First-trimester miscarriage in the background of endometrial carcinoma.

BACKGROUND: Endometrial cancer in young women (less than 40-year-old) is associated with anovulatory menses, polycystic ovarian syndrome (PCOS) and subfertility. Endometrial cancer occurring in a miscarriage is rare. We highlight a case of endometrial cancer occurring during miscarriage of a non-viable pregnancy, its management and the outcome. CASE: A 32-year-old woman, Gravida 1 Para 0, was referred to our center at 7 weeks gestation in 2018 for uncontrolled diabetes mellitus diagnosed during investigation for subfertility. Her poor compliance with the treatment is consistent with an HbA1c of 8%. During the assessment, she was already complaining of lower abdominal pain. Ultrasound showed irregular IUGS with no fetal echo. She had a miscarriage soon; however, due to ultrasound evidence of thickened and irregular endometrium (17 mm) with mixed echogenicity, dilatation and curettage (D + C) were commenced. The first and second tissues were reported as the product of conception (POC) and well differentiated endometrioid adenocarcinoma, respectively. The first hysteroscopy showed foci area of polypoidal growth at the right posterior endometrium, obscuring the right ostium, with similar histology report. She was commenced on high-dose progestogen with hysteroscopy surveillance 6 months later, which showed disease regression. After two normal hysteroscopies and endometrial biopsies with continuous progestogen therapy for 12 months, cyclical progestogen for 12 months and follow-up for another 6 months, she had spontaneous conception and is currently pregnant at 16 weeks gestation. CONCLUSION: Endometrial cancer should be suspected in high-risk patients with first-trimester miscarriage. Individualized treatment with high dose progestogen and follow-up with the proper patient and partner counselling and education has high successful regressionand later on, pregnancy rate.

The Effectiveness of Breastfeeding Intervention on Breastfeeding Exclusivity and Duration among Primiparous Mothers in Hospital Universiti Sains Malaysia

Background: In Malaysia, the rates of mothers practising breastfeeding exclusively among babies at six months of age still do not achieve the Global Nutritional Targets 2025 which is 50%. Objective: To determine the effectiveness of breastfeeding intervention in improving breastfeeding outcomes. Method: A quasi-experimental design was used involving a purposive sample of 96 primigravidas (intervention group (IG) = 48, control group (CG) = 48) recruited at Hospital USM. Data were collected using the Breastfeeding Assessment Questionnaire. Mothers in IG received the current usual care and two hours of an additional education programme on breastfeeding, breastfeeding booklet, notes from the module, and postnatal breastfeeding support in the first week of postpartum. Mothers in CG received the current usual care only. The mothers were assessed on the first and sixth week and then the fourth and sixth month of postpartum. Results: The results indicated that there was a statistically significant difference between the groups on the fourth month postpartum (X2 = 5.671, P = 0.017) in practicing full breastfeeding. The breastfeeding duration rates of the IG were longer than those of the CG. However, the results showed only two follow-up weeks that were significant (week 6, X2 = 5.414, P = 0.020, month 4, X2 = 7.515, P = 0.006). There was a statistically significant difference between IG and CG as determined by one-way ANCOVA on the breastfeeding duration after controlling age and occupation, F (3, 82) = 6.7, P = 0.011. The test revealed that the breastfeeding duration among IG was significantly higher (20.80 ± 6.31) compared to CG (16.98 ± 8.97). Conclusions: Breastfeeding intervention can effectively increase breastfeeding duration and exclusivity outcomes among primiparous mother

Pyruvate reduces in vitro the embryotoxic effect of peritoneal fluid from infertile women with endometriosis.

OBJECTIVES: To ascertain the embryotoxicity of peritoneal fluid from infertile women with endometriosis (PF-E), on mouse embryos in culture and to examine the effect of pyruvate in the culture medium on PF-E induced embryotoxicity. STUDY DESIGN: Blood-free peritoneal fluid samples were obtained during laparoscopic investigation for infertility from 21 infertile women with endometriosis. The severity of endometriosis ranged from minimal or mild (PF-min to mild-E; n=7), moderate (PF-mod-E; n=7), to severe (PF-sev-E; n=7). Peritoneal fluid samples were centrifuged at 600 x g for 10 min and 4 degrees C, and the supernatant was incubated at 56 degrees C for 30 min in a water bath to inactivate the complement protein. Mice were super ovulated with intraperitoneal injection (IP) of 5IU of pregnant mare serum gonadotrophin and human chorion gonadotrophin. Twenty-four hours after confirmation of mating two-cell mouse embryos were obtained. They were then cultured in modified Whitten's medium (mWM) with peritoneal fluid from patients with endometriosis, and either in the absence or presence of excess pyruvate (0.062 mmol(-1)). Embryos were cultured for 72 h. RESULTS AND CONCLUSION: Addition of 5% PF-E significantly (p<0.001) suppressed embryo growth at 24, 48, and 72 h of culture and the degree of suppression correlated with the severity of the disease. The presence of 0.062 mmol(-1) pyruvate in the culture medium significantly (p<0.001) reduced the embryotoxicity of PF-min to mild-E and PF-mod-E at each stage of development, but was only seen at 24h of culture (p<0.001) in cultures with PF-sev-E even when the concentration of pyruvate in the medium was increased to 0.31 mmol(-1). This study confirms the embryotoxicity of PF-E in vitro, which was reduced by the presence pyruvate in the culture medium, particularly in cultures containing fluid from women with endometriosis of minimum or mild to moderate severity.

The absence of factor V Leiden mutation in Malays with recurrent spontaneous abortions.

OBJECTIVES: The objectives of this study were to investigate the prevalence of factor V Leiden mutation in Malay women with recurrent spontaneous abortion and to clarify the contribution of the factor V Leiden mutation to recurrent miscarriages in these women. DESIGN: A prospective case control study between June 1999 and April 2000. SETTING: Hospital University Science of Malaysia, Kubang Kerian, Kelantan, and Maternal and Child Health Clinic, Pasir Mas, Kelantan, Malaysia. SAMPLES: A total of 46 Malay women with a history of three or more first or second trimester miscarriages were studied. The control group consisted of 46 parous women without obstetric complications. METHODS: Diagnosis of factor V Leiden mutation was made by examination of factor V Leiden allele product following Mnl I digestion of factor V Leiden alleles amplified by polymerase chain reaction. RESULTS: None of the 46 women with recurrent spontaneous abortion carried the mutation. Also, we found no subject carrying the factor V Leiden alleles in the control group. CONCLUSION: These results suggest that that there is no association between the factor V Leiden mutation and recurrent spontaneous abortion in the Malay population.