ABSTRACT
BACKGROUND: Heterotopic pregnancy is a rare but life-threatening situation. This is a situation where a woman has one or more intrauterine pregnancies and at least one ectopic pregnancy. CASE DESCRIPTION: Heterotopic pregnancy was discovered in a 37-year-old woman during a routine ultrasound check. This pregnancy occurred after intrauterine insemination with ovulation induction. CONCLUSION: Heterotopic pregnancies require early diagnosis and treatment. Physicians should be extra vigilant when a woman has become pregnant after using assisted reproductive techniques, because these techniques increase the probability of heterotopic pregnancy. The symptoms of such pregnancies are similar to the symptoms of extrauterine gravidity. However, confirmed intrauterine gravidity does not exclude the existence of extrauterine gravidity. The diagnosis is based entirely on the transvaginal ultrasound. The intact intrauterine gravidity limits treatment options. Tubectomy is the treatment of first choice, but embryo aspiration could also be a safe method in certain circumstances.
Subject(s)
Fertilization in Vitro , Ovulation Induction , Pregnancy, Heterotopic , Ultrasonography, Prenatal/methods , Adult , Early Diagnosis , Early Medical Intervention , Female , Fertilization in Vitro/adverse effects , Fertilization in Vitro/methods , Humans , Ovulation Induction/adverse effects , Ovulation Induction/methods , Pregnancy , Pregnancy, Heterotopic/diagnosis , Pregnancy, Heterotopic/etiology , Salpingectomy/methodsABSTRACT
BACKGROUND: When two successive pregnancies end in intra-uterine fetal death (IUFD), the question of whether it is coincidental or if there is an underlying abnormality arises. Although diagnostic investigations into the underlying cause are not always carried out after IUFD, they are recommended by the professional body. CASE DESCRIPTION: A 28-year-old female attended our gynaecology outpatient clinic for a second opinion following two intra-uterine fetal deaths. Her own treating physician was of the opinion that there was no connection between the two IUFDs. After a multidisciplinary evaluation, the phenotype fetal akinesia deformation sequence (FADS) was diagnosed in both cases. This is a rare, clinically and aetiologically heterogeneous group of disorders. Thereafter the patient and her husband were offered specific pre-conception counseling. CONCLUSION: Every IUFD justifies systemic and multidisciplinary investigation to determine any underlying aetiology such as FADS. This may contribute to better pre-conception advice and prenatal individualised diagnostics in a subsequent pregnancy.
Subject(s)
Arthrogryposis/diagnosis , Fetal Death/etiology , Adult , Arthrogryposis/complications , Female , Fetal Death/diagnosis , Fetal Movement/physiology , Gestational Age , Humans , PregnancyABSTRACT
BACKGROUND: Patients with polycystic ovary syndrome (PCOS) are at risk of arterial disease. We examined the risk of (non)fatal coronary heart disease (CHD) or stroke in patients with PCOS and ovulatory women without PCOS, and assessed whether obesity might explain a higher risk of CHD or stroke. METHODS: We performed a systematic review and meta-analysis of controlled observational studies. Four definitions of PCOS were considered: World Health Organization type II anovulation, National Institutes of Health criteria, Rotterdam consensus and Androgen-excess criteria. Obesity was defined as BMI > 30 kg/m(2) and/or waist circumference >88 cm. Study quality was assessed using the Newcastle-Ottawa Scale. Primary outcome was fatal/non-fatal CHD or stroke. Definitions of CHD and stroke were based on criteria used by the various authors. The effect measure was the pooled relative risk in a random effects model. Risk ratios and rate ratios were combined here. RESULTS: After identifying 1340 articles, 5 follow-up studies published between 2000 and 2008 were included. The studies showed heterogeneity in design, definitions and quality. In a random effects model the relative risk for CHD or stroke were 2.02 comparing women with PCOS to women without PCOS (95% confidence interval 1.47, 2.76). Pooling the two studies with risk estimates adjusted for BMI showed a relative risk of 1.55 (1.27, 1.89). CONCLUSIONS: This meta-analysis showed a 2-fold risk of arterial disease for patients with PCOS relative to women without PCOS. BMI adjustment did not affect this finding, suggesting the increased risk for cardiovascular events in PCOS is not completely related to a higher BMI in patients with PCOS.
