European journal of obstetrics, gynecology, and reproductive biology
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Mar 2013
Association of low maternal levels of salusins with gestational diabetes mellitus and with small-for-gestational-age fetuses.
To evaluate maternal and cord serum concentrations of salusin-α and salusin-β in women with gestational diabetes mellitus (GDM) and with small-for-gestational age (SGA) fetuses. ⋯ The low levels of maternal serum salusin-α and salusin-β may have negative impact on metabolic disorders and vascular dysfunction.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Mar 2013
Review Case ReportsStarvation ketoacidosis in pregnancy.
Starvation ketosis outside pregnancy is rare and infrequently causes a severe acidosis. Placental production of hormones, including glucagon and human placental lactogen, leads to the insulin resistance that is seen in pregnancy, which in turn increases susceptibility to ketosis particularly in the third trimester. Starvation ketoacidosis in pregnancy has been reported and is usually precipitated by a period of severe vomiting. ⋯ This article features four cases of women with vomiting in the third trimester of pregnancy associated with a severe metabolic acidosis. The mechanism underlying ketogenesis, the evidence for accelerated ketogenesis in pregnancy and other similar published cases are reviewed. A proposed strategy for management of these women is presented.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Mar 2013
Prognostic factors for the success of endometrial ablation in the treatment of menorrhagia with special reference to previous cesarean section.
To assess whether, among other prognostic factors, a history of Cesarean section is associated with endometrial ablation failure in the treatment of menorrhagia. Study design We compared women who had failed ablation to women who had successful ablation for menorrhagia in a case-control study. Failed ablation was defined as the need for hysterectomy due to persistent heavy menstrual bleeding after ablation. Successful ablation was defined as an ablation for menorrhagia not needing hysterectomy and the woman being satisfied with the result. Both cases and controls were identified from the surgery registration in the Máxima Medical Center between January 1999 and January 2009. Cases were women that had an endometrial ablation and a hysterectomy, whereas controls only had an endometrial ablation. From the medical files we collected for each patient clinical history, including the presence of a previous Cesarean section, baseline characteristics at the moment of initial ablation, data of the ablation technique and follow-up status. We used univariable and multivariable logistic regression to estimate the risk of failure of endometrial ablation. ⋯ A previous Cesarean delivery is not associated with an increased risk of failure of endometrial ablation, but dysmenorrhea, a submucous myoma and longer uterine depth are. This should be incorporated in the counseling of women considering endometrial ablation.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Feb 2013
Management of large adnexal tumors by isobaric laparoendoscopic single-site surgery with a wound retractor.
To report our experience with isobaric transumbilical laparoendoscopic single-site surgery for the management of large adnexal tumors exceeding 500g of excised tissue weight including cystic contents. ⋯ The transumbilical wound retraction system combined with an intra-abdominal fan retractor appears to contribute favorably to laparoendoscopic single-site surgery for the management of large adnexal tumors, because the device permits flexible and wide circumferential access by efficient wound retraction during instrumentation without the need for closed condition associated with pneumoperitoneum.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Jan 2013
Review Meta AnalysisAnalgesic effectiveness of transversus abdominis plane blocks after hysterectomy: a meta-analysis.
To determine the effectiveness of transversus abdominis plane blocks in gynecological surgery by systematic review and meta-analysis. Embase, MEDLINE and the Cochrane Library (CENTRAL) bibliographic databases were searched using a Cochrane Library search strategy modified for gynecological surgery. We included randomized controlled trials comparing transversus abdominis plane block with no block or placebo block. ⋯ Transversus abdominis plane block resulted in significantly less postoperative requirement for morphine use at 24h (-11.76 mg, 95% CI -18.77 to -4.75) but not at 48 h (-16.01 mg, 95% CI -39.40 to 7.39). Evidence exists for the short-term efficacy (within 24 h) of transversus abdominis plane blocks during hysterectomy in terms of reported pain and morphine consumption, which may not be sustained at 48 h. Updates to this review should be undertaken periodically, and until further robust evidence is available, anesthetists should not rush to adopt this procedure into routine practice.