ATLAS OF ROENTGENOGRAPHIC POSITIONS

Mere diagnosis of a valvular heart lesion without circulatory incapacity is inconsequential in considering the prognosis for a pregnant woman.There are grave dangers of heart failure during pregnancy, labor or the postpartum period in women who have had congestive failure prior to pregnancy or during a previous pregnancy and delivery.Decisions as to whether or not to recommend avoidance of pregnancy or therapeutic abortion should depend not alone upon the prospect of death during gestation or at the time of delivery, but also upon the possibility of increased impairment of heart function and physical incapacity of the mother in the postpartum period.Because of the extensive surgical procedure there are few indications for interrupting pregnancy after the third lunar month; and because the major circulatory loads do not increase after the eighth month, rarely should labor be prematurely induced after that time.The exertion of labor, although generally inconsequential, in some cases may produce sustained oxygen debt. In cases in which labor in a previous pregnancy has been accompanied by heart failure, cesarean section should be considered as a means of lessening the possibility of serious failure or death, although this is not a frequent consideration.In the resemblance of circulatory changes that occur, during delivery and immediately postpartum, to those changes produced by the closure of an arteriovenous shunt or patent ductus arteriosus, lies a suggestion as to some of the causative factors in heart failure during or soon after delivery. Probably of great importance is the decrease in blood volume and hemoconcentration at delivery followed by the return of water to the circulatory system, with consequent transient increase in blood volume, in the postpartum period. Additionally, the rise of venous pressure after use of oxytocic drugs suggests that rapid infusion of blood from an engorged uterus may cause an abrupt and perhaps poorly tolerated hypervolemia.Death by heart failure in pregnancy and the puerperium has become extremely rare in recent years due to the frequent observations, meticulous diagnosis of impending failure and improved care of cardiac patients jointly by the obstetrician and the internist. In addition to digitalis therapy and sodium restriction, patients exhibiting evidence of impending heart failure may require bed rest through the entire third trimester of pregnancy. Oxygen should be administered during labor in such patients and anoxia guarded against during anesthesia.     

Heart disease as a complication of pregnancy; with emphasis on indications for recommending therapeutic abortion or avoidance of conception

Mere diagnosis of a valvular heart lesion without circulatory incapacity is inconsequential in considering the prognosis for a pregnant woman.There are grave dangers of heart failure during pregnancy, labor or the postpartum period in women who have had congestive failure prior to pregnancy or during a previous pregnancy and delivery. Decisions as to whether or not to recommend avoidance of pregnancy or therapeutic abortion should depend not alone upon the prospect of death during gestation or at the time of delivery, but also upon the possibility of increased impairment of heart function and physical incapacity of the mother in the postpartum period. Because of the extensive surgical procedure there are few indications for interrupting pregnancy after the third lunar month; and because the major circulatory loads do not increase after the eighth month, rarely should labor be prematurely induced after that time.The exertion of labor, although generally inconsequential, in some cases may produce sustained oxygen debt. In cases in which labor in a previous pregnancy has been accompanied by heart failure, cesarean section should be considered as a means of lessening the possibility of serious failure or death, although this is not a frequent consideration. In the resemblance of circulatory changes that occur, during delivery and immediately postpartum, to those changes produced by the closure of an arteriovenous shunt or patent ductus arteriosus, lies a suggestion as to some of the causative factors in heart failure during or soon after delivery. Probably of great importance is the decrease in blood volume and hemoconcentration at delivery followed by the return of water to the circulatory system, with consequent transient increase in blood volume, in the postpartum period. Additionally, the rise of venous pressure after use of oxytocic drugs suggests that rapid infusion of blood from an engorged uterus may cause an abrupt and perhaps poorly tolerated hypervolemia. Death by heart failure in pregnancy and the puerperium has become extremely rare in recent years due to the frequent observations, meticulous diagnosis of impending failure and improved care of cardiac patients jointly by the obstetrician and the internist. In addition to digitalis therapy and sodium restriction, patients exhibiting evidence of impending heart failure may require bed rest through the entire third trimester of pregnancy. Oxygen should be administered during labor in such patients and anoxia guarded against during anesthesia.     

子宫内膜容受性检测技术在反复种植失败患者冻融胚胎移植中的应用价值及其临床妊娠的影响因素分析

摘要 目的：探讨子宫内膜容受性检测（ERT）技术在反复种植失败患者冻融胚胎移植（FET）中的应用价值,并分析其临床妊娠的影响因素。方法：回顾性分析2019年10月~2022年4月期间海南省妇女儿童医学中心收治的150例反复种植失败患者的临床资料,根据是否接受ERT技术分为ERT组（n=78,接受ERT技术）和无ERT组（n=72,未接受ERT技术）。按照反复种植失败患者是否临床妊娠分为临床妊娠组和未临床妊娠组。采用单因素和多因素Logistic回归模型分析临床妊娠的影响因素。结果：两组异位妊娠率组间对比未见统计学差异（P>0.05）。ERT组临床妊娠率、活产率高于无ERT组,移植日内膜厚度大于无ERT组,移植胚胎数少于无ERT组,流产率低于无ERT组（P<0.05）。所有患者按照是否临床妊娠分为临床妊娠组（n=85）和未临床妊娠组（n=65）。单因素分析结果显示：临床妊娠与年龄、移植胚胎类别、移植胚胎数量、总周期数、FSH、子宫内膜厚度、子宫内膜类型有关（P<0.05）,而与体质量指数（BMI）、不孕年限、不孕类型、胚胎冷冻保存时间无关（P>0.05）。多因素Logistic回归分析结果显示：年龄偏大、FSH偏高是临床妊娠的危险因素,而移植胚胎类别为囊胚、移植胚胎数量偏多是临床妊娠的保护因素（P<0.05）。结论：ERT技术用于反复种植失败患者FET中,可有效改善患者的临床妊娠。年龄、FSH、移植胚胎类别、移植胚胎数量是临床妊娠的影响因素。     

Maternal serum reactivity to species-specific antigens in sheep-goat interspecific pregnancy.

Three models were used to test the hypothesis that interspecific pregnancy failure between the sheep and goat is due to a species-specific, maternal antibody response. Interspecific pregnancies were established in ewes and does, sheep in equilibrium goat chimeric conceptuses produced by injection of ovine blastocysts were transferred to ovine recipients, and ovine and caprine pregnancies were established in interspecific chimeras. Complement-mediated lymphocytotoxic and hemolytic assays were used to monitor onset and titer of antibodies. Sera from 3 of 8 injection-chimera recipients reacted with all caprine peripheral blood lymphocytes (PBL) and red blood cells (RBC) tested (n = 18). Sera from 3 of 6 ewes and 7 of 7 does also were pancytotoxic to PBL of the other species (n greater than or equal to 20). Absorptions with xenogeneic RBC generally removed the reactivity. The data were consistent with responses to species-specific, monomorphic antigens expressed on PBL and RBC, and probably trophoblast. The response preceded or coincided with interspecific pregnancy failure in does, but not in ewes. Accordingly, no xenoreactivity was observed in chimera sera but caprine pregnancies were resorbed (n = 16) and ovine pregnancies developed to term (n = 11). The data did not support the hypothesis that failure of caprine pregnancy in ewes or chimeras is due to a species-specific, maternal antibody response. In contrast, a maternal, cytotoxic antibody response to species-specific antigen(s) may contribute to failure of hybrid or ovine pregnancy in does.     

Infertility in a line of mice with the high growth mutation is due to luteal insufficiency resulting from disruption at the hypothalamic-pituitary axis.

Animals with extreme body growth frequently experience poor reproductive performance, but the cause for this association has not been clearly established. A line of mice homozygous for the high growth (hg) mutation, a mutation that has a major effect on post-weaning growth, exhibits several reproductive deficits including an abnormally high incidence of luteal failure. The objective of the present study was to investigate luteal failure in high-growth (HG) mice during pregnancy and to determine whether the cause of the apparent luteal failure resides in the ovary or the hypothalamic-pituitary unit. In HG females with a demonstrated history of infertility, progesterone injections (1 mg s.c. daily) beginning on Day 1 postcoitum (p.c.) increased the proportion of animals pregnant at Day 17 of gestation. Twice-daily injections of 100 microgram of ovine prolactin (PRL) in alkaline saline given to another group of females beginning on Day 1 p.c. increased the proportion of HG females that were pregnant on Day 6 of gestation compared with saline-injected HG females, although PRL did not increase the pregnancy rate in HG females when compared with a group of noninjected control females. When ovaries from HG females were transplanted into ovariectomized congenic C57 hosts, the C57 graft hosts displayed normal estrous cycles, and upon mating the majority of graft hosts became pregnant. In contrast, when ovaries from C57 females were transplanted into ovariectomized HG hosts, the HG graft hosts displayed normal estrous cycles, but upon mating most were unable to maintain pregnancy. These results suggest that the hypothalamic-pituitary unit of the HG female provides an inadequate signal to the ovaries to maintain pregnancy. Luteal failure in HG females may be due to insufficient PRL as required for establishment and early maintenance of the CL during pregnancy in mice.     

Pregnancy in women with pulmonary hypertension

Women with pulmonary hypertension have a high risk of morbidity and mortality during pregnancy. The inability to increase cardiac output leads to heart failure while further risks are introduced with hypercoagulability and decrease in systemic vascular resistance. There is no proof that new advanced therapies for pulmonary hypertension decrease the risk, though some promising results have been reported. However, pregnancy should still be regarded as contraindicated in women with pulmonary hypertension. When pregnancy occurs and termination is declined, pregnancy and delivery should be managed by multidisciplinary services with experience in the management of both pulmonary hypertension and high-risk pregnancies.     

iTRAQ-based analysis of sperm proteome from normozoospermic men achieving the rescue-ICSI pregnancy after the IVF failure

Background

In the assisted reproduction, the infertile molecules of spermatozoa from normozoospermic men who underwent the unexplained failure of in vitro fertilization (IVF) due to the lack of sperm binding to the normal zona pellucida, and then achieved pregnancy with the rescue intracytoplasmic sperm injection (R-ICSI) remain unclear. More works are still necessary to explore this male infertile mechanism.

Methods

Normozoospermicmen with the IVF pregnancy and normozoospermic men with the R-ICSI pregnancy after the conventional IVF failure were collected. iTRAQ-based proteomic approach were performed to reveal the new infertile causes between the IVF pregnancy men and the R-ICSI pregnancy men. To validate the confidence of proteome data, the individual samples were analyzed by western blot and immunofluorescence. Further, the spontaneous acrosome reactions were measured to evaluate the sperm quality.

Results

Compared with IVF pregnancy group, 56 sperm proteins were differentially expressed in the R-ICSI pregnancy group. Bioinformatic analyses (PANTHER, DAVID, PubMed and STRING) indicated these altered sperm proteins were involved in various molecular functions: reproduction, chromosome organization, and sperm-oocyte interaction. Moreover, the confidence of proteome data was confirmed by western blot and immunofluorescence using the individual samples, which were consistent with our proteomic data. Additionally, an increased rate of the spontaneous acrosome reaction rate was found in the R-ICSI pregnancy group.

Conclusions

The sealtered sperm proteins and the increased spontaneous acrosome reaction rate might account for this unexplained male infertility in the R-ICSI pregnancy patients. The present proteomic results will throw light on the better understanding of the unexplained infertile mechanisms underlying these normozoospermic man who achieved R-ICSI pregnancy after IVF failure.

     

Studies on the control of the corpus luteum in the vole, Microtus agrestis.

The lifespan of corpora lutea resulting from hormonally induced ovulations was prolonged by exogenous prolactin, concurrent lactation, or pregnancy. Treatment of mated females with bromocriptine resulted in failure of luteal function only when the drug was given before Day 6 of pregnancy. Pregnancy was dependent on the presence of the ovaries in its later stages. The results suggest that prolactin is luteotrophic in early pregnancy but that a placental luteotrophin may become effective by Day 6 of pregnancy.     

Pregnancy and virologic response to antiretroviral therapy in South Africa

Background

Although women of reproductive age are the largest group of HIV-infected individuals in sub-Saharan Africa, little is known about the impact of pregnancy on response to highly active antiretroviral therapy (HAART) in that setting. We examined the effect of incident pregnancy after HAART initiation on virologic response to HAART.

Methods and Findings

We evaluated a prospective clinical cohort of adult women who initiated HAART in Johannesburg, South Africa between 1 April 2004 and 30 September 2009, and followed up until an event, death, transfer, drop-out, or administrative end of follow-up on 31 March 2010. Women over age 45 and women who were pregnant at HAART initiation were excluded from the study; final sample size for analysis was 5,494 women. Main exposure was incident pregnancy, experienced by 541 women; main outcome was virologic failure, defined as a failure to suppress virus to ≤400 copies/ml by six months or virologic rebound >400 copies/ml thereafter. We calculated adjusted hazard ratios using marginal structural Cox proportional hazards models and weighted lifetable analysis to calculate adjusted five-year risk differences. The weighted hazard ratio for the effect of pregnancy on time to virologic failure was 1.34 (95% confidence limit [CL] 1.02, 1.78). Sensitivity analyses generally confirmed these main results.

Conclusions

Incident pregnancy after HAART initiation was associated with modest increases in both relative and absolute risks of virologic failure, although uncontrolled confounding cannot be ruled out. Nonetheless, these results reinforce that family planning is an essential part of care for HIV-positive women in sub-Saharan Africa. More work is needed to confirm these findings and to explore specific etiologic pathways by which such effects may operate.     

The effect of human chorionic gonadotrophin and exogenous progesterone on luteal function during early pregnancy in pony mares

Previous reports have indicated that repeated administrations of human chorionic gonadotrophin (hCG) to pony mares before day 38 of gestation caused pregnancy failure, but that this could be prevented by the prior or simultaneous administration of progesterone. The present paper describes the circulating progestagen concentrations during these experiments, and shows that pregnancy failure resulted from luteolysis after hCG administration. Most of the mares which received progesterone maintained their pregnancies after hCG injection, but progestagen concentrations fell, suggesting that partial lysis of the corpus luteum occurred. After day 38 of gestation repeated doses of hCG had no effect on plasma progestagen concentrations.     

游离睾酮指数联合血清GnSAF、SHBG对多囊卵巢综合征不孕患者IVF-ET治疗妊娠结局的预测价值

摘要 目的：探讨游离睾酮指数（FAI）联合血清促性腺激素平抑因子（GnSAF）、性激素结合球蛋白（SHBG）对多囊卵巢综合征（PCOS）不孕患者体外受精-胚胎移植（IVF-ET）治疗妊娠结局的预测价值。方法：选取2020年1月～2022年6月湖南省妇幼保健院生殖医学中心收治的197例PCOS不孕患者为PCOS组,根据IVF-ET治疗妊娠结局分为妊娠失败组和妊娠成功组,另选取同期68名体检健康妇女为对照组。收集PCOS不孕患者临床资料,计算FAI并检测血清GnSAF、SHBG水平。采用单因素和多因素Logistic回归分析PCOS不孕患者IVF-ET治疗妊娠结局的影响因素,采用受试者工作特征（ROC）曲线分析FAI和血清GnSAF、SHBG对PCOS不孕患者IVF-ET治疗妊娠结局的预测价值。结果：PCOS组FAI和血清GnSAF水平高于对照组,SHBG水平低于对照组（P＜0.05）。197例PCOS不孕患者IVF-ET治疗妊娠成功率为51.27%（101/197）。单因素分析显示,妊娠失败组体质指数、黄体生成素（LH）、LH/促卵泡生成素（FSH）、睾酮、抗苗勒管激素（AMH）、FAI、GnSAF高于妊娠成功组,FSH、受精率、优胚率、SHBG低于妊娠成功组（P＜0.05）。多因素Logistic回归分析显示,体质指数增加和LH、LH/FSH、AMH、FAI、GnSAF升高为PCOS不孕患者IVF-ET治疗妊娠失败的独立危险因素,SHBG升高为其独立保护因素（P＜0.05）。ROC曲线分析显示,FAI和血清GnSAF、SHBG联合预测PCOS不孕患者IVF-ET治疗妊娠结局的曲线下面积大于FAI、GnSAF、SHBG单独预测。结论：FAI和血清GnSAF、SHBG水平联合预测PCOS不孕患者IVF-ET治疗妊娠结局的价值较高。     

Failed medical management in ovarian pregnancy despite favorable prognostic factors--a case report

Primary ovarian pregnancy is a rare form of ectopic pregnancy that must be demonstrated with use of 4 Spiegelberg criteria. It is usually diagnosed at laparotomy or laparoscopy, although it may resemble a hemorrhagic corpus luteum. Successful conservative management of ovarian pregnancy with methotrexate has been reported only occasionally. This may be partly because of the rarity of this condition and partly because when medical treatment is successful, the patient does not need to undergo laparotomy or laparoscopy, and an occasional ovarian pregnancy may have been diagnosed as a tubal pregnancy. We present a case of ovarian pregnancy (diagnosed at laparotomy) for which initial medical management with methotrexate failed despite favorable prognostic factors. Whether the unusual location (ovary) could have contributed toward treatment failure is unknown.     

Inflammation-Related Molecules at the Maternal–Fetal Interface during Pregnancy and in Pathologically Altered Endometrium

The blastocyst expresses paternally derived alloantigens and induces inflammation during implantation. However, it is necessary for the onset of pregnancy. An abnormal response might result in a pathological course of pregnancy or pregnancy failure. On the other hand, a state of maternal immune tolerance is necessary to ensure the normal development of pregnancy by suppressing inflammatory processes. This article discusses recognized mechanisms and the significance of inflammatory processes for embryo implantation and pregnancy establishment. We would also like to present disorders involving excessive inflammatory response and their influence on events occurring during embryo implantation. The chain of correlation between the processes responsible for embryo implantation and the subsequent physiological course of pregnancy is complicated. Many of those interrelationships are still yet to be discovered. Undoubtedly, their recognition will give hope to infertile couples for the emergence of new treatments that will increase the chance of giving birth to a healthy child.     

Plasma progesterone concentrations during early pregnancy in spring- and autumn-bred ewes

The objective of this experiment was to measure blood progesterone concentrations during early gestation to determine if the apparent reproductive failure in ewes bred out-of-season is due to a failure to conceive or embryonic loss. Blood samples were collected from spring- (n=61) and autumn-bred ewes (n=29) from Days 8 to 39 post-oestrus. Serum progesterone concentrations were analysed to ascertain whether ewes were ovulating and failing to maintain pregnancy, or conception was failing. Following pregnancy diagnosis 62 days after ram introduction, ewes were categorised as; no display of oestrus, mated but then identified as non-pregnant, or pregnant. A majority of spring-bred ewes that failed to display oestrus had silent oestrus (86%) and 66% of those ewes had abnormally short-lived corpora lutea. Circulating progesterone concentrations during dioestrus in ewes that had ovulated and displayed oestrus were unaffected by season. Similarly, progesterone concentrations during dioestrus did not differ between pregnant and mated non-pregnant ewes. The results indicated that while early luteylosis, low progesterone secretion from corpora lutea and embryo mortality did occur, these were in only a small proportion of ewes. Progesterone concentrations indicated that a majority of mated non-pregnant ewes had elevated progesterone concentrations necessary for the production of at least one viable embryo/foetus. This may be indicative to the failure of maternal recognition of pregnancy, and it is recommended that events surrounding this stage of pregnancy (Days 12-14) be examined more closely in ewes during the non-breeding season.     

36例妊娠性急性脂肪肝救治方法分析

目的探讨妊娠急性脂肪肝（acute fatty liver of pregnancy,AFLP）的有效治疗方法。方法回顾性分析36例AFIP的治疗方法,其中31例妊娠急性脂肪肝,首选剖宫产术终止妊娠,其次考虑阴道分娩。5例患者因为发生肝功能衰竭而采用MARS联合血浆置换治疗。结果31例的患者获得了良好的预后,尤其是5例AFLP肝功能衰竭患者均采用人工肝血浆置换疗法,均获痊愈。结论妊娠急性脂肪肝通过治疗,能获得良好的预后。     

A serious complication in the puerperium: peripartum cardiomyopathy

Two women, aged 27, presented with different symptoms shortly after giving birth to their first child. Peripartum cardiomyopathy (PPCM) was diagnosed. PPCM is a rare form of cardiac failure occurring late in pregnancy or in the postpartum period. Many women experience dyspnoea, fatigue, and pedal oedema in the last month of pregnancy or postpartum, symptoms which are identical to early congestive heart failure. Therefore, the diagnosis of PPCM requires vigilance. A high mortality rate and overall poor clinical outcome has been reported in a high percentage of these patients. Subsequent pregnancies remain controversial. (Neth Heart J 2008;16:415-8.)     

Chromosomal abnormalities: a potential quality issue for cloned cattle embryos

Nuclear transfer in cattle is associated with high levels of embryonic mortality and often with congenital malformation. Chromosomal abnormalities are a well-known cause of pregnancy failure and congenital malformation in humans, but their relative contribution to pregnancy failure and congenital malformation in cloned embryos and calves is largely unknown. This paper reviews existing literature on the chromosomal constitution of bovine embryos produced by fertilization in vivo and in vitro, parthenogenetic activation, and nuclear transfer. The published data suggest that chromosomally abnormal cells are common in embryos; however, the frequency reported varies with the method of embryo production. The most frequently observed deviation from the diploid karyotype was mixoploidy resulting from aberrant cell division causing polyploidy in a variable proportion of the embryo's cells.     

L’utilisation du MSOME: expérience de six ans

Introduction

MSOME (Motile Sperm Organellar Morphology Examination) is a new method for real-time evaluation of sperm morphology under 6600x high magnification. ICSI modified procedure with sperm selected by MSOME is named IMSI (Intracytoplasmic Morphologically Selected sperm Injection). IMSI has been developed to improve ongoing pregnancy rate in couples with repeated implantation failure.

Material and methods

The study concern an observational cohort of 11535 ICSI performed with fresh ejaculated sperm in our ART lab between January 2004 and July 2009. Among them, 2509 were realized with IMSI. The primary outcome measures were cleavage rate per injected oocyte on day 2, clinical pregnancy and abortion rates. Comparisons were performed using Chi square² test and univariate analysis of variance.

Results

There were no significant difference between conventional ICSI and IMSI groups in term of cleavage and pregnancy rates. Couples with abnormal sperm (teratozoospermia, oligozoospermia and oligoteratozoospermia) and no previous ICSI failure, had a significantly higher clinical pregnancy with IMSI than with ICSI (34.4% vs. 27.1%, p = 0.02). Furthermore, pregnancies obtained in patients with teratozoospermia were associated with a lower abortion rate after IMSI than after ICSI, close to significance (12.6% vs. 19.6%, p = 0.08).

Conclusion

In cases of severe teratozoospermia, IMSI appears to improve pregnancy rate and pregnancy outcome.     

Molecular aspects of implantation failure

Despite expanding global experience with advanced reproductive technologies, the majority of IVF attempts do not result in a successful pregnancy, foremost as a result of implantation failure. The process of embryo implantation, a remarkably dynamic and precisely controlled molecular and cellular event, appears inefficient in humans and is poorly understood. However, insights gained from clinical implantation failure, early pregnancy loss, and emerging techologies that enable molecular interrogation of endometrial–embryo interactions are unravelling this major limiting step in human reproduction. We review current molecular concepts thought to underlie implantation failure, consider the contribution of embryonic and endometrial factors, and discuss the clinical value of putative markers of impaired endometrial receptivity. Finally we highlight the nature of the dialogue between the maternal endometrium and the implanting embryo and discuss the concept of natural embryo selection. This article is part of a Special Issue entitled: Molecular Genetics of Human Reproductive Failure.     

Manipulation of cytokine production profiles as a therapeutic approach for immunologic pregnancy loss

Pregnancy is not as successful as one might think; it can be compromised by several complications such as recurrent spontaneous miscarriage, pre-term delivery, pre-eclampsia etc. Much attention has been paid to the possibility of the maternal immune system mediating deleterious effects on pregnancy. Research conducted during the last two decades has shed much light on cell-mediated immunologic effectors that might underlie these pregnancy complications. Of particular interest are the effects that pro-inflammatory and anti-inflammatory cytokines have on the foetus and placenta, and thus on the success and failure of pregnancy. This review presents evidences that certain cytokine profiles are associated with recurrent miscarriage and pre-term delivery and discusses possible pathways of effector function of cytokines in pregnancy loss and the redirection of cytokine profiles from one that is antagonistic to pregnancy towards one that is conducive to the success of pregnancy. Among the promising agents for the modulation of the Th1/Th2 balance are progestogens like progesterone and dydrogesterone; this review also discusses recent evidence that progestogens are capable of modulating cytokine production patterns in pregnancy loss.