Ovulation stimulation after treatment for a molar pregnancy for or against?

The case of a 29-year-old patient who underwent invitro fertilization due to secondary sterility, after a spontaneous but molar pregnancy, is described. Afterwards there was no spontaneous conception for five years. With the couple's consent, we decided to perform in vitro fertilization, i.e., ovulation induction and the ICSI (intracytoplasmic sperm injection) method.

Different medicaments in fetus maturation--corticosteroid usage.

OBJECTIVE: The object of work is pointing out the significance of improvement highly risk pregnancies by applying artificial fetal lungs maturation in relation to expected outcomes without adequate therapy. METHODS: We analyzed fetal lung maturation by using lecithin and sphingomyelin ratio in embryo fluid received by foam test. We examined successfulness of artificial fetal lungs maturation by applying corticosteroids to the embryo in a group of patients with serious form of growth retardation (group A), then to the mother (group B) and by inducing partial mild form of asphyxia with oxytocin infusion (group C). RESULTS: The success of the method is shown by the success of finished pregnancies. We followed the difference between expected and actual term of delivery. CONCLUSION: Artificial fetal lungs maturation by applying fetal corticosteroids efficiently increases the creation of lecithin and sphingomyelin and enables life of neonate even in period up to 30th week of gestation.

Cerebrovascular diseases during pregnancy and puerperium.

OBJECTIVE: We have studied 37 women with all forms of cerebrovascular diseases. Our aim was to study the etiology, clinical manifestations and prognosis of such conditions during pregnancy or puerperium. METHODS: We analyzed the most common causes of cerebrovascular diseases during the given period. RESULTS: The most common causes of cerebrovascular diseases during pregnancy or puerperium are hematological coagulation disorders, cardio embolism and eclampsia, whereas other causes ara rarer. CONCLUSIONS: The incidence of cerebrovascular diseases during pregnancy or puerperium is 11%. Cerebrovascular diseases are more frequent in puerperium than during pregnancy, being 1.8:1. Etiology remains undetermined in 35% of the cases.

Intramuscular fetal corticosteroid therapy short-term effect on maternal-fetal Doppler velocimetry.

AIM: The aim of the study was to assess the short-term effects of intramuscular (IM) corticosteroid therapy (CST) on fetoplacental and fetal circulation in high-risk pregnancies of preterm labor. METHOD: We evaluated the effect of IM fetal single-dose dexamethasone (4 mg/kg) on fetoplacental and fetal circulation two hours before and 0-4 hours after CST in 38 fetuses after the 32nd week of gestation. RESULT: Changes in the umbilical artery (UA) resistance index (RI) after fetal CST (AU RI1) were significantly correlated with gestational age after the 32nd week at recording r = 0.354; p < 0.05. There was a statistically significant difference of RI in the descending aorta (DAo) before and after therapy; p < 0.001 (-0.04-0.01), 95% confidence interval (CI) for differences. CONCLUSION: Short-time effects after fetal IM CST include an increased index resistance in DAO as well as decreased RI in UA after the 32nd week.

Two cases of immature teratoma with positive reproductive outcomes.

The peak incidence of immature teratoma is in the early reproductive period of a woman's life and fertility preservation is an inevitable topic when discussing treatment options. We present two cases of immature teratoma with positive reproductive outcome. Our experience supports the standpoint that surgery alone is curative in most cases, irrespective of tumor grade. Bearing this in mind, the long-term effect of chemotherapy on ovarian function can be avoided and fertility, an important factor in the overall quality of life, can be preserved.

Uterine sarcoma diagnosed during colon surgery--a complete precise diagnosis.

Uterine sarcomas are very rare tumors with the greatest malignant potential of all uterine tumors, and they differ significantly from endometrial carcinoma by their specific course, propagation and prognosis. A 54-year-old patient, after three vaginal deliveries and negative personal and family history, as well as regular cycles, presented with secondary problems related to occasional constipation with sporadic diarrhea and bloody stools. Colonoscopy revealed a colon tumor.

Cervical and duodenal polyps and their malignant alterations--case report.

During routine examination of a 32-year-old patient, a cervical polyp was found and CIN III was confirmed by biopsy. After performing colposcopy, biopsy and establishing CIN III as well as performing gastroscopy where a duodenal polyp was found, thorough diagnostic exams and therapy were carried out. Complete duodenal resection and conization were performed. The medical board decided that neither further radiation nor chemotherapy was needed.

Hysterectomy in a malignant molar pregnancy and a healthy baby.

Hydatidiform mole is a degenerative chorion disturbance of unknown etiology. It is characterized by a permanent whitish enlargement of the chorionic villi with a grape-like appearance and poor vascularization. The symptoms of a molar pregnancy are nausea and vomiting which are present in more than one-third of the patients. Other symptoms include an enlarged uterus and vaginal bleeding. Our patient was a 19-year-old primipara with a twin pregnancy where one embryo was molar. Diagnosis was confirmed by beta-hCG levels.

Cervical carcinoma and pregnancy in a young primipara.

Cervical carcinoma is the fourth most common malignant disease in women, after breast, lung and colon cancer. It is present in two-thirds of all malignant diseases of the genital tract. Although in most of Europe patients are subjected to regular health screening, diagnoses of severe life-threatening alterations are often made when they are already in late stages.

Breast cancer and borderline ovarian carcinoma in young patients--case report.

Cystosarcoma phyloides is a breast cancer with deterrent features because of its size and fast growth. Borderline ovarian tumors comprise 10% to 15% of all epithelial tumors of the ovary. Regardless of the tumor type (serous, mucinous, clear cell, Brenner, mixed) they can be benign, borderline or malignant. There is a close physiological relation between the breasts and genital tract. By routine examination of girls in secondary schools, suspected ultrasonography findings were found in two out of 180 examinees.

New approach of the treatment of von Willebrand's disease during pregnancy.

AIM: The aim of the study was to analyze the effectiveness of the application of DDAVP (desmopressin) and Hemate P with cryoprecipitate pre- and postpartum in patients with von Willebrand disease. METHODS: We monitored 32 patients with von Willebrand disease during the study period 1993-2003. DDAVP was applied in the 36th/37th week of gestation and cryoprecipitate and fresh frozen plasma were applied 1 day before and 3 days after delivery. DDAVP treatment continued for 4 weeks. Factor VIII (Hemate P) at the day of delivery RESULTS: No complications occurred in the studied population. CONCLUSION: Precipitation of DDAVP, Hemate P, and cryoprecipitate may help in the treatment of pregnant women with von Willebrand disease.

The significance of C-reactive protein in the diagnosis of fetal tachycardia and therapy of chorioamnionitis.

BACKGROUND: [corrected] Pregnant woman with fetal tachycardia have a risk of chorioamnionitis as cause of tachycardia. Different studies have supported or refuted the use of C-reactive protein (CRP) to diagnose chorioamnionitis. The goal of this study was to evaluate serial serum CRP levels for diagnosis of chorioamnionitis. METHODS: The study included 60 woman with chorioamnionitis confirmed after measuring the levels of CRP. Patients were monitored by CRP determination, white blood cell (WBC) count, maternal temperature, maternal and fetal heart rate. RESULTS: Elevated CRP level was present in 93.33% of cases. Fetal tachycardia was present in 91,67 cases, all associated with elevated CRP level. Increased WBC count was present in 63.33%. A statistically significant difference was found in the level of CRP in pregnant women with increased WBC count compared with those without (p < 0.01). CONCLUSION: Elevated C-reactive protein levels were more sensitive than other standard laboratory or clinical tests in predicting chorioamnionitis. Also, recent reports indicate that serial CRP levels during this interval may be useful for monitoring antibiotic treatment.

Epidural anesthesia from an obstetrics point of view.

With the acceptance of new ideas in medicine and modernization of life styles, it is necessary to conduct delivery as a beautiful act of giving life with the least amount of pain possible using epidural anesthesia. Thus, not only is the physical aspect of delivery improved but also benefits from anesthesia are seen in obstetrics. To conduct epidural anesthesia successfully during delivery, certain conditions are necessary regarding the fetus and mother. Such conditions include an adequate Bishop score, fetal head presentation, the presence of amnion, adequate term of delivery and Doppler flows that do not compromise vaginal delivery. Primiparas in term pregnancies without pathological conditions related to mother or fetus were examined. The duration of delivery was observed in a group of primiparas that did not receive epidural anesthesia (group A) and a group of primiparas that received epidural anesthesia (group B). The study lasted one year.

Ultrasound and surgery for gall bladder carcinoma during pregnancy.

Gall bladder carcinoma is the most common carcinoma of the biliary tract and the fifth most common malignant tumor of the gastrointestinal tract. The patients usually have no symptoms at all or non-specific symptoms are present. The therapy for gall bladder carcinoma is complete removal. Unfortunately, in 80% of the cases the survival period is less than one year.

The significance of Doppler flow in early detection of uterine sarcoma in older primigravida pregnancies.

During a four-year period we analyzed the significance, sensitivity and sensibility of myoma Doppler flow during pregnancy in relation to the course and outcome of the pregnancy and to later histopathological findings. By following 36 older primigravidas with determined myomas, we observed the course of the pregnancies in all trimesters and analyzed myoma Doppler flow. In conditions where the resistance index showed the possibility of uterine sarcoma, the pregnancy was ended by surgery; not only was myomectomy performed but also complete uterine hysterectomy with the previous consent of the patient. Doppler flow was accepted as the authoritative parameter for non-invasive detection of a malignant process. Considering the obstetrical findings, other patients were delivered vaginally or operatively, but after puerperium they were subjected to control examinations and myomectomy because Doppler flow findings did not show any indications of sarcoma. By histopathological analysis, we received benign results in 31 cases, while in four cases where we decided on hysterectomy and surgical delivery, we received malignant results, i.e. leiomyosarcoma. In four cases of performed hysterectomy immediately after cesarean section, the resistance index (RI) of revascularization within the myoma was in the range between RI 0.30 +/- 0.02. Flows within the uterine artery were 0.54 +/- 0.03.

The significance of Doppler flow and anamnesis in the diagnosis of fallopian tube cancer.

By following Doppler flow of the small pelvis with laboratory parameters and anamnesis data, we obtained more precise diagnostic possibilities for timely discovering of malignant processes in adnexal region and fallopian tube. By following patients who had come for routine check ups, prompted by a positive family history for malignant processes, resistant indexes of blood vessels in the adnexal region and vascularisation pattern were determined. Out of 78 women observed in the postmenopausal period with diagnosed adnexal masses, we found two cases of fallopian tube cancer. Resistance indexes ranged between 0.20 and 0.30 during a one-month period. Hystopathological analysis pointed to fallopian tube cancer. Besides Doppler flow, only patient history of amber extract use was significant. By CA 125 marker analysis, we found an increased value but not signifiant enough. Both patients had a positive family history according to the female hereditary line.

Bacterial infections--the cause of preterm delivery.

Within diagnostic procedures protocols in preterm delivery, the objective of the study was to examine bacterial causes of preterm deliveries in relation to term deliveries. The study included 106 patients delivered before term (24 to 37 weeks of gestation) and 126 patients with term delivery after 37 to 42 weeks of gestation. Bacterial analysis included hospital material: cervix smear in patients before the delivery and protective and functional fetal elements.

Artificial fetal lung maturation--prevention of antenatal complications in premature deliveries.

Keeping in mind the frequency of preterm deliveries as well as the morbidity and mortality of the newborn population, many ways of bringing about faster maturation of the fetus have been. Today, we can say that after the 24th week of gestation, when the pneumocites time 2 are anatomically formatted, medical treatment of the fetus for maturation not only of the lungs but all the vulnerable organs is available. By stimulating the pneumocites to make surfactant and sphingomyeline and phosphatidilinositol and phosphatidilglycerol, we can reduce respiratory distress syndrome. Moreover, the frequency of intracranial haemorage is lowered. We have performed many studies with all of their positive and negative effects, including: use of corticosteroids, thyroxine, aminophilline, surfactant, inositole and beta adrenergic agonist.

Perinatal outcome in multiple pregnancies--spontaneous gestation versus.

The purpose of this investigation was to determine if twin pregnancies induced by in vitro fertilization (IVF) are under greater risk of negative perinatal outcome than "spontaneous" twin pregnancies. The study included 240 patients with gemellar pregnancies. Each patient with a gemellar IVF pregnancy (120) was assigned to a pregnant woman with appropriate age, education and parity from the "spontaneous" group as a control. Pregnancies were followed clinically, with laboratory analyses and ultrasonography.

Pancreatic tumor in a pregnant woman: a rare case report.

We have analyzed a case of pancreatic carcinoma in a pregnant woman, 37 years old, in the second trimester of the pregnancy. She had a positive family history of digestive tract carcinoma. The delivery ended surgically and hysterectomy was performed at the same time.