ABSTRACT
Endometrial ablation can be performed using a variety of techniques, including resectoscopic or non-resectoscopic approaches. In this study, we compared 2 resectoscopic endometrial ablation techniques. The first technique was rollerball coagulation followed by endometrectomy (type A; n = 103), and the second was the reverse (type B; n = 107). Besides excessive bleeding in 4 cases, the procedures were uneventful in both groups of patients. We did not encounter uterine perforation or cervical laceration. Satisfaction rates were 97% and 99% with an overall hysterectomy rate of 2.9%. These results compared favorably with those in the literature. The results of our study show that hysteroscopic endometrectomy is effective with few associated complications.
Subject(s)
Endometrial Ablation Techniques , Menorrhagia , Female , Humans , Pregnancy , Menorrhagia/surgery , Endometrial Ablation Techniques/methods , Hysterectomy , Hysteroscopy/methods , Endometrium , Treatment OutcomeABSTRACT
The melatonin system in preeclamptic pregnancies has been largely overlooked, especially in the placenta. We have previously documented melatonin production and expression of its receptors in normal human placentas. In addition, we and others have shown a beneficial role of melatonin in placental and fetal functions. In line with this, decreased maternal blood levels of melatonin are found in preeclamptic compared with normotensive pregnancies. However, melatonin production and expression of its receptors in preeclamptic compared with normotensive pregnancy placentas has never been examined. This study compares (i) melatonin-synthesizing enzyme expression and activity, (ii) melatonin and serotonin, melatonin's immediate precursor, levels and (iii) expression of MT1 and MT2 melatonin receptors in placentas from preeclamptic and normotensive pregnancies. Protein and mRNA expression of aralkylamine N-acetyltransferase (AANAT) and hydroxyindole O-methyltransferase (HIOMT), the melatonin-synthesizing enzymes, as well as MT1 and MT2 receptors were determined by RT-qPCR and Western blot, respectively. The activities of melatonin-synthesizing enzymes were assessed by radiometric assays while melatonin levels were determined by LC-MS/MS. There is a significant inhibition of AANAT, melatonin's rate-limiting enzyme, expression and activity in preeclamptic placentas, correlating with decreased melatonin levels. Likewise, MT1 and MT2 expression is significantly reduced in preeclamptic compared with normotensive pregnancy placentas. We propose that reduced maternal plasma melatonin levels may be an early diagnostic tool to identify pregnancies complicated by preeclampsia. This study indicates a clinical utility of melatonin as a potential treatment for preeclampsia in women where reduced maternal plasma levels have been identified.
Subject(s)
Melatonin/analysis , Placenta/chemistry , Pre-Eclampsia/metabolism , Receptor, Melatonin, MT1/analysis , Acetylserotonin O-Methyltransferase/analysis , Acetylserotonin O-Methyltransferase/genetics , Adult , Arylalkylamine N-Acetyltransferase/analysis , Arylalkylamine N-Acetyltransferase/genetics , Blotting, Western , Case-Control Studies , Chromatography, Liquid , Down-Regulation , Female , Gestational Age , Humans , Pre-Eclampsia/genetics , Pregnancy , RNA, Messenger/analysis , Radiometry , Receptor, Melatonin, MT1/genetics , Receptor, Melatonin, MT2 , Reverse Transcriptase Polymerase Chain Reaction , Serotonin/analysis , Tandem Mass Spectrometry , Young AdultABSTRACT
Uterine blood supply is a critical issue for fetal well-being, since it carries all the nutrients, including O2, required for fetal growth and gets rid of several fetal waste products. During pregnancy, uterine blood flow increases by almost 20 times and this is permitted by marked remodeling of the vessel wall. In the rat, uterine arterial remodeling takes place in the last 7-8 days of gestation (over 22) and is reversible in the postpartum period upon a similar time frame. It was also described as both hypertrophy and hyperplasia of all the constituents of the vascular wall. Several hypotheses have been proposed to explain such a phenomenon, including the driving role not only of sexual steroid hormones, progesterone and estrogens, but also of trophic factors of fetal origin. We have shown that alterations of the renin-angiotensin-aldosterone system, by manipulating sodium intake in the rats, reduced the pregnancy-induced remodeling of uterine arteries. These maneuvres resulted in the birth of pups that had characteristics of intrauterine growth restriction or in the development in the mother of "experimental" gestational hypertension, depending on, respectively, restriction or increased of sodium intake.
