Herniation of gravid uterus: report of 2 cases and review of literature

Anterior abdominal wall hernias are uncommon, and herniation of a gravid uterus into these hernias is even rarer. Although reducible initially, the herniation of pregnant uterus may be complicated by incarceration and subsequent strangulation within the hernial sac, late in the course of pregnancy. There is no consensus over the management of this rare condition. Each case should be individualized. If uncomplicated, a conservative approach until term followed by delivery and herniorrhaphy is a good option. Here, 2 cases of herniation of gravid uterus into the anterior abdominal wall are described along with a brief review of literature pertaining to its presentation, complications, and management.     

Does placenta position modify the risk of placental abruption in car crashes?

The goal of this paper is to study the influence of placenta position on the risk of placenta abruption following a car crash involving a full term pregnant woman in the driver's seat. We developed an anatomically precise finite element numerical model of a pregnant woman. This numerical model was validated using experimental data from crash tests using cadavers given to science. For a frontal impact at a speed of 20 km/h, the mean value of peak strain levels at the utero-placenta interface were found to be close to 20%, independent of placenta position, representing an adverse foetal outcome risk of approximately 15%. This study found no significant effect of placenta position on the risk of placenta abruption. Our anatomically precise approach does however confirm the interest of using a numerical model when studying injury mechanisms in pregnant women involved in car crashes.     

Inhibition of postpartum uterine involution in the rat by relaxin

The possible contribution of relaxin to the support of uterine accommodation during late gestation by retarding tissue lysis was examined using the involuting postpartum uteri of unilaterally pregnant rats. In otherwise intact animals, twice-daily administration of 0.1 mg of relaxin (porcine fraction B) significantly retarded the regression of both gravid and, to a greater extent, nongravid tissue during the first 4 days postpartum, and collagenolysis was similarly delayed. Immediate postpartum ovariectomy had little effect on the uterus, although 5 micrograms estradiol benzoate daily suppressed uterine involution in the gravid tissue to about 50% and was even more effective in the nongravid uterus. Relaxin alone had little effect on the gravid uterus following ovariectomy, but augmented estrogen to the extent that less than half of the tissue and its collagen were lost during 4 days. The effect on nongravid tissue was even more striking in that the combination of estrogen and relaxin prevented any degradation of tissue in general or of collagen. Although we have reported that relaxin can stimulate uterine collagen synthesis as well as uterine growth, the magnitude of its postpartum effect in the presence of estrogen suggests a stabilizing or anticatabolic effect upon the uterus.     

Iodine status of Turkish pregnant women and their offspring: A national cross-sectional survey

BackgroundThis national cross-sectional survey aimed to assess the iodine status in pregnant women and their offspring, and also to demonstrate regional differences by measuring urinary iodine concentration (UIC). For each woman and her newborn a questionnaire was prepared with basic facts as age, parity number or birth weight and additional information regarding thyroid diseases, use of iodized salt in the household, extra iodine supplementation during pregnancy, education level and wage income.MethodsThe target population represented 1444 pregnant women who gave birth between January 1 st, 2018 and 2019, and their offspring. Iodine deficiency for pregnant women and their offspring were defined as urine iodine level <150 μg/L and <100 μg/L, respectively. Results are given as median (25th–75th percentile).ResultsThe median UIC in the group of pregnant woman was 94 (52–153) μg/L. Within the sample of 1444 pregnant women, UIC indicative of mild iodine deficiency (100−149 μg/L) was present in 21 % (n = 306), moderate deficiency (50−99 μg/L) in 30 % (n = 430), and severe deficiency (<50 μg/L) in 23 % (n = 337). This study showed a prevalence of 74 % of iodine deficiency in Turkish pregnant woman. The median UIC in the group of offspring was 96 (41−191) μg/L. Within the new-borns, UIC indicative of mild iodine deficiency (50−99 μg/L) was present in 22 % (n = 323), moderate deficiency (20−49 μg/L) in 15 % (n = 222), and severe deficiency (<20 μg/L) in 13 % (n = 192). This survey showed a prevalence of 51 % of iodine deficiency in Turkish new-borns. Pregnant women with lower socioeconomic and education level, lower access to household iodized salt, lower rates of exposure to povidone-iodine containing skin disinfectant, higher parity and higher iodine deficiency had higher rates of iodine deficiency in their offspring. Regional differences were observed both in mothers and their offspring concerning their iodine status.ConclusionsOur findings suggest that iodine deficiency is still an important public health problem in Turkey. More drastic measures should be taken to decrease these important iodine deficiencies, both in pregnant women and in their offspring.     

定坤丹联合益母草冲剂治疗孕妇流产后月经失调的临床效果分析

目的:探讨定坤丹联合益母草冲剂治疗孕妇流产后月经失调的临床效果。方法:选取2016年1月-2016年12月我院接受药物流产终止妊娠的妇女120例为研究对象,根据数字随机表法将其随机分为研究组和对照组,每组60例。研究组在妊娠囊排出宫腔后开始服益母草冲剂,1包/次,3次/日,服用2周后加服定坤丹,1丸/次,2次/日,持续服用到月经恢复正常。对照组在同一时间段期间服用益母草冲剂。对比两组患者腹痛消失时间和月经恢复正常时间、恢复正常月经后月经周期、月经量以及治疗有效率。结果:对照组和研究组腹痛消失时间分别为7.62±1.33 d、3.17±0.76 d,月经恢复正常时间分别为69.62±8.45 d、43.21±6.65 d,研究组均显著短于对照组(P0.05)。患者月经恢复后,对照组中有42例正常,研究组有54例正常,研究组月经周期时间正常率显著高于对照组(P0.05)。对照组中月经量有45例正常,研究组中月经量有54例正常,两组月经量比较,研究组月经量正常率显著高于对照组(P0.05)。对照组中痊愈39例,研究组中痊愈51例,研究组治疗有效率显著高于对照组(P0.05)。结论:定坤丹联合益母草冲剂治疗孕妇流产后月经失调临床疗效明显优于单用益母草冲剂治疗。     

Material properties of the placenta under dynamic loading conditions

Trauma during pregnancy especially occurring during car crashes leads to many foetal losses. Numerical modelling is widely used in car occupant safety issue and injury mechanisms analysis and is particularly adapted to the pregnant woman. Material modelling of the gravid uterus tissues is crucial for injury risk evaluation especially for the abruption placentae which is widely assumed as the leading cause of foetal loss. Experimental studies on placenta behaviour in tension are reported in the literature, but none in compression to the authors' knowledge. This lack of data is addressed in this study. To complement the already available experimental literature data on the placenta mechanical behaviour and characterise it in a compression loading condition, 80 indentation tests on fresh placentae are presented. Hyperelastic like mean experimental stress versus strain and corridors are exposed. The results of the experimental placenta indentations compared with the tensile literature results tend to show a quasi-symmetrical behaviour of the tissue. An inverse analysis using simple finite element models has permitted to propose parameters for an Ogden material model for the placenta which exhibits a realistic behaviour in both tension and compression.     

A female head–neck model for rear impact simulations

Several mathematical cervical models of the 50th percentile male have been developed and used for impact biomechanics research. However, for the 50th percentile female no similar modelling efforts have been made, despite females being subject to a higher risk of soft tissue neck injuries. This is a limitation for the development of automotive protective systems addressing Whiplash Associated Disorders (WADs), most commonly caused in rear impacts, as the risk for females sustaining WAD symptoms is double that of males.In this study, a finite element head and neck model of a 50th percentile female was validated in rear impacts. A previously validated ligamentous cervical spine model was complemented with a rigid body head, soft tissues and muscles. In both physiological flexion-extension motions and simulated rear impacts, the kinematic response at segment level was comparable to that of human subjects. Evaluation of ligament stress levels in simulations with varied initial cervical curvature revealed that if an individual assumes a more lordotic posture than the neutral, a higher risk of WAD might occur in rear impact.The female head and neck model, together with a kinematical whole body model which is under development, addresses a need for tools for assessment of automotive protection systems for the group which is at the highest risk to sustain WAD.     

Up-regulation of mesotocin receptors in the tammar wallaby myometrium is pregnancy-specific and independent of estrogen

The oxytocin-like peptide of most Australian marsupials is mesotocin, which stimulates uterine contractions and is important for normal birth in the tammar wallaby. Female marsupials have two uteri and, in monovular species such as the tammar, one uterus is gravid with a single fetus, whereas the contralateral uterus is nongravid. A significant increase in myometrial mesotocin receptor concentrations occurs only in the gravid uterus on Day 23 of the 26-day gestation. This study examined whether or not mesotocin receptors are present in the myometrium and are up-regulated at the equivalent stage of the luteal phase in unmated tammars. In contrast to the marked increase in mesotocin receptor mRNA and protein concentrations in the myometrium of the gravid uterus during pregnancy, receptors did not increase in the unmated animals. There were also no significant differences between the two uteri, except on Day 27. Plasma profiles of peripheral estradiol-17beta and progesterone did not differ significantly between pregnant and nonpregnant cycles. However, progesterone concentrations were significantly lower on Day 1 postpartum compared with Day 27 of the nonpregnant cycle. In pregnant tammars, the molar ratio of circulating estradiol-17beta to progesterone increased significantly between Day 25 of gestation and 1 day postpartum, but was not correlated with an increase in mesotocin receptor concentrations in either uterus. The data confirm that a local fetal influence is more important than systemic factors, such as estrogen, in the regulation of uterine mesotocin receptors in the tammar wallaby.     

Fundal height as a predictor of early preterm triplet delivery.

The purpose of this study was to create graphs of fundal height parameters in triplet pregnancies compared with those in twin pregnancies, and to investigate whether larger fundal heights in triplet pregnancies would predispose them to earlier delivery (before 34 weeks). The subjects were 727 twin pregnant women and 133 triplet pregnant women, who delivered after 1984. Triplet pregnancies showed significantly higher fundal heights compared with twin pregnancies at each gestational age (weeks). In triplet pregnancies, a single fundal height measurement above the 90th percentile before 34 weeks yielded a sensitivity of 31.3% and specificity of 82.4% for delivery before 34 weeks, with a positive predictive value of 50.0% and a negative predictive value of 68.0%. After adjusting for each associated factor using logistic regression, the risk of preterm labour was not significantly associated with a single fundal height measurement above the 90th percentile recorded before 34 weeks.     

Effects of fetectomy on oxytocin receptors in the myometrium of the tammar wallaby

Mesotocin, an oxytocin-like peptide, stimulates uterine contractions during marsupial parturition. Female marsupials have two separate uteri, and in monovular species, the uterus with the conceptus is gravid, whereas the contralateral uterus is nongravid. Marsupials are unique because systemic and feto-placental factors in the regulation of uterine function can be differentiated. In pregnant tammar wallabies, a marked increase in myometrial mesotocin receptors (MTRs) occurs on Day 23 of the 26-day gestation, but only in the gravid uterus. The objective of this study was to investigate the effects of removing the conceptus on this MTR up-regulation. Complete fetectomy on Day 20 of gestation resulted in significantly lower MTR mRNA and receptor concentrations on Day 23 compared with sham-operated controls. In contrast, there was no significant difference in MTR expression between controls and partially fetectomized animals in which uterine distension was maintained in the absence of a conceptus. In a related study, we examined MTRs in the myometrium of animals that appeared to be pregnant with a large, distended uterus. However, these uteri contained an abnormally developed fetus and avascular placenta. In these animals, MTR levels were significantly higher in the distended uterus compared with the nondistended uterus, and did not differ from controls. These data demonstrate that uterine occupancy is essential for the marked increase in uterine MTRs observed on Day 23 gestation. It also appears that distension may be one of the key factors involved.     

Hydrometra in goats: Diagnosis with real-time ultrasound and treatment with prostaglandins or oxytocin

This paper describes the diagnosis, treatment and outcome of treatment in 10 cases of hydrometra in goats. Seven animals had recorded mating dates and three showed permanent anoestrus. During real-time ultrasound scanning of the right ventro-lateral abdominal wall, large fluid compartments were seen to be separated by thin tissue walls in cases of a well-developed hydrometra. As no such tissue trabeculae were found within the uterus of one animal during laparatomy, these tissue walls represent other segments of the same uterus seen through the walls of the curved, fluid-filled uterine horns. In two animals the hydrometra appeared less developed, and the final diagnosis was based on the absence of fetuses, membranes, and placentomes.In plasma samples obtained from eight animals, elevated progesterone concentrations (2 to 10 ng/ml) were measured before treatment. Spontaneous discharge of uterine fluid (“cloudburst”) in one goat on Day 157 after mating was accompanied by a fall in the plasma progesterone concentration.Single prostaglandin injections were given intramuscularly (i.m.) to five animals, and three animals were treated with 50 IU oxytocin i.m. twice daily for four consecutive days. Both treatments resulted in luteolysis, discharge of the uterine fluid and oestrous behaviour between 1.5 and 4 days after the start of treatment. However, some fluid remained in the uterus of five does, and additional oxytocin had to be given to two of them to achieve complete uterine involution.The luteolysis resulting from the oxytocin treatment indirectly indicates that in cases of hydrometra the uterine wall is still capable of producing prostaglandins. Six animals became pregnant from matings after treatment.     

Fetal Endoxins and Complications of Pregnancy

Maternal endoxin (digoxinlike substance) is proposed as arising in the fetal area of the fetal adrenal cortex. Its function may be to sensitize the uterus for labor, much as does cortisol in the sheep fetus. Because endoxin is a sodium-potassium-adenosine triphosphatase inhibitor, however, it may also induce maternal vasoconstriction. On our service, normal pregnant women have detectable endoxin after 35 weeks with increasing amounts at term. Specimens of cord blood often have “digoxin” in the therapeutic range. We find that about 40% of women in premature labor and 65% of pregnant women with hypertension have elevated levels of serum endoxin. Postdate gravid women sometimes have very low endoxin levels. Pregnant women with complications and elevated digoxin (endoxin) levels could have specific antidigoxin therapy if endoxin proves to be a modulator of their symptoms. Digoxinlike substances are also sometimes elevated in ill nonpregnant persons, such as those with renal, liver, or heart failure, or hypertension.     

采用三次样条拟合胎儿体格发育指标百分位数参考值

目的:生长发育评价标准的最佳形式是年龄别百分位数,然而,目前我国缺乏胎儿的孕周别体格发育指标百分位数评价标准,影响了胎儿宫内生长发育水平的准确评价,本研究拟建立陕西省正常单胎妊娠孕妇胎儿体格发育指标百分位数参考标准。方法:以陕西省西安、汉中、延安5所大型综合医院超声科或妇产科超声室为数据采集点,选择2010-01-01到2010-12-31间进行常规孕期检查的正常单胎妊娠胎儿的超声测量数据,随机抽取一次测量结果,共收集到6832个单胎正常妊娠胎儿的超声测量数据。采用三次样条法对陕西省孕16-41周正常单胎妊娠胎儿的双顶径、腹围、股骨长百分位数进行拟合。结果:三次样条拟合胎儿的双顶径、腹围、股骨长百分位数,各百分位数的决定系数均在0.95以上,均方差均在各指标重复测量的容许误差内,拟合结果满意。计算出了胎儿的孕周别双顶径、腹围、股骨长的P3、P10、P25、P50、P75、P90、P97百分位数。结论:三次样条兼顾了曲线拟合中的拟合优度和光滑度,能更好的实现曲线拟合的目的。所建立的孕周别胎儿体格发育指标百分位数符合胎儿宫内生长发育规律,为胎儿宫内生长发育的准确评价提供了科学、准确的评价工具,可用于产科临床和研究工作中。     

Garlic Ingestion by Pregnant Women Alters the Odor of Amniotic Fluid

Amniotic fluid samples were obtained from 10 pregnant womenundergoing routine amniocentesis procedure. Approximately 45min prior to the procedure, five of the women ingested placebocapsules, whereas the remaining five ingested capsules containingthe essential oil of garlic. Randomly selected pairs of samples,one from a woman who ingested garlic and the other from a womanwho ingested placebo capsules, were then evaluated by a sensorypanel of adults. The odor of the amniotic fluid obtained fromfour of the five women who had ingested the garlic capsuleswas judged to be stronger or more like garlic than the pairedsamples collected from the women consuming placebo capsules.Thus, garlic ingestion by pregnant women significantly altersthe odor of their amniotic fluid.     

Evidence for several fold more activity of NAD+-dependent uterine prostaglandin 15-hydroxydehydrogenase in transsexual than in non-transsexual women

The activity of NAD+-dependent PGDH was measured in the cytosolic fractions (100,000 x g) of uterine tissues obtained from transsexual, pregnant and non-pregnant women. The specific activity (mean +/- SD) of the enzyme at maximum velocity of the enzyme reaction in these three groups of women was 5.5 +/- 2.30, 0.53 +/- 0.27 and 0.54 +/- 0.25 mU/mg protein respectively using PGE2 as substrate, and with PGF2 alpha as substrate the respective values were 5.48 +/- 2.80, 0.49 +/- 0.41 and 0.51 +/- 0.30 mU/mg protein. These data suggest that, with either substrate, the uterine enzyme activity in the transsexuals was about 10-fold greater than in pregnant and non-pregnant women (p less than 0.001). However, the Km values of the enzyme for both PGE2 and PGF2 alpha were similar in all three groups, indicating the presence of same enzyme in the uterus of transsexual, pregnant and non-pregnant women. We speculate that PGDH activity was raised in the uterus of transsexual women because of the prolonged androgen therapy they received for the management of female-to-male transsexualism.     

Νον-Islet Cell Tumor Hypoglycemia Associated With Uterine Leiomyomata

ObjectiveWe report a case of non-islet cell tumor hypoglycemia (NICTH) in a patient with large leiomyomata.MethodsWe present the clinical, laboratory, and pathologic findings of a diabetic patient who presented with recurrent hypoglycemia later linked to uterine leiomyomata.ResultsAn 80-year-old woman with diabetes was admitted after falling at home. She reported dizziness and had recorded low capillary blood glucose despite discontinuing her diabetic medication prior to admission. Her physical examination was remarkable for nonorthostatic vital signs, normal cardiovascular and lung examination, and a pelvi-abdominal mass the size of a gravid uterus at 28 weeks of gestation. After receiving a 50% dextrose infusion, she became alert with no focal neurological deficit. Capillary blood glucose rose from 31 mg/ dL to 110 mg/dL. A pelvic sonogram confirmed fibromyomata. She was initially treated with steroids after ahormonal profile suggested NICTH (normal fasting insulin, C-peptide, cosyntropin and glucagon stimulation tests, and negative insulin antibodies). Insulinlike growth factor (IGF) levels were IGF-1, 69 ng/mL and IGF-2, 782 ng/mL, and the IGF-2/IGF-1 ratio was 10.8. The patient underwent a total abdominal hysterectomy. Pathology reported a 3-kg uterus with multiple, large cellular fibromyomas. After steroids were discontinued, she became hyperglycemic requiring insulin and oral diabetic agents. Repeat IGF-2 and IGF-1 measurements were 261 ng/mL and 36 ng/mL, respectively. She was discharged 2 weeks after surgery.ConclusionNICTH is a rare complication associated with large neoplasms. Leiomyomata should be included in the differential diagnoses of NICTH. Surgery is curative in such cases. (Endocr Pract. 2011;17:e109-e112)     

Evaluation of tocolytic efficacy of selective beta2 adrenoceptor agonists on buffalo uterus

Present study was conducted on prostaglandin F2alpha (PGF2alpha), oxytocin, (OT), potassium chloride (KCI) and barium chloride (BaCl2) pre-contracted perimetrial uterine strips of dioestrus and pregnant buffaloes to evaluate the tocolytic efficacy of selective beta2 adrenoceptor agonists-albuterol (salbutamol) and terbutaline. Cumulative concentration-response curves of both the beta2 adrenoceptor agonists were constructed and the mean effective concentration (EC50) values determined and compared statistically. Based on the comparative EC50 values in relaxing the pre-contracted uterine strips with different spasmogens, the rank order potency of albuterol was found to be--PGF2alpha > BaCl2 > OT > KCl on uterine strips from dioestrus animals, while OT> BaCl2> PGF2alpha >KCl on the uterine strips of pregnant buffaloes. The rank order potency of terbutaline on uterine strips from dioestrus stage animals was- BaCl2 > OT > KCl > PGF2alpha, while BaCl2 > PGF2alpha > KCl > OT on uterine tissues of pregnant animals. Thus, irrespective of the state of uterus, whether gravid or non-gravid, KCl-depolarized uterine tissues required comparatively higher concentrations of albuterol or terbutaline to produce tocolytic effect. High concentrations of K+ in biophase may have interfered with the beta2 adrenoceptor agonists-induced outward K+ current and hyperpolarization. From the results of present study, it was evident that selective beta2 adrenergic agonists had good tocolytic efficacy on the uterus of buffaloes. Further, indirectly the possibility of existence and activation of K(Ca) channels by selective beta2 adrenoceptor agonists in mediating tocolysis of buffalo myometrium can not be ruled out, however, detailed studies using specific K(Ca) channel blockers are required for characterizing the nature of such channels in buffalo uterus.     

Risk prediction of complex diseases from family history and known susceptibility loci, with applications for cancer screening

Risk prediction based on genomic profiles has raised a lot of attention recently. However, family history is usually ignored in genetic risk prediction. In this study we proposed a statistical framework for risk prediction given an individual's genotype profile and family history. Genotype information about the relatives can also be incorporated. We allow risk prediction given the current age and follow-up period and consider competing risks of mortality. The framework allows easy extension to any family size and structure. In addition, the predicted risk at any percentile and the risk distribution graphs can be computed analytically. We applied the method to risk prediction for breast and prostate cancers by using known susceptibility loci from genome-wide association studies. For breast cancer, in the population the 10-year risk at age 50 ranged from 1.1% at the 5th percentile to 4.7% at the 95th percentile. If we consider the average 10-year risk at age 50 (2.39%) as the threshold for screening, the screening age ranged from 62 at the 20th percentile to 38 at the 95th percentile (and some never reach the threshold). For women with one affected first-degree relative, the 10-year risks ranged from 2.6% (at the 5th percentile) to 8.1% (at the 95th percentile). For prostate cancer, the corresponding 10-year risks at age 60 varied from 1.8% to 14.9% in the population and from 4.2% to 23.2% in those with an affected first-degree relative. We suggest that for some diseases genetic testing that incorporates family history can stratify people into diverse risk categories and might be useful in targeted prevention and screening.     

The contractile proteins of the human myometrium

The contractile proteins of the human myometrium were quantified and characterized in order to investigate their possible modifications during pregnancy. The myosin concentration was found to be 1 to 5 mg/g of tissue, while actin concentration ranged from 16 to 60 mg/g, leading to an actin/myosin ratio higher (Mean = 14) than in other smooth muscles. Purified myosin submitted to two-dimensional gel electrophoresis exhibited two isoelectric forms for the 17 KD Light Chain, the more acidic being predominant in the pregnant organ, the more basic in the non gravid one. The mobility of myosin of form filaments was studied using electron microscopy. Only the myosin purified from gravid uteri in its phosphorylated form did aggregate in long bipolar filaments. Actin was characterized in crude muscle extracts using two-dimensional gel electrophoresis. It appeared in three forms differing by their isoelectric points. The more basic form (gamma) predominates in the pregnant organ, as soon as 17 weeks of pregnancy, while in the non-pregnant uterus it is the intermediate (beta) form which is predominant.     

Insulinoma diagnosed in the postpartum: clinical and immunohistochemical features

Insulinomas are rare pancreatic β-cell tumors with an estimated incidence of 1:250.000 persons/year. We present a novel case of insulinoma manifesting immediately after childbirth. Eight days after delivery, a 21-year-old, previously healthy woman presented paresthesia in hands, upper and lower limbs muscle weakness with difficult walking, which worsened during breastfeeding sessions. Laboratory tests showed blood glucose levels between 37 and 55 mg/dL with inappropriately normal insulin levels (7.78 μUI/mL; normal range: 5-29). An abdominal computed tomography showed a nodular lesion measuring 2 cm at the head of the pancreas. Tumor enucleation resulted in complete resolution of hypoglycemia. Histopathological and immunohistochemical analysis were consistent with an insulinoma. About 27 cases of insulinoma associated with pregnancy have been reported to date, mostly diagnosed before the 16th week. The beginning of symptoms soon after delivery is less common. Understanding the interactions between pancreatic β-cell function and all the physiological metabolic and hormonal adaptations associated with gestation is essential for the adequate management of hypoglycemic disorders in pregnant women.