The role of nitrates in the prevention of preeclampsia: an update.

PURPOSE OF REVIEW: Defective nitric oxide synthesis and nitric oxide-mediated vasodilatation is widely documented in the pathophysiology of preeclampsia, a leading cause of maternal and perinatal morbidity and mortality worldwide. Several studies demonstrated the beneficial role of nitric oxide agents, especially glyceryl trinitrate and L-arginine in reducing the blood pressure and improving the uteroplacental blood flow velocities. However, there is insufficient evidence on the efficacy and safety of these agents in the prevention of preeclampsia and its complications, as there are very few randomized controlled trials with small number of women. The aim of this review is to summarize and evaluate the role of nitrates in the prevention of preeclampsia based on the available evidence in the literature till date and suggestions for future research. RECENT FINDINGS: Supplementation with L-arginine and antioxidant vitamins reduced the incidence of preeclampsia in women at high risk of preeclampsia [P < 0.001, absolute risk reduction 0.17 (confidence interval 0.12-0.21)]. SUMMARY: On the basis of the recent evidence, nitric oxide agents may be beneficial in the prevention of preeclampsia. Randomized controlled trials initiated in the first trimester and using long-acting nitrates are needed in high-risk women to validate these findings.

Laparoscopic excision of uterine adenomatoid tumour: two cases and literature review.

INTRODUCTION: Adenomatoid tumours are rare, benign neoplasms of the genital tract, occurring most commonly during the reproductive years. In females, the uterus is the most common site. These tumours can be associated with fibroids and tend to mimic them clinically and radiologically, making pre-operative diagnosis very difficult. We report two cases of uterine adenomatoid tumours that were excised laparoscopically. Intraoperatively, there was no clear line of demarcation between the uterus and the tumours and laparoscopic manipulation of the tumours was difficult due to their friable nature. Simple excision with uterine conservation is the treatment of choice, especially in women who desire future fertility, as degeneration, recurrence, malignant transformation or metastasis has not been reported. CONCLUSION: Adenomatoid tumours should always be included in the differential diagnosis along with adenomyosis and post-GnRH analogue treatment changes, when difficulty is encountered in identification of operative planes during a routine laparoscopic myomectomy. Apart from explaining the operative difficulties, the identification of these tumours also helps in post-operative counselling of these patients as these tumours unlike fibroids do not recur.