol/L estradiol benzoate for 24 hours were (64.8 +/- 10.7)%, (75.9 +/- 12.6)%, (80.4 +/- 8.2)%, (83.2 +/- 7.6)%, which were significantly higher than that of the control [(28.0 +/- 3.3)%, (29.0 +/- 5.6)%, (29.0 +/- 5.0)%, (30.0 +/- 6.4)%, P < 0.05] and that of estradiol benzoate + ICI 182780 for 24 hours [(28.2 +/- 2.1)%, (29.7 +/- 3.2)%, (35.0 +/- 4.7)%, (34.7 +/- 6.5)%, P < 0.05]. The expression of HSP70 in 10(-9), 10(-8), 10(-7), 10(-6) mol/L estradiol benzoate for 24 hours were (38.4 +/- 5.7)%, (35.3 +/- 4.9)%, (32.5 +/- 3.1)%, (25.3 +/- 6.2)%, which were significantly lower than that of the control. The estradiol benzoate-induced effects on HSP70 levels were not attenuated by the antiestrogen ICI 182780. CONCLUSIONS: The effects of estradiol benzoate on the cell growth and HSP90 expression are estrogen receptor-dependent and the expression of HSP90 may be beneficial to the cell growth. The effect of estradiol on the expression of HSP70 is estrogen receptor-independent and the expression of HSP70 may protect the cell from damage.

[Expression and significance of heat shock protein 70, 90 in endometrial carcinomas].

AIM: To explore the expression and significance of heat shock protein (HSP)70, 90 in endometrial carcinomas. METHODS: Expresssions of HSP70 and HSP90 in 30 normal endometrium, 30 endometrial hyperplasia and 53 endometrial carcinomas were detected by Envision immunohistochemical staining and imaging pattern analyser. RESULTS: Gray Scale value(GS) of HSP70 in endometrial carcinoma being (209.06+/-5.36) GS was obviously higher than that in normal endometrium (145.21+/-4.09)GS, P<0.01 and endometrial hyperplasia(148.59+/-4.23)GS, P<0.01. GS of HSP90 in endometrial carcinoma being (166.98+/-5.71)GS was markedly lower than that in normal endometrium (208.57+/-3.14)GS,P<0.05 and endometrial hyperplasia (249.73+/-4.94)GS, P<0.01. Expression of HSP70 increased with increased pathological grading of tumor P<0.01, whereas HSP90 expression decreased with increased pathological grading P<0.01. Expression of HSP70 in nonendometrioid carcinoma (229.90+/-3.77)GS was higher than in endometrioid carcinoma (198.37+/-3.15)GS,P<0.01 and the expression pattern of HSP90(140.21+/-3.22)was contrary to that of HSP70 (176.59+/-2.79)GS,P<0.01. There was no correlations among expression of HSP70, 90 in endometrial carcinoma and depth invaded into muscular layer, clinical stage and lymph node metastasis. CONCLUSION: Both HSP70 and HSP90 may have relation to the genesis and prognosis of endometrial carcinoma.