Fetal reduction for hyperreactio luteinalis.

OBJECTIVE: To present an unusual case of hyperreactio luteinalis and a comprehensive review of the recent literature. Hyperreactio luteinalis is a benign ovarian condition of pregnancy that at times becomes life threatening. The medical literature provides only case reports. DESIGN: Case report and systematic review of the literature. SETTING: University Center. PATIENT(S): A multiparous woman with polycystic ovary syndrome who underwent ovarian stimulation with oral and injectable medications and conceived triplets. She presented at 10 weeks of pregnancy with hyperreactio luteinalis. INTERVENTION(S): Fetal reduction to singleton. MAIN OUTCOME MEASURE(S): Resolution of condition. RESULT(S): The condition resolved 6 weeks after fetal reduction. The patient delivered at term without further complications. CONCLUSION(S): Our review showed that many unnecessary surgeries are performed to treat hyperreactio luteinalis. When feasible, fetal reduction may improve outcome and represents an effective approach that does not compromise maternal well-being or future fertility.

Large luteinized follicular cyst of pregnancy.

A large (165 × 235 × 250 mm) solitary, unilocular cyst with a thin, smooth wall and homogeneous anechoic content was detected during a routine ultrasound scan at 24 weeks of gestation in an asymptomatic 39-year-old woman with a singleton pregnancy. The cyst was aseptate, lacked mural blood flow and was not associated with ascites. It was located in the central abdominal area above and anterior to the uterus. Gradually increasing abdominal discomfort developed, and a laparotomy was performed at 27 weeks; the cyst was removed after aspiration of 6.3 L of serous fluid and the ipsilateral ovary was preserved. Pathological examination indicated a large luteinized follicular cyst of pregnancy. A healthy male infant was delivered vaginally at term. A rapidly enlarging ovarian mass in pregnancy poses significant diagnostic problems. Large luteinized cysts of pregnancy are uncommon and thought to involve stimulation by human chorionic gonadotropin (hCG), or increased tissue sensitivity to hCG. A literature search identified four previous cases that had been detected prenatally. With one exception, the cysts appeared to enlarge during pregnancy, eventually becoming symptomatic, and two previous cases also required removal of the cyst before birth. Adverse pregnancy outcome was only reported in one of the previous cases. In summary, large luteinized cysts of pregnancy are an uncommon type of cystic mass particular to pregnancy, characterized by the combination of a benign appearance and a tendency to enlarge rapidly, eventually becoming symptomatic and most often necessitating surgery.

Luteal function induced by transvaginal ultrasonic-guided follicular aspiration in mares.

Ultrasonic-guided transvaginal follicle aspiration was performed in 58 crossbreed mares in order to determine whether aspiration of various dominant follicle diameters resulted in luteal tissue capable of producing progesterone (P(4)). The mares were randomly assigned to three groups according to follicular diameter (25-29 mm; 30-35 mm and >35 mm). Mares that had ovulations naturally served as controls. The serum progesterone (P(4)) concentrations in the aspirated mares were greater (P < 0.0001; r(2) = 0.6687; CV = 21.52) in mares with natural ovulation compared to mares with aspirated follicles regardless of groups. Serum P(4) concentration in aspired mares with follicular diameter of 25-29 mm declined 0.365 ng/ml/day (P = 0.0065) from the day of aspiration (D0) up to D8. In mares with follicle diameter of 30-35 mm, serum P(4) concentration increased (0.258 ng/ml/day; P = 0.001), as well as in the mares with follicles >35 mm diameter (0.481 ng/ml/day; P < 0.0001), and in mares with natural ovulation (1.236 ng/ml/day; P < 0.0001). Out of the 25 mares with follicular aspirations that formed Corpora hemorragica (P(4) >1 ng/ml), 23 (92%) had greater (>2 ng/ml) serum P(4) concentrations on Day 8 after aspiration. Of these 23 mares, 75% were in the 25-29 mm group, 9/10 (90%) in the 30-35 mm group, and 11/11 (100%) of the mares in the >35 mm follicular diameter group had luteinization (P(4) >2 ng/ml). These results suggest that a functional Corpus luteum can be induced in mares using follicular aspiration and that a minimum 35 mm follicular diameter is needed to reach a progesterone serum concentration compatible with that of a Corpus luteum produced by natural ovulation.

Examination of cyclic changes in bovine luteal echotexture using computer-assisted statistical pattern recognition techniques.

B-mode sonography is a well-established diagnostic tool for determination of cycle stage in gynaecology. The aim of this study was to determine whether computer-assisted texture analysis of B- mode sonographic images of bovine luteal glands provides further information about the animal's plasma progesterone concentration and cycle stage. Four Simmenthal cows were examined during two consecutive estrous cycles with an ultrasound device equipped with a 7.5MHz microconvex probe. During each examination three B-mode images of the corpus luteum (CL) were digitized and analyzed off-line using a computer-assisted texture analysis program. Size, echogeneity, and echotexture of the CL were characterized by the following texture parameters: area of cross-sectional planes of the CL (A), mean gray level (MGL), correlation (CORR), run percentage (RPERC), and long-run emphasis (LREM). Plasma progesterone levels (P4) were also determined. All parameters showed characteristic changes during the estrous cycle (P<0.05). Variance component estimates for the effect of Day of estrous cycle on A, MGL, CORR, RPERC, and LREM were 56.6%, 64.6%, 77.6%, 89.9%, and 86.0%, respectively, and 20.6%, 24.5%, 7.2%, 0.0%, and 14.0% for the influence of the individual cow. The factor estrous cycle within cows was responsible for 22.8%, 10.9%, 15.2%, 10.1%, and 0.0% of the variability of A, MGL, CORR, RPERC and LREM values, respectively. Cyclic changes were similar in A and P4. In contrast to P4, which decreased already between Days -5 and -3 (Day 0=ovulation), A stayed at constant high values until Day -3. Mean MGL values were higher (P<0.05) on Days 7, 9, and 13 compared to Days 3 and -3. Mean CORR values were constantly high (P>0.05) during the first days after ovulation and decreased continuously (P<0.05) between Days 5 and 13. Thereafter, mean CORR values remained low (P<0.05) until the next ovulation, except on Day -3 (P<0.05). Mean RPERC rose between Days 1 and 9 from low to high values (P<0.0001) remained at these high values (P>0.05) between Days 9 and 15, and decreased (P<0.05) afterwards to baseline values on Day -1. Mean LREM inclined steeply (P<0.0001) from minimum to maximum between Days 1 and 5. From Days 7 to -3, mean LREM remained (P>0.05) at a constant level close below the maximum value, and decreased to baseline values on Day -1. The results of this study show that statistical pattern recognition techniques provide new information about the luteal glands, thus facilitating a more accurate differentiation between different cycle stages in cows.

[The morpho-functional changes of the follicular apparatus and yellow body of the ovary in women of the reproductive age with myoma].

It have been studied the morpho-functional changes of the ovaries in women of reproductive age with proliferative myoma of uteri. Based on the analysis of the result of the investigation on the myomatic knots of the women in the condition of high activity of proliferation of myocytes a very complexes, multifactorial pathogenetic mechanisms of the myoma has been outlined. Switch in the common changes in the dynamic oxidative stress and hyperestrogenemia promotes development of the myoma.

Early prenatal sonographic diagnosis of twin triploid gestation presenting with fetal hydrops and theca-lutein ovarian cysts.

The presence of theca-lutein ovarian cysts in the early second trimester of pregnancy is highly suspicious for a complete hydatidiform molar pregnancy but can be seen in association with a partial mole. Theca-lutein cysts may occur following hormonal stimulation for assisted reproductive techniques or in association with multiple gestations. Rare causes include immune and nonimmune fetal hydrops, maternal hypothyroidism, and triploid gestations. We report a case of a monochorionic twin gestation in which prenatal sonography demonstrated multiple anomalies and hydrops in each twin and bilateral theca-lutein ovarian cysts. Triploidy in both twins and a partial hydatidiform mole were confirmed at pathologic examination.