Progesterone in Pregnancy: Evidence-Based Strategies to Reduce Miscarriage and Enhance Assisted Reproductive Technology.

The incidence of miscarriage in early pregnancy, between 5-20 weeks, is common, with a prevalence of between 5-22% of all pregnancies. Miscarriage can have physical, social, and mental health impacts on women and their families. In societies such as Taiwan, where the birth rate is falling and life expectancy is increasing, there is concern that factors that reduce birth rates will have detrimental economic and societal effects. Progesterone has a significant role in maintaining early and successful pregnancy to term. Evidence from preclinical and clinical research on the roles of progesterone has supported recent clinical guidelines in obstetrics and gynecology to reduce rates of early miscarriage and improve methods of assisted reproductive technology (ART). This article aims to present an evidence-based review of current recommendations for the use of progesterone in early pregnancy to reduce miscarriage rates and in luteal phase support for ART, including embryo transfer.

Florid polypoid endometriosis exacerbated by tamoxifen therapy in breast cancer.

BACKGROUND: We report an unusual case where tamoxifen may have exacerbated the growth of multiple polypoid endometriotic implants. CASE: A premenopausal woman with right breast intraductal carcinoma underwent modified radical mastectomy and received six courses of chemotherapy, followed by continuous oral tamoxifen. Irregular vaginal bleeding was noted 5 years after the mastectomy and transvaginal ultrasound detected a 6-cm cul-de-sac mass. The serum CA 125 level was 138.86 U/mL. Surgical pathology showed florid polypoid endometriosis over the resected rectal segment and endometriotic implants over multiple biopsy sites of the peritoneal surface. CONCLUSION: The estrogenic effects of tamoxifen may have induced florid endometriosis in this hypoestrogenic woman. If breast cancer patients have preexisting endometriosis, adjuvant hormonal therapy other than tamoxifen should be considered.

Comparison of laparoscopy and laparotomy in managing hemodynamically stable patients with ruptured corpus luteum with hemoperitoneum.

STUDY OBJECTIVE: To compare differences between laparoscopy and laparotomy in managing women ruptured corpus luteum with hemoperitoneum. DESIGN: Three-year, prospective, nonrandomized study (Canadian Task Force classification II-2). SETTING: University-affiliated regional hospital. PATIENTS: Sixty hemodynamically stable women. INTERVENTION: Laparoscopic surgery (30 women) and laparotomy (30). MEASUREMENTS AND MAIN RESULTS: Laparoscopic surgery had significant advantages over laparotomy, including shorter hospital stay (55.33 +/- 7.67 vs 97.77 +/- 14.45 hrs, p < 0.001) without increased adverse events. Laparoscopic surgery also showed trends of shorter operating time, improved wound care, and less postoperative pain. CONCLUSION: Laparoscopy surgery for diagnosis and treatment of women with ruptured hemorrhagic corpus luteum appears superior to laparotomy. We suggest that surgeons try laparoscopy first as a diagnostic and probably therapeutic procedure.