Combined Use of Cerclage, Obstetric Pessary, and Micronised Progesterone in Recurrent Miscarriage

World Journal of Gynecology & Womens Health

In recent years, the use of progesterone, cerclage, and obstetric pessaries in patients with cervical incompetence has been studied extensively. However, there have not been any published reports of combined use of these methods. Here, we describe a case of successful combined use of cerclage, obstetric pessary, and micronised progesterone for preterm birth prevention in a nulliparous woman with recurrent miscarriage.

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Trophoblastic Disease During the Third Trimester of Pregnancy: Ultrasonic Diagnostic, Clinical Case and Perinatal Outcomes

Gynecology and Womens Health

Trophoblastic disease (TFD) considers rare tumors arising preferentially in reproductive age women. TFD is a relatively rare pathology and occurs at a rate of 1 in 22000 to 1 in 100000 pregnancies [1-3]. Trophoblastic tumors are always associated with pregnancy and can manifest both during pregnancy and after its completion (from several days to several years). The concept of “trophoblastic disease” unites several interconnected various forms of pathological condition of trophoblast: a hydatidiform mole, an invasive mole, choriocarcinoma, a placental bed tumor and an epithelioid trophoblastic tumor [2].
These tumours are rare, and they appear when cells in the womb start proliferating. Early diagnosis of GTD is essential for successful management while preserving fertility.
Malignant trophoblastic tumors (TT) are distinguished by high aggressiveness, rapid metastasis but, at the same time, high cure rates only with chemotherapy, even in the presence of distant metastases [4-6]. Various forms of TFD are considered by oncogynecologists as a single etiopathogenetic process [7]. The incidence of successful treatment of invasive forms of TFD, including choriocarcinoma, according to various authors, exceeds 80–90% [2]. After the cure of TFD, reproductive function is preserved in the absolute majority of young women.

The special properties of the ovarium, the effect of viruses (in particular, the influenza virus) on the trophoblast, immunological factors, increased hyaluronidase activity, chromosomal aberrations, and protein deficiency appear among the etiological prerequisites for TFD [8,9].

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Fetal Assessment in the 21st Century

Gynecology and Womens Health

Placental insufficiency remains the major reason for fetal hypoxia and accounts for 20-40% of perinatal mortality. There is no unanimity of opinion in the obstetrical community concerning the use of available tests of fetal well-being. These antepartum tests may be divided into three major groups:
a. Fetal heart rate assessment (NST, OCT).
b. Assessments of fetal biophysical activities other than fetal heart rate (fetal breathing movements, fetal gross body movements, fetal tone, and assessment of amniotic fluid volume).

c. Evaluation of maternal-fetal circulation (Doppler assessment of uterine, umbilical and major fetal vessels).

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Investigation of Leptin Receptor and eNOS Gene Polymorphisms in Preeclamptic Umbilical Cords

Gynecology and Womens Health

Background: Preeclampsia occurs in the umbilical artery with proteinuria and edema accompanying pregnancy-induced hypertension. Vasoconstriction results in severe complications such as intrauterine growth restriction, preterm birth, fetal death due to decreased uteroplacental blood flow. Preeclampsia may cause perinatal mortality and morbidity and it is one of the most important causes of maternal mortality. The etiology and pathogenesis of preeclampsia, which is present in 7,18% of all pregnancies, has not yet been elucidated. However, it is thought that one of the causes of pathogenesis may be caused by possible changes in the synthesis of endothelial nitric oxide synthase (eNOS) mediated nitric oxide (NO). DNA sequencing studies revealed many single nucleotide polymorphisms (SNPs) in the promoter region, exons and introns of this gene. T-786C SNP is found in the promoter region of the eNOS gene. There are several agents affecting eNOS activity in preeclampsia. Leptin is one of these agents. The exact reason of why leptin, which is a vasodilator agent, has no effect on preeclamptic pregnancies, is not known yet. However, it is thought that the leptin receptor gene Lys109Arg SNP in exon4 and Gly223Arg SNP in exon6 may affect receptor function and signaling.
Materials and methods: We investigated polymorphisms of eNOS and leptin receptor genes with HRM and PCR-RFLP techniques.
Results: Both analyses showed no SNPs in exon4 of leptin receptor (LEPR) gene in preeclampsia patients suggesting that there should be no relationship with exon4 of LEPR gene and preeclampsia. We found that there were SNPs in promoter region of eNOS gene and exon6 of LEPR gene.

Conclusion: HRM and PCR-RFLP gave different number of SNPs, these SNPs of these genes could be related with preeclampsia. This study is a preliminary step for our next molecular studies although few numbers of the samples were included. Increasing the number of samples would give the statistically significant results.

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