Can we improve the outcome of pregnancies with low serum PAPP-A in the first trimester?

OBJECTIVE: This study aimed to assess the impact of micronized progesterone (VMP4) supplementation on pregnancies with low serum pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) values during first-trimester screening. METHODS: Out of 8933 patients evaluated, 116 pregnant women with low PAPP-A concentrations in their blood and no fetal chromosomal anomalies (CAs) were included. Three groups were formed: group 1 received VMP4 from 11 to 16 weeks (29 women, 25%), group 2 received VMP4 from 11 to 36 weeks (25 women, 21.5%), and group 3 (62 women, 53.5%) served as controls without receiving progesterone. RESULTS: Results indicated that group 3 had higher rates of complications, including miscarriages (16.37%), preterm delivery (17.8%), and fetal developmental abnormalities (19.4%). Birthweight variations were elevated in pregnancies without progesterone, contrasting with lower variations in VMP4 groups. Group 2, receiving VMP4 until 36 weeks, reported the lowest incidence of abortion and preterm birth (PB), along with the highest mean birth weight. CONCLUSIONS: The conclusion suggests that 200 mg per day of VMP4 up to 36 weeks of supplementation led to fewer placental-related complications in women with very low PAPP-A at first-trimester screening (0.399 MoM). By reporting lower rates of miscarriages, PBs, and fetal developmental abnormalities in the micronized progesterone-treated groups, the study suggests a potential reduction in complications.

Maternal-fetal transport kinetics of manganese in perfused human placental lobule in vitro.

OBJECTIVE: There have been no detailed reports relating to maternal-fetal transport kinetics of manganese, an essential trace element in the human pregnancies, and hence we have attempted to study the transport kinetics of this trace element in the human placenta in vitro. METHODS: Human placentae from normal uncomplicated pregnancies were collected postpartum. Manganese chloride solution (GFS Chem Inc., Columbus, OH), 10 times the physiological concentrations, along with antipyrine (Sigma Chem Co., St. Louis, MO) as reference marker were then injected as a single bolus (100 µl) into the maternal arterial circulation of perfused placental lobules and perfusate samples collected from maternal and fetal circulations over a period of five minutes. National Culture and Tissue Collection medium, diluted with Earle's buffered salt solution was used as the perfusate and serial perfusate samples from fetal venous perfusate collected for a period of 30 min. Concentration of manganese in perfusate samples was assessed by atomic absorption spectrophotometry, while that of antipyrine was assessed by spectrophotometry. Transport kinetics of substances studied were computed using established permeation parameters. RESULTS: Differential transport rates of manganese and antipyrine in 12 perfusions differed significantly for 25.75, 90% efflux fractions (ANOVA test, p < 0.05), while those of 10 and 50% efflux fractions were not significantly different between the study and reference substances. Transport fraction (TF) of manganese averaged 54.9% of bolus dose in 12 perfusions, whereas that of antipyrine averaged 89% of bolus dose, representing 61.80% of reference marker TF. The difference observed in TF values of manganese and antipyrine was statistically significant (Student's t-test, p < 0.05). Pharmacokinetic parameters such as area under the curve, clearance, absorption rate, elimination rate of manganese compared to reference marker were significantly different (ANOVA test, p < 0.05) between the study and reference substances. CONCLUSIONS: Our studies show for the first time maternal-fetal transport kinetics of manganese in human placenta in vitro. Considering the restricted transfer of this essential trace element despite its small molecular weight, we hypothesize possibility of active transport of manganese across the human placental membrane. Further studies relating to manganese placental transport in "diabetic model" placental perfusions are in progress.

Prospective study of intraabdominal adhesions among women of different races with or without keloids.

OBJECTIVE: We sought to evaluate postsurgical adhesions in women of different races with or without keloids. STUDY DESIGN: This was a prospective study evaluating postsurgical adhesions after a cesarean delivery in 429 women with or without keloids. The outcome measures were the prevalence and extent of adhesions in women of different races with or without keloids. RESULTS: There was no difference in the prevalence of adhesions and adhesion score in various sites among women of different races. Compared with whites (0.5%), keloids were significantly more common in African Americans (7.1%; P = .007; odds ratio, 16.5) and in Asians (5.2%; P = .02; odds ratio, 11.9). Women with keloids were found to have more dense adhesions between the uterus and the bladder (P = .028; 95% confidence interval, 0-12) and between the uterus and the anterior abdominal wall (P < .0001; 95% confidence interval, 8-12). CONCLUSION: The prevalence and degree of postsurgical adhesions in women of different races are comparable. Women with keloids on the cesarean scar have increased adhesions between the uterus and the bladder and between the uterus and the abdominal wall.

Effects of ovarian puncture for in vitro maturation on subsequent in vitro fertilization cycle in women with polycystic ovaries.

We conducted a case-control study and compared the results of IVF treatment in two groups of women with polycystic ovaries. The first group consisted of 42 women who were previously treated unsuccessfully with in vitro maturation (IVM), and the second group, 48 others with no previous IVM (control group). We included the first IVF cycle only. Our preliminary result shows that previous ovarian puncture for IVM is associated with improved number of mature oocytes retrieved and total number of embryos produced. However, it is not associated with a better pregnancy rate. A larger study is needed.

Patient satisfaction after laparoscopic total or supracervical hysterectomy.

BACKGROUND/AIMS: To evaluate patient satisfaction after laparoscopic supracervical (LASH) or total hysterectomy (TLH). METHODS: Retrospective study of patient satisfaction after LASH or TLH. RESULTS: We studied 40 cases of LASH and another 40 of TLH. The age of the patients, marital status, education level and employment status between the two groups were comparable. Both LASH and TLH results in improvement of general health and symptoms. However, there was no significant difference in patient satisfaction with surgery, in general health, body and self-images, and sexual satisfaction between the LASH and TLH group. Before surgery, patients in the TLH group experienced more pain with a sexual relationship than those in the LASH group. The difference became non-significant after surgery. There was no difference in urinary or gastrointestinal symptoms after either type of hysterectomy. CONCLUSIONS: Both LASH and TLH result in improvement of general health and symptoms. Body and self-images, sexual function, gastrointestinal and urinary functions after LASH or TLH are comparable.