International Journal of Infertility and Fetal Medicine最新文献

{"title":"Prenatal Diagnosis and Management of Fetal Goiter: A Case Series from Tertiary Perinatal Center in South India","authors":"S. Vavilala, Manjula Budidapadu, G. Kolar","doi":"10.5005/jp-journals-10016-1187","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1187","url":null,"abstract":"The reported incidence of fetal goiter is 1 in 40,000 live births. The effects of fetal goiter and thyroid dysfunction are significant. The objective of our study is to assess the safety, feasibility, and efficacy of intra-amniotic instillation of levothyroxine (LT4) in fetal goitrous hypothyroidism.\u0000\u0000\u0000\u0000A retrospective observational study of prenatally diagnosed cases of fetal goiter on routine antenatal ultrasound between January 2010 and January 2018 at Fernandez Hospital Foundation, Hyderabad, tertiary perinatal referral center. Data retrieved from electronic database.\u0000\u0000\u0000\u0000During this period, 9 cases of fetal goiter were diagnosed on routine ultrasonography with the incidence of 1 in 7,000 live births. The gestation age at diagnosis ranged between 21 weeks and 29 weeks (mean 26 weeks). Of the nine fetuses with goiter, two were excluded as one ended in a miscarriage at 22 weeks and the other was terminated elsewhere at 26 weeks. Data were analyzed in the remaining seven fetuses. Cordocentesis was performed in five fetuses and amniocentesis was performed in one woman with dichorionic diamniotic (DCDA) twin gestation which revealed hypothyroid status. Fetal therapy was offered to all the remaining seven fetuses with intra-amniotic instillation of LT4 100 to 200 μg at 2–3 weeks’ interval. First dose of LT4 was given at mean gestation of 27 weeks (range 23–30 weeks), and the mean time between the identification of fetal goiter and the first dose of LT4 was 6 days (range 2–15 days). Number of injections given ranged between 1 and 7. No adverse events were recorded. Follow-up sonogram showed subjective reduction in the goiter size. All the babies had hypothyroidism at birth.\u0000\u0000\u0000\u0000Our case series confirms the safety and feasibility of intra-amniotic instillation of LT4 for fetal goitrous hypothyroidism. Although fetal therapy has resulted in reduction in the size of the goiter, the thyroid hormone levels at birth were low. Further research is required to establish the proper management guidelines for this disorder.\u0000\u0000Budidapadu M, Vavilala S, Kolar G. Prenatal Diagnosis and Management of Fetal Goiter: A Case Series from Tertiary Perinatal Center in South India. Int J Infertil Fetal Med 2019;10(3):37–41.","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46444142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention and Management of Ovarian Hyperstimulation Syndrome","authors":"K. Rao, Deepika Krishna, S. Agarwal","doi":"10.5005/jp-journals-10016-1193","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1193","url":null,"abstract":"Ab s t r Ac t Ovarian hyperstimulation syndrome (OHSS) is a potential iatrogenic life-threatening situation. It is difficult to decipher OHSS pathophysiology.1 The occurrence is directly proportional to estradiol in blood, follicle number, and human chorionic gonadotropin (hCG) with more chances of happening in polycystic ovarian disease. Complete prevention of OHSS is never possible, but endocrine profile and ultrasonographic follicular monitoring are the mainstay of its prediction. Complications such as hemoconcentration, hypovolemia, and thromboembolism can occur. Withholding hCG, continuation of gonadotropin-releasing hormone analogs, coasting, agonist trigger, intravenous albumin, dopamine agonists, and cryopreservation of embryos are cornerstones of OHSS prevention.2 Mild OHSS usually requires no active therapy. Moderate and severe cases have to be treated. Surgery may be needed in ruptured ovarian cysts, torsion, or concomitant ectopic pregnancy. Transvaginal paracentesis is recommended in cases of severe ascites. Inpatient management is typically based on preventing complications such as derangement of kidney and liver functions, thrombosis, and severe respiratory depression. Recent ART treatment protocols behold more patient-friendly mild ovarian stimulation regimes that are individualized depending on patient’s ovarian reserve.3","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45870240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Novel Variants in NLRP7 Gene in an Egyptian Female Patient with Consecutive Molar Pregnancies Complicated by Choriocarcinoma","authors":"Taghreed Shalabi, M. Abdel-Hamid, Mai Shaker","doi":"10.5005/jp-journals-10016-1191","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1191","url":null,"abstract":"\u0000\u0000\u0000Hydatidiform mole, whether complete or partial mole, is one of the most common forms of gestational trophoblastic disease. It is characterized by extreme trophoblastic proliferation and atypical embryonic growth. Though almost all of complete hydatidiform moles are diploid androgenetic, scarce cases are biparental and caused mainly by mutations in NLRP7 and KHDC3L genes. NLRP7 mutations are more common and were reported in around 50–80% of cases from diverse populations while KHDC3 mutations were only found in 5–10% of cases.\u0000\u0000\u0000\u0000A healthy 40-year-old Egyptian woman was referred to the Clinic of Prenatal Diagnosis and Fetal Medicine Department for counseling. She was married for 20 years to a first-degree relative and experienced 17 consecutive pregnancy losses without having any live births. Uterus ultrasound revealed endometrial thickening and subseptate uterus and in her last pregnancy failure, she complained of abdominal pain and severe shortness of breath. Immunochemistry tests were positive for β-human chorionic gonadotropin and histopathology-confirmed choriocarcinoma. Genetic testing revealed two novel heterozygous variants in the NLPR7 gene.\u0000\u0000\u0000\u0000We presented a case with 17 recurrent hydatidiform moles that was complicated by choriocarcinoma due to novel variants in the NLRP7 gene.\u0000\u0000\u0000\u0000This is the first Egyptian case with recurrent hydatidiform mole. We identified novel NLPR7 variants, thus expanding the mutational spectrum associated with this rare disease.\u0000\u0000Shalabi TA, Abdel-Hamid MS, Shaker MM. Two Novel Variants in NLRP7 Gene in an Egyptian Female Patient with Consecutive Molar Pregnancies Complicated by Choriocarcinoma. Int J Infertil Fetal Med 2019;10(3):54–57.\u0000","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41417904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Body Mass Index on the Prevalence of Metabolic Syndrome among Infertile South Indian Women","authors":"R. Vembu, Mathivanan Nandini Devi, S. Nellepalli, M. Pandurangi, S. Nagireddy","doi":"10.5005/jp-journals-10016-1188","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1188","url":null,"abstract":"\u0000\u0000\u0000To study the prevalence of metabolic syndrome (MBS) in different body mass index (BMI) group infertile women in both polycystic ovarian syndrome (PCOS) and non-PCOS subgroups.\u0000\u0000\u0000\u0000A prospective cross-sectional study of all infertile women attending the outpatient in the department of reproductive medicine and surgery in a tertiary care center catering patients from South India was conducted. These women were categorized based on BMI into groups as ≤23 kg/m2, 23.1–25 kg/m2, 25.1–27 kg/m2, 27.1–30 kg/m2, and >30 kg/m2. They were further subdivided as PCOS and non-PCOS based on Rotterdam criteria (2003). These women underwent screening for MBS according to the modified American Heart Association/National Heart Lung Blood Institute AHA/NHLBI (ATP III 2005) definition. The results were analyzed for significance by the unpaired t test and the Chi-square test.\u0000\u0000\u0000\u0000A total of 1,030 infertile women were analyzed. The mean age was 28.8 ± 4.5 years; mean BMI was 26.9 ± 3.7 kg/m2. More than 90% of women had waist circumference >80 cm. The prevalence of MBS among the infertile women was 35.3% and among PCOS and non-PCOS women was 44.7 and 28.9%, respectively. Even though there was statistically no significant difference in the metabolic parameters among PCOS and non-PCOS subgroups in different BMI cutoff levels, there was an increase in abnormal metabolic parameters with increase in BMI. The prevalence of MBS in the BMI groups among PCOS women was 11.1, 28.1, 29.7, 51.8, and 73.6%, respectively (p = 0.0005) and among non-PCOS women was 4.9, 20.4, 24.6, 41.6, and 66.7%, respectively (p = 0.0005).\u0000\u0000\u0000\u0000The BMI is an independent risk factor for MBS in both PCOS and non-PCOS infertile women.\u0000\u0000\u0000\u0000Screening for MBS in infertile women helps in early identification and primary prevention by lifestyle modification helps in delaying long-term consequences of type 2 diabetes mellitus and cardiovascular diseases.\u0000\u0000Vembu R, Nandini Devi M, Nellepalli SR, et al. Impact of Body Mass Index on the Prevalence of Metabolic Syndrome among Infertile South Indian Women. Int J Infertil Fetal Med 2019;10(3):42–45.\u0000","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41956165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complicated Triplet Gestation Reduced to Twins with Partial Hydatidiform Mole and a Coexisting Live Fetus: A Case Report Managed in a Tertiary Care Center","authors":"Ketki S. Kulkarni, Minal Dhanvij, A. Goel","doi":"10.5005/jp-journals-10016-1192","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1192","url":null,"abstract":"\u0000Pregnancies with hydatidiform mole and a live fetus are extremely rare, arising in about 1 in 20,000–100,000 pregnancies. Multifetal gestations are increasing due to increase in infertility treatment, and so the complications related to it are on the verge of rising. Also, the partial mole with live fetus is a rare entity, and only few cases are reported in the literature. The objective of the study is reporting a rare case and reviewing the available literature in an attempt to make clinical guidelines. We are reporting a case of 36-year-old, elderly primigravida with in vitro fertilization conception at 29.1 weeks of gestation with severe preeclampsia. She was triplet gestation in early ultrasonography scan reports, and fetal reduction was done at 11 weeks and reduced to twins. A lower segment cesarean section was done, and a healthy male fetus of 1,100 g was delivered. Placenta of the live triplet and the fetus papyraceous (200 g) was delivered with a thin cord attached to hydatidiform molar placenta and vesicles. The dilemma is whether to continue such pregnancy or to terminate it, as it is a critical issue to solve. The watchful monitoring of such cases can provide optimum outcome and prevention of metastasis.\u0000How to cite this article: Kulkarni KS, Dhanvij MP, Goel A. Complicated Triplet Gestation Reduced to Twins with Partial Hydatidiform Mole and a Coexisting Live Fetus: A Case Report Managed in a Tertiary Care Center. Int J Infertil Fetal Med 2019;10(3):58–62.","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41985737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osseous Endometrial Metaplasia in a Case of Primary Infertility","authors":"D. Shrivastava, Arzoo M Chadha, M. Salve, Asawari A Deo","doi":"10.5005/jp-journals-10016-1189","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1189","url":null,"abstract":"Endometrial osseous metaplasia is a rare pathological condition characterized by the presence of bone-like tissue in the endometrium and can be a cause for menstrual abnormalities and infertility as bone in the endometrium can act like an intrauterine contraceptive device. It is a rare entity with an estimated incidence of 3/10,000. Exact etiopathogenesis is not known but the most accepted theory is metaplasia of stromal cells into osteoblast cells, which results in the formation of bones. The possibility of malignant mixed Mullerian tumor should also be kept in mind. Here, we report one such case of primary infertility in a 27-year-old woman presenting with history of oligomenorrhea. Endometrial stromal (osseous) metaplasia is a condition that is rarely seen and may have a potential to be overlooked and misdiagnosed. It is important to recognize the non-neoplastic nature of this condition to avoid misinterpretation as malignant mixed Mullerian tumor of the uterus. Its contraceptive nature makes it an extremely rare but treatable cause of infertility. Complete removal of bony spicules by hysteroscopy can help regain fertility.","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42772897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conjoint Twins: “Constant Togetherness” a Sign of Double Trouble","authors":"Roopa Padavagodu Shivanada, S. Guruvare, Shubha Rao, Radhakrishnan Periyasamy","doi":"10.5005/JP-JOURNALS-10016-1207","DOIUrl":"https://doi.org/10.5005/JP-JOURNALS-10016-1207","url":null,"abstract":"","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":"24 1","pages":"72-75"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76948061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterine Torsion Associated with Previable Preterm Premature Rupture of Membranes Diagnosed at Cesarean Section","authors":"P. Dasari, Ashraf M Ali, T. Chitra","doi":"10.5005/jp-journals-10016-1184","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1184","url":null,"abstract":"Ab s t r Ac t Background: Torsion of gravid uterus is a rare and sporadic event, and its association with previable preterm premature rupture of membrane (PPROM) is not reported in literature. Case description: A 35-year-old third gravida with previous two early pregnancy losses was managed conservatively following previable rupture of membranes at 20 + 6 weeks of gestation. Torsion of gravid uterus to 180° was diagnosed at elective cesarean section performed at 32 + 2 weeks in view of Breech presentation with severe oligoamnios and tubular cervix. An alive baby of 1.48 kg with good APGAR score was extracted through a low vertical incision given on anterior surface of uterus after detortion. Discussion: Torsion is diagnosed when uterus rotates itself on its long axis 45° or more, and the etiology may be fibroid uterus adhesions and ovarian cysts. Preoperative diagnosis is rare except when magnetic resonance imaging is performed. Most of the cases reported in the literature are diagnosed at cesarean section undertaken for fetal distress or nonprogress of labor. In the case presented here, there were no predisposing factors except that she was on prolonged bed rest due to PPROM, and there was a cornual implantation of placenta. Conclusion: Conservative management of maternal position may predispose to uterine torsion, and in such cases, vigilant monitoring and timely termination can save the fetus. Clinical significance: Presence of a tubular cervix with mal-presentation is one of the clinical features to suspect torsion during pregnancy and labor.","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46944481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfusion-related Acute Lung Injury in a Case of Ruptured Ectopic Pregnancy","authors":"S. Wanjari","doi":"10.5005/jp-journals-10016-1185","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1185","url":null,"abstract":"Ab s t r Ac t Aim: To highlight an uncommon complication of blood transfusion, which can be detected early based on suspicion, especially when the presentation is mild or atypical. Background: Transfusion-related acute lung injury (TRALI) is a rare complication of blood transfusion which can be life-threatening. TRALI is most commonly associated with plasma-containing blood products. The transfusion components can be fresh frozen plasma (FFP), whole blood platelet concentrates, and apheresis platelets and packed red blood cells. TRALI is thought to be caused by activation of recipient neutrophils by donor-derived antibodies targeting human leukocyte antigen (HLA). Case description: We are herewith presenting the case of a 26-year-old lady who was admitted with the diagnosis of ruptured ectopic pregnancy and a hemoglobin of 5.6 g%. Exploratory laparotomy was done, and she received three transfusions intra and postoperatively. After a few hours, we noticed that she was not maintaining SpO2 at room air. Chest X-ray showed infiltrates, and ECHO was normal. With the diagnosis of TRALI, she was started on nasal oxygen and was investigated. She responded well to injection hydrocortisone and diuretics and recovered within 72 hours. Conclusion: TRALI is a clinical diagnosis that should be considered in all patients who have respiratory difficulty and pulmonary insufficiency during or after transfusion. Timely recognition and adequate treatment are crucial in its management. Clinical significance: The classical presentation of TRALI includes onset of dyspnea and tachypnea within 6 hours of a transfusion. TRALI should be differentiated from transfusion-associated circulatory overload (TACO) and other transfusion reactions and also from cardiac conditions and pulmonary embolism. In mild cases, nasal oxygen administration is sufficient to achieve clinical improvement. In severe cases, mechanical ventilation may be necessary. Our patient responded well to hydrocortisone and diuretics and oxygen inhalation at 2 L/minute.","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48593646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic Counseling in Reproductive Issues: Emphasis on the Genetic Aspects","authors":"Aishwarya Pargaonkar, Rukmini Talagadadeevi, V. Parvathi","doi":"10.5005/jp-journals-10016-1182","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1182","url":null,"abstract":"","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46506882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}