Journal of clinical gynecology and obstetrics最新文献

{"title":"A Report of Two Cases of Human Metapneumovirus Infection in Pregnancy Involving Superimposed Bacterial Pneumonia and Severe Respiratory Illness","authors":"J. Emont, K. Chung, D. Rouse","doi":"10.14740/JCGO.V8I4.573","DOIUrl":"https://doi.org/10.14740/JCGO.V8I4.573","url":null,"abstract":"Human metapneumovirus (HMPV) is a cause of mild to severe respiratory viral infection. There are few descriptions of infection with HMPV in pregnancy. We present two cases of HMPV infection occurring in pregnancy, including a case of superimposed bacterial pneumonia in a pregnant woman after HMPV infection. In the first case, a 40-year-old woman at 29 weeks of gestation developed an asthma exacerbation in association with a positive respiratory pathogen panel (RPP) for HMPV infection. She was admitted to the intensive care unit (ICU) for progressive respiratory failure. In the second case, a 36-year-old woman at 31 weeks of gestation developed respiratory distress in association with a positive RPP for HMPV. A subsequent sputum culture was positive for beta-lactamase producing Haemophilus influenzae raising concern for superimposed bacterial pneumonia. HMPV can be an important cause of severe respiratory illness in pregnant women and may predispose pregnant women to superimposed bacterial pneumonia. J Clin Gynecol Obstet. 2019;8(4):107-110 doi: https://doi.org/10.14740/jcgo573","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":"8 1","pages":"107-110"},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41444340","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":"Miliary Tuberculosis Presenting as Pyrexia of Unknown Origin in Pregnancy","authors":"Tong Carmen, L. Zailan, Ravinder Singh, A. Wright","doi":"10.14740/jcgo591","DOIUrl":"https://doi.org/10.14740/jcgo591","url":null,"abstract":"Miliary tuberculosis (TB) due to the widespread dissemination of Mycobacterium tuberculosis remains rare, occurring in less than 1-2% of cases, and is usually associated with risk factors including female gender, extremes of age, immunosuppressed states, poor socioeconomic status and alcoholism. Delay in diagnosis or treatment of TB has been associated with poor maternal and fetal outcomes such as anemia, preeclampsia, pneumonia, preterm labor, congenital infection and intra-uterine death. We described a case of miliary TB in pregnancy presenting as prolonged fever with a negative workup showing the challenges in diagnosing miliary TB antenatally, as manifestations can be non-specific and investigation results are inconclusive. This case emphasizes the importance of a multidisciplinary team, especially of obstetricians with expertise in high-risk pregnancies, infectious diseases, rheumatologists and neonatologists. J Clin Gynecol Obstet. 2019;8(4):114-117 doi: https://doi.org/10.14740/jcgo591","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44567113","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":"Resistant Ovary Syndrome Masquerading as Premature Ovarian Insufficiency","authors":"I. Woo, Yulan Zhang, H. Hui, E. Mor","doi":"10.14740/jcgo575","DOIUrl":"https://doi.org/10.14740/jcgo575","url":null,"abstract":"Premature ovarian insufficiency (POI) is typically the end result of premature depletion of primordial follicles. However gonadotropin-resistant ovary syndrome could result in a similar clinical and laboratory picture with a more favorable outcome. A 29-year-old G0 woman with POI referred to our infertility clinic for egg donation. On ultrasound, her ovaries contained multiple resting antral follicles (AFs). Patient underwent transvaginal ultrasound-guided follicle aspiration of all visible small antral follicles. Eggs were in vitro matured and resulting embryos cryopreserved. Patient achieved a successful live birth with her own eggs. Gonadotropin-resistant ovary syndrome must be considered in all women diagnosed with hypergonadotropic hypogonadal POI and normal antral follicle count (AFC) and anti-Mullerian hormone (AMH). In these patients, pregnancy can be achieved with their own eggs. J Clin Gynecol Obstet. 2019;8(4):111-113 doi: https://doi.org/10.14740/jcgo575","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44558865","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":"The Unusual Presentation of HELLP Syndrome","authors":"R. Lee, B. Ajay","doi":"10.14740/jcgo605","DOIUrl":"https://doi.org/10.14740/jcgo605","url":null,"abstract":"HELLP syndrome is a serious pregnancy-related syndrome characterised by hemolysis, elevated liver enzymes and low platelet count occurring in 0.5-0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. Typical presenting symptoms are right upper quadrant or epigastric pain, nausea and vomiting. Seventy percent of the cases develop antepartum, majority between the 27th and 37th gestational weeks. Thirty percent of the cases are diagnosed postpartum, often within 48 h post-delivery. The occurrence of preeclampsia post-delivery is well established. However, in most reported cases, HELLP syndrome persisted since late pregnancy. We report a case of HELLP syndrome in combination with preeclampsia that developed 2 days post-delivery in an uncomplicated pregnancy. J Clin Gynecol Obstet. 2019;8(4):118-120 doi: https://doi.org/10.14740/jcgo605","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49419064","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":"Current Status of Bacterial Resistance in Obstetric Patients in a Third Level Center","authors":"C. M. Sepúlveda-Rivera, A. Ruiz-Beltran, Jessica Aidee Mora-Galvan, M. Ramírez, Mayela Berenice Gomez-Jaime, G. Villeda-Gabriel","doi":"10.14740/jcgo599","DOIUrl":"https://doi.org/10.14740/jcgo599","url":null,"abstract":"Background: The aim of the study was to know the range of bacterial resistance in pathogens of epidemiological importance isolated from urine samples, secretion of surgical wound and blood culture in the Instituto Nacional de Perinatologia. Methods: In this retrospective study, we reviewed all the antibiograms obtained from isolates of microorganisms from: urine, surgical wound secretion and blood culture of obstetric patients (pregnancy and puerperium) in the period from January 2016 to June 2019 at the Instituto Nacional de Perinatologia. Results: A total of 3,322 microorganisms were isolated, 2,882 from urine sample, 270 from surgical wound secretion and 170 from blood cultures. The most frequent microorganism isolated was Escherichia coli (2,223 isolates), 2,042 from urine samples, 98 from surgical wound secretion and 83 from blood cultures. Conclusions: The use of the results of antimicrobial susceptibility of the isolated microorganisms allowed producing record from 2 years of pharmacological resistance for most of the species of epidemiological importance. Same results will allow initiating an empirical management under a sustenance of scientific evidence. J Clin Gynecol Obstet. 2019;8(4):103-106 doi: https://doi.org/10.14740/jcgo599","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46090055","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":"Minimal Stimulation Using Letrozole in Poor Responders","authors":"Ker Yi Wong, T. Ee, H. Tan","doi":"10.14740/jcgo557","DOIUrl":"https://doi.org/10.14740/jcgo557","url":null,"abstract":"Background: Poor responders refer to women who undergo ovarian stimulation with suboptimal response and an optimal treatment for them has yet to be proven. Minimal stimulation which uses lower doses of gonadotropins than standard long protocols had been shown to yield fewer but higher quality embryos. Minimal stimulation had thus been proposed as an option for poor responders who do not benefit from longer and higher cost regimens. The aim of this retrospective study was to evaluate outcomes of poor responders who underwent minimal stimulation using letrozole and whether they are comparable to outcomes of conventional in vitro fertilization (IVF) in a tertiary center in Singapore. Methods: This was a retrospective study of 43 poor responders who underwent minimal stimulation protocol in KK Women’s and Children’s Hospital IVF center between March 2011 and March 2014. The protocol involved sequential administration of letrozole followed by low-dose gonadotropins and a gonadotropin-releasing hormone (GnRH) antagonist. Primary outcomes included clinical pregnancy rate and live birth rate per patient. A subgroup analysis was done for women undergoing minimal stimulation protocol and having failed conventional IVF protocol in which their outcomes were compared. Results: The average age at time of stimulation was 38.6 years old. Clinical pregnancies were achieved in nine women (20.9%), out of which eight (18.6%) were live births. In the subgroup analysis, cleavage rate obtained in the minimal stimulation protocol was significantly higher at 61.3% compared to the cleavage rate obtained in the conventional IVF cycle at 28.7%. There were no significant differences in the pregnancy and live birth rates of the two cycles. Conclusion: Minimal stimulation protocol using letrozole produces a reasonable live birth rate in poor responders and potentially higher quality oocytes than conventional IVF protocol. J Clin Gynecol Obstet. 2019;8(3):77-80 doi: https://doi.org/10.14740/jcgo557","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42243013","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":"Use of Cyanoacrylate N-Butyl Versus Subcuticular Suture in the Dermal Closure Following Cesarean Delivery: A Randomized Controlled Trial","authors":"Jessica Aidee Mora-Galvan, Norberto Reyes-Paredes, J. M. Grosso-Espinosa, M. Ortiz-Ramirez, M. Godines-Enriquez, C. M. Sepúlveda-Rivera","doi":"10.14740/jcgo560","DOIUrl":"https://doi.org/10.14740/jcgo560","url":null,"abstract":"Background: Currently the use of tissue adhesives for surgical wound closure has multiplied; however, its use in cesarean sections is still not well determined. The objective of this study was to compare the surgical wound healing following cesarean sections between N-butyl cyanoacrylate (Tisuacryl) and suture (Monocryl 2-0). Methods: A randomized, non-blinded controlled clinical trial was conducted from October 2017 to March 2018 at the Instituto Nacional de Perinatologia. Forty women undergoing cesarean delivery were randomly assigned to skin closure group using a random number table: 20 with N-butyl cyanoacrylate (Tisuacryl) (cases group) and 20 with Monocryl (control group). Scars were evaluated at 24 h, 1 week, 1 month and 3 months. Primary objective was to evaluate the esthetics of the scar with the scar cosmesis assessment and rating (SCAR) scale. Secondary objectives were skin closing time, the satisfaction of the patient and the satisfaction of the surgeon. Results: Demographic characteristics, including average age, body mass index and number of pregnancies, were similar in both groups. The skin closing time showed a significant decrease with a P value of 0.000 between Tisuacryl and Monocryl (54.95 ± 10.353 s in the first group vs. 407.5 ± 72.61 s). The esthetic evolution of surgery using the SCAR scale showed a better evolution in the first visits (weekly and monthly) in the Monocryl group (2.05 ± 0.60 and 1.68 ± 0.477) vs. Tisuacryl (2.77 ± 0.685 and 2.55 ± 0.74) with a P value of 0.001 in SCAR 1 (first visit) and 0.000 in SCAR 2 (second visit). However, no significant differences were observed in the last result at 3 months (SCAR 3). Similarly, no significant differences were observed regarding the satisfaction of the surgeon or the patient. Conclusions: The results of skin healing with Tisuacryl vs. Monocryl were similar in terms of the esthetics and satisfaction of the patient or the surgeon. Therefore, the use of each one depends on surgeon/patient preferences and the availability of materials. J Clin Gynecol Obstet. 2019;8(3):85-90 doi: https://doi.org/10.14740/jcgo560","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48744569","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":"Opportunistic Salpingectomy Techniques at the Time of Cesarean Delivery: A Retrospective Cohort Study","authors":"N. Nguyen, A. Alabaster, S. Simmons, M. Weintraub, C. Powell","doi":"10.14740/jcgo574","DOIUrl":"https://doi.org/10.14740/jcgo574","url":null,"abstract":"Background: Recent studies have addressed uptake and safety of opportunistic salpingectomy at the time of cesarean delivery. However, there are limited data on outcomes of the surgical techniques used for salpingectomy at cesarean delivery, thus addressing this topic may influence uptake of opportunistic salpingectomy. This study aimed to compare perioperative outcomes of opportunistic salpingectomy techniques used at the time of cesarean delivery. Methods: This was a retrospective cohort study of women undergoing opportunistic salpingectomy for elective sterilization at cesarean delivery between 2011 and 2016 within Kaiser Permanente Northern California. We compared outcomes of salpingectomy performed with a bipolar electrocautery device (LigaSure, Metronic, MD, USA) versus suture ligation. Primary outcomes were surgical and operative room times. Secondary outcomes included estimated blood loss, intraoperative complications, blood transfusions, number of surgeons, length of hospital stay, readmissions and emergency room visits after discharge. We used bivariate and multivariable analyses to identify factors associated with salpingectomy technique. Results: We identified 194 patients with salpingectomies at time of cesarean delivery, of whom 97 (50%) had salpingectomies by bipolar electrocautery and 97 (50%) by suture ligation. In bivariate analysis, salpingectomy by bipolar electrocautery was associated with less estimated blood loss (600 vs. 760 mL, 95%, P = 0.04), shorter operating room times (96 vs. 104 min, P = 0.046) and more surgeons involved (P < 0.001), while the difference in surgery time was not significant (59 vs. 65 min, P = 0.06). Adjusting for statistically significant covariates in multivariable analysis, body mass index and prior abdominal surgery, salpingectomies using bipolar electrocautery were shorter in surgery time than using suture ligation (-10.74 min, confidence interval: -21, -0.49). There were no statistical differences in length of stay, readmission, emergency room visits after discharge, or number of surgeons involved. Two intraoperative complications occurred during salpingectomy and there were two blood transfusions. Conclusions: Salpingectomy was associated with shorter surgery time of 11 min with bipolar electrocautery instead of suture ligation, with no observed differences in postoperative complications. J Clin Gynecol Obstet. 2019;8(3):70-76 doi: https://doi.org/10.14740/jcgo574","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45514674","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":"Postpartum Cervical Manipulation, Vertebral Artery Dissection and Reversible Cerebral Vasoconstriction: A Case Report","authors":"Jodi L. Keane, Lewis Teo Piaw Liew","doi":"10.14740/jcgo576","DOIUrl":"https://doi.org/10.14740/jcgo576","url":null,"abstract":"Stroke in the postpartum population is rare, but more common than non-pregnant states. Pathophysiology is more evenly split between hemorrhagic and ischemic etiologies and antecedent severe hypertensive disorders such as pre-eclampsia predominate. We describe a case of both potential minimally traumatic significant vertebral arterial dissection, posterior circulation ischemic stroke with lateral medullary syndrome and concomitant incidental reversible cerebral vasoconstriction on neuroimaging initially referred to the obstetric team as late postpartum pre-eclampsia and discuss diagnostic and management challenges. J Clin Gynecol Obstet. 2019;8(3):97-102 doi: https://doi.org/10.14740/jcgo576","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44389458","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":"Prenatal Probiotics: The Way Forward in Prevention of Preterm Birth","authors":"K. R. Dhanasekar, B. Shilpa, N. Gomathy, S. Kundavi","doi":"10.14740/JCGO.V8I3.571","DOIUrl":"https://doi.org/10.14740/JCGO.V8I3.571","url":null,"abstract":"Preterm birth (PTB) has presented a major challenge since decades among the obstetricians. Many premature born individuals have learning disabilities, visual and hearing problems. Abnormal vaginal microbiota and bacterial vaginosis (BV) are important risk factors for PTB and premature rupture of the membranes. In women with BV, there is a dramatic reduction of Lactobacillus and heavy colonization of the pathogenic bacteria. Administration of Lactobacillus rhamnosus GR1 and Lactobacillus reuteri RC14 in pregnant women restores the normal vaginal flora and acidic pH and interrupts the infectious/inflammatory process. Probiotics are preferred over tocolytic therapy to reduce the adverse maternal and fetal outcome. J Clin Gynecol Obstet. 2019;8(3):63-69 doi: https://doi.org/10.14740/jcgo571","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":"8 1","pages":"63-69"},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45793949","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}