ABSTRACT
The authors present smooth muscle tumors of uncertain malignant potential (STUMP) diagnosis and surgical management of a spontaneously-ruptured degenerated uterine fibroids. A 48-year-old nulliparous presented with a two-day history of abdominal pain, bloating, constipation, and menorrhagia. Within eight hours, her distress level increased. Computed tomography (CT) scanning of the abdomen showed a large, 31 x 25 cm solid-cystic lesion. An emergency laparotomy was indicated. Surgery revealed approximately 2,000 cc of blood and a 30 cm degenerated uterine fibroid with a fundal rupture, cystic, and solid components extending to the lower pole of the liver. Pathology results noted mild nuclear atypia, six mitoses per ten high-power fields (hpf) and necrosis spread that was not coagulative with a STUMP diagnosis. STUMP presents a problematic group of uterine smooth muscle tumors for any clinician. In addition, STUMP can rarely cause acute complications like a rupture. Therefore, prompt diagnosis and effective management are important.
Subject(s)
Leiomyoma/complications , Uterine Hemorrhage/etiology , Uterine Neoplasms/complications , Acute Disease , Female , Humans , Middle Aged , Rupture, SpontaneousABSTRACT
This study in Turkey evaluated the impact of age-based mandatory single-embryo transfer (SET) legislation with the subsequent increase in frozen-thawed embryo transfer (FT-EU) on pregnancy outcome of in vitro fertilization (IVF) patients. SET, FT-FT and double-embryo transfer were used in 5632 patients after legislation, while traditional IVF and FT-FT approach was used in 6029 patients before legislation. The cumulative pregnancy rate after legislation was slightly lower (38.2%) than before legislation (42.0%) but not significantly so. The single pregnancy rate for SET and traditional IVF were similar between the 2 groups (37.8% versus 28.7%), while multiple pregnancy rates were significantly higher before than after legislation (13.7% versus 0.3%). For FT-ET, the number of cycles was significantly higher after legislation (862 versus 616). SET yielded similar results to traditional IVF. In order to reduce multiple pregnancies without significantly decreasing pregnancy rates, SET might be a successful strategy.
Subject(s)
Fertilization in Vitro/legislation & jurisprudence , Pregnancy Outcome , Pregnancy Rate , Single Embryo Transfer/methods , Age Factors , Female , Humans , Pregnancy , Retrospective Studies , TurkeyABSTRACT
This study in Turkey evaluated the impact of age-based mandatory single-embryo transfer [SET] legislation with the subsequent increase in frozen-thawed embryo transfer [FT-ET] on pregnancy outcome of in vitrofertilization [IVF] patients. SET, FT-ET and double-embryo transfer were used in 5632 patients after legislation, while traditional IVF and FT-ET approach was used in 6029 patients before legislation. The cumulative pregnancy rate after legislation was slightly lower [38.2%] than before legislation [42.0%] but not significantly so. The single pregnancy rate for SET and traditional IVF were similar between the 2 groups [37.8% versus 28.7%], while multiple pregnancy rates were significantly higher before than after legislation [13.7% versus 0.3%]. For FT-ET, the number of cycles was significantly higher after legislation [862 versus 616]. SET yielded similar results to traditional IVF. In order to reduce multiple pregnancies without significantly decreasing pregnancy rates, SET might be a successful strategy
