High-risk pregnancy in rhesus monkeys (Macaca mulatta): a case of ectopic, abdominal pregnancy with birth of a live, term infant, and a case of gestational diabetes complicated by pre-eclampsia

Background  Cases of abdominal pregnancy, in the form of intra-abdominal mummified fetuses, have been described in nonhuman primates. Gestational diabetes and pre-eclampsia are common pregnancy complications in women.
Methods  Two timed-bred rhesus monkeys had high-risk pregnancies, an abdominal pregnancy with delivery of a live term infant, and a case of gestational diabetes that later developed pre-eclampsia.
Results  The monkey that had abdominal pregnancy later died from septic peritonitis. The monkey had a colonic adenocarcinoma that may have allowed leakage of intestinal contents into the abdomen. Her infant was fostered to another female and survived. The monkey with gestational diabetes and pre-eclampsia was treated with a regimen similar to that used in women, and a live infant was delivered at day 157 of gestation by Caesarian section.
Conclusion  These cases underscore the value of timed-breeding and the similarities between pregnancy complications in women and in nonhuman primates.     

经阴道彩超联合腹部超声在异位妊娠中的诊治分析

目的：与经阴道彩超检查相比较探讨经阴道彩超联合腹部超声检查在异位妊娠中的诊治价值。方法：选取我院2009 年3月至2012 年12 月之间诊治的136 例疑为异位妊娠患者,其中70 例经阴道彩超联合腹部超声诊断,66 例经阴道彩超诊断,采用SPSS13.0 统计学软件对数据进行统计学分析,所有计数资料均行x2检验,以P〈0.05 为差异有统计学意义。结果：在70 例经阴道彩超联合腹部超声检查的病例中,有68 人与手术结果相符合,诊断符合率达97.10%,1 例误诊,1 例漏诊;在另外66 例经阴道彩超检查患者中,有59例与手术结果相符合,诊断符合率为89.40%,6 例误诊,1 例漏诊。结论：经阴道彩超与经腹部超声的联合相对于经阴道彩超而言,诊断的准确率有所提高,决定这一结果的关键因素在于腹部超声减少了误诊例数。     

Incidence,trends, and risks of ectopic pregnancy in a population of women.

In a 20-year longitudinal study on ectopic pregnancy in a defined population of women aged 15-39 years the rate of ectopic pregnancy per 1000 diagnosed conceptions increased from 5.8 during 1960-4 to 11.1 during 1975-9. The mean annual incidence of ectopic pregnancy per 1000 women increased from 0.6 to 1.2 during the same period. The numbers of ectopic pregnancies per 1000 diagnosed conceptions increased with increasing age of the women and were 4.1, in the teenage group 6.9, in women aged 20-29 years, and 12.9 in women aged 30-39. Among 20- to 29-year-old sexually active women at risk of pregnancy who had never had acute salpingitis the rates of ectopic pregnancy per 100 woman-years were the same in those who did not use contraceptives as in those using non-medicated or copper-medicated intrauterine contraceptive devices (IUCDs; 0.3/100 woman years). The risk of an ectopic pregnancy increased sevenfold after acute salpingitis. These findings confirm the increased risk of ectopic pregnancy after salpingitis and suggest that the increase in the incidence of ectopic pregnancy in Lund from 1960 to 1979 was partly accounted for by the use of IUCDs.     

经阴道彩超在子宫瘢痕处早期妊娠诊断中的应用

目的：探讨经阴道彩色多普勒超声（彩超）在子宫瘢痕处早期妊娠诊断中的应用价值。方法：研究对象为2011年2月．2012年2月我院接诊的26例经手术或病理确诊的子宫瘢痕处早期妊娠患者,回顾性总结了26例患者的经腹及经彩超资料。结果：通过经阴道彩超的图像声像图分析,及其与手术中病理确诊对比。经阴道彩超诊断符合率（96．1％）显著高于经腹部彩超检查诊断符合率（73．1％）（P〈0．05）。从声像图可以将其分为三型,分别为孕囊型、不均质包快型和混合型。其声像图有各自独特的表现,主要区别在于子宫前壁的下段的表现,及周围血流信号的不同。结论：与经腹壁超声相比,经阴道彩超避免了腹部器官的影响,做到无创,快捷,方便,对子宫瘢痕处早期妊娠的诊断有较高的应用价值,值得推广应用。     

Delayed ectopic pregnancy following vaginal hysterectomy

A patient with ectopic pregnancy occurring a considerable interval after vaginal hysterectomy is reported. She presented with recurrent lower abdominal pain and the correct diagnosis was only established at laparotomy. Although 14 cases of this late complication of hysterectomy have been reported in the literature no fatalities have been recorded.     

Ectopic dioctophymosis in a dog – Clinical,diagnostic and pathological challenges of a silent disease

A 9-month old, female, stray dog was rescued and conducted to a university veterinary hospital. Moderate anemia was observed and abdominal ultrasound revealed pancreatitis. Right kidney was not visualized due to intestinal gas. Urinalysis was normal. Castration was performed three weeks later. Before discharge, abdominal ultrasound was performed for internal sutures examination. A cyst-like structure was present in the right retroperitoneal space with what appeared to be tubular worms inside it, not observed in previous evaluation. An ectopic dioctophymosis diagnosis was made. Two female Dioctophyme renale were surgically removed from the structure. Right kidney was hyperemic but not removed. No sign of peritonitis was observed. The dog recovered well. Laboratory follow-up showed no abnormalities a year after the episode and Doppler ultrasound revealed a mild right nephropathy. This is the first canine ectopic dioctophymosis case with only an abdominal cyst-like structure containing viable nematodes, successfully treated. It represents the rarity and difficulties in diagnosing ectopic dioctophymosis even in enzootic locations, highlighting the importance of ultrasonographic screening for such silent, potentially zoonotic disease.     

Computed tomographic excretory urography for diagnosing ectopic ureter in a female rhesus macaque (Macaca mulatta)

Ectopic ureter is a congenital abnormality where the ureter terminates at a site other than the urinary bladder. A five-year-old female rhesus monkey presented with a urine odor, a wet perineum, and persistent dribbling of urine. An ultrasound examination revealed a cyst-like structure (1 × 0.75 cm) on the left side of the bladder. Computed tomographic excretory urography (CTEU) imaging revealed a left unilateral extramural ectopic ureter, which was connected to the vagina. The perineum and wet hair were dried and disinfected with 0.4% chlorhexidine for perineal hygiene and skin care. The animal was closely monitored for potential moist dermatitis near the perineum and for urinary tract infection. The complete blood count (CBC) and blood chemistry results showed no signs of inflammation during the observation period. This is the first report of detailed diagnosis of ectopic ureter by ultrasound and CTEU in a female rhesus monkey.     

早期异位妊娠患者经阴道彩色多普勒示可疑妊娠滋养细胞流动与血清甲胎蛋白水平的相关性

摘要 目的：探究早期异位妊娠患者经阴道彩色多普勒示可疑妊娠滋养细胞流动与血清甲胎蛋白水平的相关性。方法：选择2021年1月至12月在本院收治的100例早期异位妊娠患者为观察研究对象。并选择同时期在本院例行正常产检的100例宫内妊娠孕妇为对照组。所有受试者进行阴道超声检查和彩色多普勒检查,并抽血进行甲胎蛋白的定量测定。测定子宫动脉、滋养细胞血流阻力及血清甲胎蛋白含量。结果：观察组腹痛、阴道不规则出血发生率较对照组升高（P<0.05）。观察组收缩期峰值速速、舒张末期速度较对照组升高,观察组滋养细胞血流阻力指数RI较对照组降低（P<0.05）。观察组收缩期峰值速速、舒张末期速度较对照组升高,观察组子宫动脉血流阻力指数RI较对照组降低（P<0.05）。观察组血清甲胎蛋白含量较对照组升高（P<0.05）。异位妊娠患者血清甲胎蛋白与滋养细胞血流RI呈负相关（r=-0.425,P<0.001）。结论：早期异位妊娠患者血清甲胎蛋白升高,经阴道彩色多普勒检查显示滋养细胞存在高流量-低阻力血管,滋养细胞血流阻力RI与血清甲胎蛋白呈负相关。     

输卵管妊娠患者术后重复性异位妊娠情况及其影响因素分析

目的:总结输卵管妊娠患者术后重复性异位妊娠情况,并分析其影响因素。方法:选取2015年1月至2017年1月于我院行输卵管妊娠手术的86例患者作为研究对象,回顾性分析所有患者的临床及随访资料,记录并总结所有患者年龄、孕次、产次、月经史、不孕史、血人绒毛膜促性腺激素(HCG)水平、妊娠部位、手术情况、避孕方式以及疾病史等和术后重复性异位妊娠发生情况,并比较不同特征患者术后重复性异位妊娠的发生率,分析影响输卵管妊娠患者术后重复性异位妊娠情况的影响因素。结果:至随访结束,86例输卵管妊娠手术患者术后出现重复性异位妊娠者22例,发生率为25.58%;年龄越大、孕、产次越多、HCG水平越高、存在不孕史、异位妊娠史、输卵管手术史、盆腔感染史以及开腹手术、双侧输卵管粘连及闭锁和长期放置宫内节育器进行避孕的患者其输卵管妊娠术后重复性异位妊娠发生率均明显较高(P0.05);经多因素Logistic回归模型分析可得存在不孕史、盆腔感染史、异位妊娠史、输卵管手术史、输卵管双侧粘连及闭锁以及开腹手术是输卵管妊娠手术患者术后重复性异位妊娠发生的独立危险因素(P0.05)。结论:输卵管妊娠患者术后重复性异位妊娠不可忽视,而对于存在不孕史、盆腔感染史、异位妊娠史、输卵管手术史、输卵管双侧粘连及闭锁以及开腹手术的输卵管妊娠手术患者则应及时治疗不孕症,尽可能选择腹腔镜手术来降低患者术后重复性异位妊娠,以此提高患者术后生育能力。     

Delayed surgical treatment for a traumatic bilateral cervical facet joint dislocation using a posterior-anterior approach: a case report

Introduction

Advanced abdominal (extrauterine) pregnancy is a rare condition with high maternal and fetal morbidity and mortality. Because the placentation in advanced abdominal pregnancy is presumed to be inadequate, advanced abdominal pregnancy can be complicated by pre-eclampsia, which is another condition with high maternal and perinatal morbidity and mortality. Diagnosis and management of advanced abdominal pregnancy is difficult.

Case presentation

We present the case of a 33-year-old African woman in her first pregnancy who had a full-term advanced abdominal pregnancy and developed gross ascites post-operatively. The patient was successfully managed; both the patient and her baby are apparently doing well.

Conclusion

Because most diagnoses of advanced abdominal pregnancy are missed pre-operatively, even with the use of sonography, the cornerstones of successful management seem to be quick intra-operative recognition, surgical skill, ready access to blood products, meticulous post-operative care and thorough assessment of the newborn.     

Maternal Serum Disintegrin and Metalloprotease Protein-12 in Early Pregnancy as a Potential Marker of Adverse Pregnancy Outcomes

Objectives

The aim of this study was to determine whether the concentration of disintegrin and metalloprotease protein12 (ADAM12) in first trimester maternal serum can be used as a marker for first-trimester complete spontaneous abortions, missed abortions, ectopic pregnancies and hydatidiform moles.

Methods

The maternal serum concentrations of ADAM12 were measured in the range of 5–9⁺⁶ weeks of gestation using an automated AutoDelfia immunoassay platform in 9 cases of complete spontaneous abortion, 27 cases of missed abortions, 56 cases of ectopic pregnancies, 12 cases of hydatidiform moles, and 100 controls. Logistic regression analysis was used to determine significant factors for predicting adverse pregnancy outcomes in early pregnancy. Screening performance was assessed using receiver operating characteristic curves.

Results

Two hundred and four women were enrolled in the study. In the control group, the level of ADAM12 increased with gestational age. The median ADAM12 levels in the spontaneous abortion (0.430 MoM), ectopic pregnancy (0.460 MoM) and hydatidiform mole (0.037 MoM) groups were lower than that in the control group, while the median ADAM12 level in the missed abortion group (1.062 MoM) was not significant from the controls (1.002 MoM). Logistic regression analysis demonstrated that the level of ADAM12 in maternal serum facilitated the detection of ectopic pregnancies (OR = 0.909; 95% CI = 0.841∼0.982) and complete spontaneous abortion (OR = 0.863; 95% CI = 0.787∼0.946).

Conclusions

In complete spontaneous abortion and ectopic pregnancy, ADAM12 maintained at low levels in early pregnancies, and there were significant differences compared to normal pregnancies. ADAM12 is a promising marker for the diagnosis of complete spontaneous abortion and ectopic pregnancy in symptomatic women, and under certain conditions, ADAM12 can diagnose ectopic pregnancy and spontaneous abortion before an ultrasonographic detection of the conditions.     

猕猴早早期妊娠实验动物模型的建立方法

目的建立猕猴早早期妊娠实验动物模型的方法。方法是选择健康有生殖能力的实验用雌雄猕猴,采用单笼适时配种,观察阴道拴,利用直肠指检、超声波等技术进行早早期妊娠诊断,从而建立妊娠20d以内的猕猴早早期妊娠实验动物模型。结果通过此法最早可建立妊娠11d,及妊娠15d、20d的实验动物模型;妊娠11d、15d、20d的确诊率分别为100%、90%、100%。结论本实验方法是建立猕猴早早期妊娠实验动物模型的一个理想方法。     

Ectopic expression of UBX and ABD-B proteins during Drosophila embryogenesis: competition, not a functional hierarchy, explains phenotypic suppression.

The Abdominal-B (Abd-B) gene, a member of the bithorax complex (BX-C), specifies the identities of parasegments (PS) 10-14 in Drosophila. Abd-B codes for two structurally related homeodomain proteins, ABD-B m and ABD-B r, that are expressed in PS10-13 and PS14-15, respectively. Although ABD-B m and r proteins have distinct developmental functions, ectopic expression of either protein during embryogenesis induces the development of filzk?rper and associated spiracular hairs, structures normally located in PS13, at ectopic sites in the larval thorax and abdomen. These results suggest that other parasegmental differences contribute to the phenotype specified by ABD-B r activity in PS14. Both ABD-B m and r repress the expression of other homeotic genes, such as Ubx and abd-A, in PS10-14. However, the importance of these and other cross-regulatory interactions among homeotic genes has been questioned. Since ectopic UBX protein apparently failed to transform abdominal segments, González-Reyes et al. (González-Reyes, A., Urquía, N., Gehring, W.J., Struhl, G. and Morata, G. (1990). Nature 344, 78-80) proposed a functional hierarchy in which ABD-A and ABD-B activities override UBX activity. We tested this model by expressing UBX and ABD-B m proteins ectopically in wild-type and BX-C-deficient embryos. Ectopic ABD-B m does not prevent transformations induced by ectopic UBX. Instead, ectopic UBX and ABD-B m proteins compete for the specification of segmental identities in a dose-dependent fashion. Our results support a quantitative competition among the homeotic proteins rather than the existence of a strict functional hierarchy. Therefore, we suggest that cross-regulatory interactions are not irrelevant but are important for repressing the expression of competing homeotic proteins. To explain the apparent failure of ectopic UBX to transform the abdominal segments, we expressed UBX at different times during embryonic development. Our results show that ectopic UBX affects abdominal cuticular identities if expressed during early stages of embryogenesis. In later embryonic stages, abdominal segments become resistant to transformation by ectopic UBX while thoracic segments remain susceptible. Head segments also show a similar stage-dependent susceptibility to transformation by ectopic UBX in early embryogenesis but become resistant in later stages. These results suggest that abdominal and head identities are determined earlier than are thoracic identities.     

Early diagnosis and treatment of ectopic pregnancy

During the period from 1995 to 1999, 64 patients were treated for ectopic pregnancy. All patients admitted to the department passed the same procedure including (complete preoperative laboratory findings, Beta HCG, serum progesterone and transvaginal colour Doppler). In patients who had ultrasound finding typical for ectopic pregnancy in combination with positive Beta HCG, conservative treatment was primarily done. In the rest of the patients, Beta HCG was tested every second day and in combination with the clinical and vaginosonographical findings the patients underwent diagnostic or operative laparoscopy. Out of 64 patients 36 had visible ectopic pregnancy when admitted to the clinical department. Three patients had no visible ectopic pregnancy neither at the time of their admission to the department nor at the time of laparoscopy. One of them had cervical pregnancy and the other two had pregnancies in the uterine part of the tube. The patient with cervical pregnancy was treated with metrotrexat (MTX) 12 mg daily in 5 doses. One patient with cornual pregnancy was treated with high doses of oxytocin infusion in combination with MEB intravenously 3 x 1 amp. The other patient with cornual pregnancy underwent laparoscopy with cornual resection and salpingectomy. Four of other tubar pregnancies were treated with metrotrexat 12 mg/day for 5 days. Other ectopic pregnancies were treated as follows: 36 laparoscopic salpingectomies, 10 laparoscopic salpingotomies with ovum expression, 9 adnexectomies by laparotomy, and 2 laparoscopic adnexectomies.     

Ectopic pregnancy; early diagnosis,clinical errors and conservative operation

This report of eight years' experience with extrauterine pregnancy by a single gynecologist is an exposition of how the diagnosis was made or why it was missed. Of 26 diagnoses of ectopic pregnancy, five were false (20 per cent); and in three cases (10 per cent) the diagnosis was not made promptly-a total error of 30 per cent. Ectopic pregnancy will be discovered earlier if obstetric patients are always examined shortly after missing the first menstrual period.A palpable adnexal mass was present in 19 of 21 ectopic pregnancies (90 per cent). A mass was palpable in only one of five cases erroneously diagnosed as ectopic pregnancy (20 per cent).Decidual casts were passed by four patients, two of whom did not have ectopic pregnancy. If two gynecologists do not agree on the question of extrauterine pregnancy, a third opinion should be sought or culdoscopy employed. Enucleation of the conceptus and salvage of the oviduct is advocated.     

Ectopic Dioctophyme renale in the thoracic and abdominal cavities associated with renal parasitism in a dog

Dioctophymosis is the disease caused by the nematode Dioctophyme renale, normally found parasitizing the right kidney of dogs. The absence of symptoms is frequent in parasitized animals. The surgical procedures are commonly performed to treat this disease. This work describes a case involving a canine with renal and ectopic parasitosis in the abdominal and thoracic regions. A mixed-breed female dog, approximately four months old, was diagnosed by ultrasound as for the presence of D. renale in the right kidney and abdominal and thoracic cavities. The animal underwent exploratory celiotomy, nephrectomy of the parasitized kidney, and transdiaphragmatic thoracotomy to remove the thoracic parasite, with a single abdominal surgical wound and excellent postoperative recovery. Several reports of ectopic parasitosis are found, however, the thoracic finding is unusual, and curative therapeutic transdiaphragmatic thoracotomy for dioctophymosis in dogs has not been previously described.     

改良大鼠子宫内膜异位症模型的建立及微血管密度观察

目的对皮下筋膜层与腹壁肌层之间移植自体子宫内膜制作的子宫内膜异位症（endometriosis,EMs）模型进行评估。方法取10只雌性未交配性成熟大鼠,术前雌激素诱导,手术开腹取右侧子宫,将自体子宫内膜种植于双侧皮下筋膜层与腹壁肌层之间,术后第29天取出异位组织,进行组织形态学观察,免疫组织化学染色观察微血管密度（Microvessel density,MVD）。结果异位内膜在腹壁内生长,呈隆起囊状小包块,内有黏液,具有正常子宫内膜基本组织结构。异位内膜中微血管密度较在位内膜和正常子宫内膜高。结论此手术方法建立的大鼠子宫内膜异位症模型异位内膜病理改变与EMs患者类似,可以作为子宫内膜异位研究的动物模型。     

血清孕酮、beta-HCG及CA125 水平在宫外孕诊断中的临床应用

目的：探讨血清孕酮、人绒毛膜促性腺激素（HCG）及癌抗原125（CA125）水平在宫外孕诊断中的临床应用价值。方法：选择 我院妇产科收治的61 例宫外孕患者作为观察组,同期选择正常早孕孕妇35例作为对照组,检测并对比两组血清孕酮、beta-HCG 48 h 内增长率及CA125 水平,研究三项指标分别检测和联合检测对宫外孕诊断的特异性、敏感性。结果：观察组血清孕酮、beta-HCG 48 h增长率及CA125 检测水平均显著低于对照组,比较差异有统计学意义（P<0.05）;单独应用时CA125 对于宫外孕具有较高的 特异性,而茁-HCG 48 h 内增长率具有较高的敏感性,三项指标联合检测特异性及敏感性均显著优于单一指标,比较差异具有统 计学意义（P<0.05）。结论：血清孕酮、beta-HCG及CA125 指标水平的分别检测或联合检测,对宫外孕的诊断均有一定的临床价值, 而三项指标的联合检测显著优于单一指标。     

The Lin28/Let-7 System in Early Human Embryonic Tissue and Ectopic Pregnancy

Our objective was to determine the expression of the elements of the Lin28/Let-7 system, and related microRNAs (miRNAs), in early stages of human placentation and ectopic pregnancy, as a means to assess the potential role of this molecular hub in the pathogenesis of ectopic gestation. Seventeen patients suffering from tubal ectopic pregnancy (cases) and forty-three women with normal on-going gestation that desired voluntary termination of pregnancy (VTOP; controls) were recruited for the study. Embryonic tissues were subjected to RNA extraction and quantitative PCR analyses for LIN28B, Let-7a, miR-132, miR-145 and mir-323-3p were performed. Our results demonstrate that the expression of LIN28B mRNA was barely detectable in embryonic tissue from early stages of gestation and sharply increased thereafter to plateau between gestational weeks 7–9. In contrast, expression levels of Let-7, mir-132 and mir-145 were high in embryonic tissue from early gestations (≤6-weeks) and abruptly declined thereafter, especially for Let-7. Opposite trends were detected for mir-323-3p. Embryonic expression of LIN28B mRNA was higher in early stages (≤6-weeks) of ectopic pregnancy than in normal gestation. In contrast, Let-7a expression was significantly lower in early ectopic pregnancies, while miR-132 and miR-145 levels were not altered. Expression of mir-323-3p was also suppressed in ectopic embryonic tissue. We are the first to document reciprocal changes in the expression profiles of the gene encoding the RNA-binding protein, LIN28B, and the related miRNAs, Let-7a, mir-132 and mir-145, in early stages of human placentation. This finding suggests the potential involvement of LIN28B/Let-7 (de)regulated pathways in the pathophysiology of ectopic pregnancy in humans.     

ECTOPIC PREGNANCY—Early Diagnosis,Clinical Errors and Conservative Operation

This report of eight years'' experience with extrauterine pregnancy by a single gynecologist is an exposition of how the diagnosis was made or why it was missed.Of 26 diagnoses of ectopic pregnancy, five were false (20 per cent); and in three cases (10 per cent) the diagnosis was not made promptly—a total error of 30 per cent.Ectopic pregnancy will be discovered earlier if obstetric patients are always examined shortly after missing the first menstrual period.A palpable adnexal mass was present in 19 of 21 ectopic pregnancies (90 per cent). A mass was palpable in only one of five cases erroneously diagnosed as ectopic pregnancy (20 per cent).Decidual casts were passed by four patients, two of whom did not have ectopic pregnancy.If two gynecologists do not agree on the question of extrauterine pregnancy, a third opinion should be sought or culdoscopy employed.Enucleation of the conceptus and salvage of the oviduct is advocated.